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Results based on filters ( 2339 jobs found )

Medical Director Grievances & Appeals

Humana
Columbus, OH
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**Become a part of our caring community**The Corporate Medical Director ...
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Summary
About the job:
relies on medical background and reviews health claims. You will work on problems of diverse scope and complexity ranging from moderate to substantial.The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. You exercise independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
Board Certified
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Network Optimization Professional

Humana
Columbus, OH
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**Become a part of our caring community**The Senior Network Optimization ...
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Summary
About the job:
Professional ensures Humana's Michigan Medicare/Medicaid provider network meets compliance standards and delivers value. Responsibilities include analyzing network performance, supporting provider contracting decisions, collaborating to resolve operational issues, and advising on network strategy. This position reports to the Network Optimization Principal.The Senior Network Optimization Professional drives network optimization and value and managing compliance with network requirements - including network adequacy - for...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Computer Network Support Specialists
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
From:
US.jobs
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Claims Review Representative 3

Humana
Columbus, OH
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**Become a part of our caring community**The Claims Review Representative 3 ...
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Summary
About the job:
makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.**Where you Come In**The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Insurance Claims and Policy Processing Clerks
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Network Operations Coordinator 4

Humana
Columbus, OH
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**Become a part of our caring community**The Network Operations Coordinator ...
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Summary
About the job:
4 maintains provider data to support customer service activities through data integrity management and gathering of provider data needed for service operations. The Network Operations Coordinator 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.**Where You Come In**The Network Operations Coordinator 4 manages provider data for health plans including but not limited to demographics, rates, and contract...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Insurance Product Compliance Professional

Humana
Columbus, OH
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**Become a part of our caring community**The Insurance Product Compliance ...
Details
Summary
About the job:
Professional meaningfully contributes in ensuring Humana's Member Marketing and Communication materials meet all federal and state regulatory requirements. You will support compliance activities for Medicare insurance products, including Dual Eligible Special Needs Plans (DSNPs). The focus is on reviewing, approving, and filing marketing and communication materials with the Centers for Medicare, Medicaid Services (CMS) and state departments.+ Review Member Marketing and Communication materials to ensure compliance with...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Regulatory Affairs Specialists
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

IDN Strategy Lead

Humana
Columbus, OH
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**Become a part of our caring community**The IDN Strategy Lead (Program ...
Details
Summary
About the job:
Delivery Lead) leads the execution of the IDN operating model by managing Service Operations Committee (SOC) forums, synthesizing provider feedback into actionable insights, alongside trending data/feedback, and drives cross-functional alignment across enterprise teams. You will play a critical role in connecting provider experience, operational performance and negotiation strategy.Further, this role strategically identifies, develops, and implements programs that influence providers, members or market leadership towards...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Clinical Policy Research Professional

Humana
Columbus, OH
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**Become a part of our caring community**The Senior Clinical Policy Research ...
Details
Summary
About the job:
Professional works closely with Humana's dental directors and medical directors to research, develop and maintain dental and medical coverage policies utilizing an evidence-based medicine review process.Humana is seeking a Senior Clinical Policy Research Professional. In this role you will:+ Research and develop dental and medical coverage policies (Medicare and Medicaid) utilizing a standardized checklist and an evidence-based medicine review process as well as utilizing CMS guidance+ Provide comprehensive verbal...
Location:
Columbus, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

IDN Strategy Lead

Humana
Saint Paul, MN
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**Become a part of our caring community**The IDN Strategy Lead (Program ...
Details
Summary
About the job:
Delivery Lead) leads the execution of the IDN operating model by managing Service Operations Committee (SOC) forums, synthesizing provider feedback into actionable insights, alongside trending data/feedback, and drives cross-functional alignment across enterprise teams. You will play a critical role in connecting provider experience, operational performance and negotiation strategy.Further, this role strategically identifies, develops, and implements programs that influence providers, members or market leadership towards...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Senior Clinical Policy Research Professional

Humana
Saint Paul, MN
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**Become a part of our caring community**The Senior Clinical Policy Research ...
Details
Summary
About the job:
Professional works closely with Humana's dental directors and medical directors to research, develop and maintain dental and medical coverage policies utilizing an evidence-based medicine review process.Humana is seeking a Senior Clinical Policy Research Professional. In this role you will:+ Research and develop dental and medical coverage policies (Medicare and Medicaid) utilizing a standardized checklist and an evidence-based medicine review process as well as utilizing CMS guidance+ Provide comprehensive verbal...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Insurance Product Compliance Professional

Humana
Saint Paul, MN
Actions
Apply
Save to My Profile
See all jobs from this company
See who you know on LinkedIn
Report this job
**Become a part of our caring community**The Insurance Product Compliance ...
Details
Summary
About the job:
Professional meaningfully contributes in ensuring Humana's Member Marketing and Communication materials meet all federal and state regulatory requirements. You will support compliance activities for Medicare insurance products, including Dual Eligible Special Needs Plans (DSNPs). The focus is on reviewing, approving, and filing marketing and communication materials with the Centers for Medicare, Medicaid Services (CMS) and state departments.+ Review Member Marketing and Communication materials to ensure compliance with...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Regulatory Affairs Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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