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Director, IT Security, Operations, & Compliance
Medical Mutual - Brooklyn, OH
Are you an IT security professional looking to expand your responsibilities? Are you passionate about operational excellence and process improvement? If so, the Director of IT Security, Operations, & Compliance may be the right position to help you advance your career. The Director of IT Security, Operations, & Compliance directs strategic, policy, and operational aspects of Medical ...
Clinical Learning & Development Specialist
Medical Mutual - Cleveland, OH
Conducts training and development needs assessment and collaborates with management on implementation plans. Develops, delivers and evaluates cross-functional clinical, non-clinical, and systems training; new employee orientation; and integration of identified quality improvement activities into training curriculum. Clinical Learning & Development Specialist Resp...
Manager, Pharmacy Quality (Pharmacist)
Medical Mutual - Cleveland, OH
Please note- this position can be remote within the State of Ohio. Executes department objectives for Medicare Stars, Drug Strategy and NCQA oversight. Works with CQHS to integrate pharmacist interventions into population health activities. Works to enhance the experience of our members with their pharmacy benefit. Responsi...
Senior Claims/Customer Care Specialist-TPA
Medical Mutual - Brooklyn, OH
Processes routine to complex healthcare claims and responds to inquiries from third party administration and/or ancillary product services customers regarding benefits, coverage or claim status in accordance with established performance expectations and service philosophy. Responsibilities Processes routine to complex healthcare claims and/or...
BI Quality Assurance Analyst (Job Family - Level I, II, Senior, Lead)
Medical Mutual - Cleveland, OH
Working in collaboration with various technical and non-technical teams, the BI Quality Assurance Analyst will drive quality assurance activities for Business Intelligence solutions and analytical work in support of clinical and business operations and other external business initiatives. Responsibilities: Coordinate quality assurance activities across teams to meet busines...
Instructional Designer II
Medical Mutual - Brooklyn, OH
Designs and develops engaging and highly effective training programs using proven adult learning methodologies. Develops classroom, virtual, online and blended learning solutions; creates, updates and redesigns instructional content. Responsibilities Develops routine to moderately complex instructor-led and online program materia...
Clinical Auditor
Medical Mutual - Brooklyn, OH
Working under limited supervision, audits typically more complex outpatient, inpatient and professional claim irregularities, overpayments and provider appeals from a clinical coding perspective, applying coding guidelines. Analyzes provider billing for abnormalities, questionable billing practices and proper coding combinations from a clinical and coding perspective and documents deni...
Learning & Development Specialist II
Medical Mutual - Brooklyn, OH
Analyzes the delivery, development and implementation of corporate or divisional training curriculum and/or development programs. Conducts program evaluations and handles ongoing administration of training and development programs. Implements tools, practices, and approaches to facilitate learning that directly supports and effectively meets the needs of participants. ...
Business Systems Analyst II
Medical Mutual - Cleveland, OH
Provides the interface between the business and information technology areas with an understanding of priorities and high-level concerns of both areas. Works with business partners to analyze/prioritize business requirements and reviews/produces specifications for any change to technology applications. Works with the systems development team throughout the project life cycle to ensure that t...
Senior Provider Contracting Representative
Medical Mutual - Cleveland, OH
Develops, manages, promotes, guides and monitors, as well as services, and educates Providers, Institutions and Network Communities in order to establish business relationships. Provides coaching and mentoring to other contracting reps and coordinators. Responsibilities: Performs as Hospital/PHO relationship manager by assisting hospitals/PHOs with ...
Director, Customer Care
Medical Mutual - Cleveland, OH
Medical Mutual provides health insurance to more than 1.6 million Ohioans. For more than 85 years, the Company has improved the lives of its members by offering high-quality group and personal healthcare coverage. Medical Mutual is seeking an experienced, success-driven Director, Customer Care to lead our Contact Center. This position will report to the Executive Vice-Pr...
Claims/Customer Care Specialist-TPA
Medical Mutual - Brooklyn, OH
Applies knowledge and skills obtained through on the job training to process routine to moderately complex healthcare claims and respond to inquiries from third party administration and/or ancillary product services customers regarding benefits, coverage or claim status, in accordance with established performance expectations and service philosophy. Re...
Claims Pre-Payment Reviewer
Medical Mutual - Brooklyn, OH
Reviews routine to moderately complex post adjudicated claims prior to disbursement and authorizes for release, utilizing various auditing techniques. Provides assurance that systems and procedures have necessary internal controls for proper adjudication and formulates recommendations where controls are inadequate or lacking. Responsibilities Reviews clai...
Dentist and Member Services Associate
Medical Mutual - Centerville, OH
Superior Dental Care, a Medical Mutual company located in Centerville, OH is searching for a Dentist and Member Services Associate to support our team. Duties include answering incoming calls from dental offices (in and out of network dentists/offices), members, clients/purchasing employers, and brokers, effectively utilizing provided resources (system and printed). Respo...
Manager, Network Development & Services - Government Programs
Medical Mutual - OH
Please note this position could be located in Columbus or our headquarters in downtown Cleveland. Oversees the company's development, implementation, administration, and monitoring of Medical Mutual's provider networks for government programs, including compliance, with the goal of achieving the best possible combination of cost, quality, and access. Lead...
