Jobs at Medical Mutual

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Service Consultant- Customer Care

Medical Mutual - Toledo, OH

In this key role, your primary responsibility will be to provide outstanding service. We'll count on you to create peace of mind as you identify and resolve customer inquiries and concerns about health insurance coverage and claims. Our specialists efficiently navigate our system to find the correct answers and communicate with clarity and empathy. To prepare you for success, ...

EXECUTIVE ASSISTANT

Medical Mutual - Cleveland, OH

Location: Cleveland, OH Headquarters Reports To: Two Vice Presidents JOB SUMMARY: Provides administrative support to one or more executives. Interacts with a diverse group of callers and visitors, as well as internal contacts at all levels of the organization. Maintains confidentiality, plans, prioritizes a...

Sourcing Specialist

Medical Mutual - Cleveland, OH

Identifies savings and process improvement opportunities; establishes collaborative relationships internally and externally; develops sourcing strategies; leads sourcing events; negotiates with suppliers; collaborates with business units to aid in internal approval process. Manages sourcing events (RFQ, RFI, RFP, or direct negotiation), supplier selection, and price/contract n...

Utilization Management Nurse Reviewer- Care Transitions

Medical Mutual - Cleveland, OH

Position can be located in Cleveland, Strongsville, or Toledo. Performs utilization management activities to ensure the provision of safe, timely, appropriate, and necessary covered healthcare services to members; promotes effective resource management by directing member care to accessible cost-effective network providers and services at the appropriate level of care; and faci...

Pega Lead System Architect

Medical Mutual - Strongsville, OH

Summary The individual selected for this position will be working with the PEGA Business Process Management tool as a Lead Systems Architect. In that role, the LSA is responsible for assuring the application is exercising best practices, and that the developers of the application are adhering to the guard-rails established. The LSA is responsible for...

Health Information Analyst

Medical Mutual - Cleveland, OH

Summary This position has increasing responsibility for independently programming standard and special group-specific reports and corporate level reporting across all lines of business. Under a Senior health Information Analyst's direction, this analyst will partner with Health Informatics and Sales to identify cost control opportunities and assi...

Java Developer

Medical Mutual - Strongsville, OH

Summary The individual selected for this position needs to be experienced in all phases of software development including design, configuration, testing , debugging, implementation and support of business-centric and process-based applications. In addition, the individual selected for this position will create application web-services in an Ag...

Digital Experience Product Owner

Medical Mutual - Cleveland, OH

Summary In this role, your work merges business and technology, delivering digital customer products that are valuable, useful and practical. As a combination of customer experience and digital strategist, you will own your product roadmap, and drive definition and priorities through to implementation. Leading cross functional teams, you will evaluate produ...

Medicare Pharmacy Specialist

Medical Mutual - Cleveland, OH

The Medicare Pharmacy Program Specialist is responsible for the successful operations and compliant administration of the Medicare Part D (pharmacy) program. Provide direct oversight of Pharmacy Benefit Manager (PBM) to meet CMS compliance for all delegated activities. Subject matter expert (SME) on operational aspects of Medicare Part D products. Acts as a liaison between Med...

Sr. Medicare Enrollment Specialist

Medical Mutual - Cleveland, OH

Under limited supervision, processes Medicare enrollment and disenrollment requests, evaluates eligibility, resolves errors, generates correspondence, and makes outbound enrollment-related calls. Ensures proper documentation for all work and a sufficient audit trail. Processes routine to varied and/or complex paper and electronic Medicare enrollments and disenrollment, includi...

Medical Drug Management Nurse Reviewer

Medical Mutual - Cleveland, OH

Performs utilization management activities to ensure the provision of safe, timely, appropriate, and necessary covered medical drugs and associated services/procedures to members. Promotes effective resource management by directing member care to accessible cost-effective network providers and services at the appropriate level of care. Facilitates timely discharge planning and continuity of ...

Provider Contracting Representative II or III

Medical Mutual - Cleveland, OH

Position can be filled as a Contracting Representative II or Contracting Representative III. Contracting Representative II Develops, manages, promotes, guides and monitors, as well as provides services and educates Providers, Institution and Network Communities in order to establish business relationships. Demonstrates a thorough understanding of assigned cont...

Utilization Management Nurse Reviewer-Care Authorizations

Medical Mutual - Cleveland, OH

Performs utilization management activities to ensure the provision of safe, timely, appropriate, and necessary covered healthcare services to members; promotes effective resource management by directing member care to accessible cost-effective network providers and services at the appropriate level of care; and facilitating timely discharge planning and continuity of care across healthcare s...

Behavioral Health Nurse Reviewer- Care Transitions

Medical Mutual - Cleveland, OH

Location: Cleveland or Strongsville Job Summary: Serves as a member of the Care Management team. Performs discharge planning and utilization management activities to ensure the provision of safe, timely, appropriate, and necessary covered healthcare services to members; promotes effective resource management ...

Medicare Operations Analyst II

Medical Mutual - Cleveland, OH

Serves as a subject matter expert in government programs, enrollment rules, enrollment file processing and membership reconciliation with a primary focus on analyzing, supporting, and identifying opportunities for improvements in business processes and systems and implementing the same. Coordinates with upstream and downstream functional areas to resolve highly complex issues. ...