- Molina Healthcare (Cleveland, OH)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Cleveland, OH)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Molina Healthcare (Cleveland, OH)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Molina Healthcare (Cleveland, OH)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Walmart (Cleveland, OH)
- …our workforce across local retail stores and is actively recruiting Senior Supermarket Rack Refrigeration HVAC Technician. If you possess relevant experience ... bring your skills to our fast-paced and welcoming work environment! As a Senior Supermarket Rack Refrigeration HVAC Technician at our local retail store, your role… more
- MetLife (Cleveland, OH)
- …and possess in-depth knowledge of plan designs, benefit features and how claims are paid * Strong understanding of industry marketplace and legal developments. ... all levels of the organization * Ability to analyze data to influence and execute on renewal decisions *...computer navigation skills and ability to work in multiple systems simultaneously (Microsoft suite, different company platforms) * Strong… more
- Elevance Health (Independence, OH)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- Subaru of America (Cleveland, OH)
- …vehicle investigations, and leading investigation activities at retailers. + Utilizes data analytics to support quality improvement activities and to research root ... cause/repair quality issues. Interprets and reports data for necessary escalation. + Provides expert advice, counsel, and technical assistance to retailer and SOA… more