- Fifth Third Bank, NA (Cincinnati, OH)
- …related experience. + Prior PC experience to include advanced Excel, Word and Access. Claims Analyst I At Fifth Third, we understand the importance of ... opening. GENERAL FUNCTION: Responsible for completing and filing investor/insurer claims within required guidelines in order to recoup 5/3's...of the default cycle. This results in approximately 200 claims being filed on a monthly basis and $30.0… more
- Molina Healthcare (Covington, KY)
- …accurate and timely implementation and maintenance of critical information on all claims and provider databases, validate data housed on databases and ensure ... that the contracts are configured correctly in QNXT. The claims are reviewed to ensure that the configured services...to detect any gaps in the correct payment of claims Make recommendations for potential revision and updates *… more
- Molina Healthcare (Covington, KY)
- …Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Molina Healthcare (Covington, KY)
- **Job Description** **Job Summary** The Sr Analyst , Encounters is responsible for monitoring inbound and outbound encounter processes and ensuring timely, accurate, ... rejection inventory, and works with other areas including IT, health plan, claims , provider, enrollment, regulators, and external vendors, as needed, to remediate… more
- Elevance Health (Cincinnati, OH)
- **Advanced Analytics Analyst Senior - Medical Economics** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Cincinnati, OH; Chicago, IL (preferred). This ... passionate about transforming American healthcare delivery. The **Advanced Analytics Analyst Senior** measures financial performance of core Carelon products… more
- Molina Healthcare (Covington, KY)
- …to the Health Care environment **Job Duties** The Operational/Regulatory Oversight Sr. Analyst works with health plans and operations departments to assess, oversee, ... and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and performs audits and oversight functions involving business-critical… more
- Fifth Third Bank, NA (Cincinnati, OH)
- …Discover a career in banking at Fifth Third Bank. GENERAL FUNCTION: The Fraud Analyst I is a cross functional position within Fraud Operations. Fraud Analyst ... Domestic Collections - Responsible for processing and decisioning fraud check dispute claims . Includes working alerts, dispute cases and inbound call inquiries… more
- ClarkDietrich (West Chester, OH)
- …and benefits. Join the ClarkDietrich team by applying to the Credit & Treasury Analyst position at our West Chester, OH location. The Credit & Treasury Analyst ... coverage + Coordinate the annual insurance renewal process and support claims management + Maintain accurate records of all insurance policies, certificates,… more
- Molina Healthcare (Covington, KY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **Job Summary** This Sr. Analyst , Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities ... skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data.… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... support for finance, pricing and actuarial functions + Healthcare Analyst I or Financial/Accounting Analyst I experience...functions + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and… more
- Elevance Health (Mason, OH)
- **Provider Contract Cost of Care Analyst Senior** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and ... is granted as required by law. The **Provider Contract Cost of Care Analyst Senior** is responsible for providing analytical support to the Cost of Care… more
- Molina Healthcare (Covington, KY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... configuration practices and outcomes **KNOWLEDGE/SKILLS/ABILITIES** + Lead audits of claims and QNXT configuration to ensure accuracy, completeness, and compliance… more
- Molina Healthcare (Covington, KY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary. + Works with fluctuating volumes… more
- Molina Healthcare (Covington, KY)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... that provider information is loaded accurately to allow for proper claims processing, outbound reporting and directory processes. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Covington, KY)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... in QNXT and act as a QNXT SME. + Networx / Pricer and claims experience is highly preferred. + SQL is highly preferred. **JOB QUALIFICATIONS** **Required Education**… more
- Elevance Health (Mason, OH)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Molina Healthcare (Covington, KY)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS… more
- Molina Healthcare (Covington, KY)
- **Job Summary** The Lead Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Reporting team. Designs and develops reporting ... * Develops custom health plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates * Assists and collaborates with the national… more
- First Student (Cincinnati, OH)
- …and technology the transportation industry has to offer.** The Senior Safety Analyst is crucial for managing safety data critical to the department's operations. ... analytics models to identify trends and insights, driving continuous improvement in claims management and safety practices. + Manages all safety standard weekly,… more