Jobs at Medical Mutual

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Displaying results 1 - 15 of 35

Customer Care Specailist

Medical Mutual - Copley, OH

Resolves and responds to customer inquiries, efficiently navigates systems and confidently provides outstanding customer service in accordance with established quality expectations and service philosophy. Responsibilities Responds to a variety of inquiries from customers through determined channels 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 ...

Provider Analyst

Medical Mutual - Cleveland, OH

Provides operational and analytical support to the facility reimbursement models used in provider negotiations. Provides analytical support during contract negotiation process. Assists contracting in building tools that model rate. Organizes and performs analytical review of opportunities with provider networks. Provides understanding of financial impact based on history. Meas...

Business Analyst

Medical Mutual - Cleveland, OH

Business Analyst position to support changes to health insurance regulations for health care reform and other government controlled insurance plans. Provides the interface between the business and the information technology areas with an understanding of priorities and high-level concerns of both areas. Coordinates and leads the systems development team throughout the project life cycle (inc...

Client Manager

Medical Mutual - Strongsville, OH

Leads and develops large group account management team, achieves persistency goals, oversees Strategic Account Management process. Roles and Responsibilities: Develops and maintains relationships with large group customers and brokers. Oversees the development and maintenance of Strategic Account Management process. Coaches and develops individual ...

Document Services Operator I

Medical Mutual - Cleveland, OH

Assists in the operation and monitoring of consoles, printers, duplication machines, and other peripheral (which includes bindery machines) equipment. Identifies and resolves hardware and software problems with the assistance of senior level operators. Assists senior level operators in resolving production problems and/or completing customer requests. This operator level adheres to the Digit...

IT Auditor

Medical Mutual - Cleveland, OH

With supervision from management and/or Sr IT Auditors, plans, performs, and oversees audit tests designed to assess the adequacy and effectiveness of application, security, and general controls over information technology hardware and software applications. Identifies opportunities for improvements in operating effectiveness and efficiency within the information technology function. ...

Customer Resolution Specialist

Medical Mutual - Cleveland, OH

Researches and responds to member and provider claims and benefits issues. Resolves complex complaints and responds to inquiries that stretch across several lines of business. Responsibilities Investigates and responds to a wide scope of member and provider initiated complaints and inquires received through various channels within ...

Sr Medicare Compliance Auditor

Medical Mutual - Cleveland, OH

Maintains knowledge of current Medicare Advantage Audit Guides, Audit Protocols as well as Medicare Advantage Part C and Part D Reporting Requirements. Working knowledge of industry regulatory issues and how they affect the Company. Performs Medicare audits including review of data extraction procedures and data analysis. Documents findings and recommendations to determine organizational com...

Compliance Specialist

Medical Mutual - Cleveland, OH

Submits required Compliance data to the Center for Medicare and Medicaid Services (CMS). Monitors progress for each submission and follows up appropriately. Communicates with CMS on routine request. Provides clerical support to the Medicare Compliance Department. Provides clerical support. Prepares and submits all data uploads ...

SR EXECUTIVE ASSISTANT

Medical Mutual - Cleveland, OH

Provides administrative support of a highly responsible and confidential nature to the EVP, Chief Information Officer. Interacts with a diverse group of callers and visitors as well as internal contacts at all levels of the organization. Independent judgment is required to plan, prioritize and organize workload. Handles correspondence through multiple media. Manages calendars an...

Claims Operations Specialist/Team Lead

Medical Mutual - Cleveland, OH

Coordinates workflow in assigned Claims Processing unit(s) to include audit, systems, processes, operations and policies. Analyzes workflow systems and provides recommendations to management for process improvements. Maintains control of the daily operational functions assigned to the unit. Provides analytical and technical expertise to assist staff and/or directly respond to ...

Clinical Pharmacist

Medical Mutual - Cleveland, OH

Responsible for clinical pharmacy activities related to medical drug management and prescription drug programs including, but not limited to: development of clinical criteria and policies for utilization of medications, monitoring and oversight of pharmacy benefits manager, providing clinical support to nurse reviewers, and presenting Medical Mutual's pharmacy programs to clients. Roles and Res...

Service Consultant- Customer Care

Medical Mutual - Beachwood, OH

Service Consultant Beachwood, Ohio Report to: Supervisor 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 fin...

Medicare Regional Sales & Service Specialist

Medical Mutual - Cincinnati, OH

Serves as a captive agenda to develop individual sales leads through event marketing, community activities, faith-based organizations and in-store visits. Focuses both on under and over 65 audience to educate and sell appropriate health insurance and ancillary products. Territory responsible for (*Territory subject to change): Cincinnati area Responsibiliti...