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Director, TPA Operations - Specialty Products
Medical Mutual - Brooklyn, OH
Directs Medical Mutual's Consumer Driven Health Plan (CDHP) and Dental product operations to meet corporate objectives and customer satisfaction. Effectively directs all activities (including but not limited to claims and benefit administration, customer care, member and provider services) for dental and specialty benefits. Provides the expertise to ensure the development, implementation and...
Provider Network Reporting Analyst
Medical Mutual - Strongsville, OH
Please note: This position is located in Strongsville but will transition to downtown Cleveland this year. Working under direct to general supervision, develops custom provider network reports in response to requests from provider contracting and sales. Provides analytical support during the sales process for network provider geographic availability and disruption analyses and ...
Data Reporting Analyst - Job Family (Senior, Level II)
Medical Mutual - Cleveland, OH
The Data Reporting Analyst is responsible for providing day-to-day report creation and analysis with our internal and external business partners. This role provides analytical support for tasks of varying complexity to any or all divisions of the organization by mining data, conducting analysis, and interpreting results related to business needs. Responsibilities : Delive...
Business Intelligence Programmer Analyst - Job Family - Senior, Level II, Level I
Medical Mutual - Cleveland, OH
Independently transforms business requirements into BI technical solutions that efficiently enable analytics capabilities to be deployed in support of business and strategic objectives. These activities include but not limited to: strong knowledge of corporate data sources; working collaboratively with Business and Quality Analysts to create innovative technical solutions; provide technical ...
Lead Software Application Developer - Clinical Applications (Software Developer IV)
Medical Mutual - Cleveland, OH
Leads the process of translating user requirements and systems objectives of increasing complexity into a logical, efficient and optimal systems design. Develops and maintains new and existing applications by writing code based on the aforementioned design to ensure that business rules, security standards and government regulations are met. Provides management with recommendations for issue ...
Internal Auditor I
Medical Mutual - Cleveland, OH
Performs and documents the results of audit tests designed to assess the adequacy and effectiveness of financial, regulatory, and operational internal controls. Identifies control deficiencies and shares recommendations for improvements with management. Responsibilities Collects and analyzes documentation and other evidentiary matters obtained in the course of performing audit pr...
Client Accounting Specialist II
Medical Mutual - Cleveland, OH
Prepares invoices for self-administered health products. Administers the terms of the group's contracts including stop loss settlements and ERISA filing information. Performs an accounting/reporting customer service role to all group contacts. Performs a support role in general for the department which would include accounting and analysis. Works under supportive supervision. Responsibilitie...
Supervisor, Clinical Pharmacy Programs
Medical Mutual - Cleveland, OH
Supervises the day-to-day operations and Pharmacist staff of the clinical pharmacy unit with emphasis on formulary management, drug policy maintenance/development, and administration of pharmacy benefits. Responsibilities: Oversees clinical pharmacy operations with emphasis on formulary management, drug policy maintenance/development, and administration of pharmacy benefits. ...
Group Underwriter
Medical Mutual - Cleveland, OH
Evaluates data and risk characteristics of groups to assist in the establishment of prospect and renewal rates that are compliant and in support of corporate financial and membership goals for all product lines. Responsibilities Calculates renewal rates and premiums for enrolled groups using standard formulas and actuarial information, recognizing system requirements and e...
Contract Administrator
Medical Mutual - Cleveland, OH
Maintains control over the legal document execution process by ensuring that all required reviews and corporate policies have been followed before submitting a legal document for signature. Coordinates reviews between various departments through the approval process. Implements and maintains a repository of legal documents entered into by the Company and its subsidiaries. Responsib...
Provider Credentialing Data Specialist- Temporary Position
Medical Mutual - Strongsville, OH
As the oldest and one of the largest health insurance companies in Ohio, Medical Mutual provides health insurance to more than 1.6 million Ohioans. For more than 85 years, Medical Mutual has improved the lives of its members by offering high-quality group and personal healthcare coverage. Medical Mutual has been selected as a Northeast Ohio Top Workplace by the Plain Dealer...
Stop Loss Administrator
Medical Mutual - Brooklyn, OH
Administers the notification, preparation, filing and balancing of routine to moderately complex stop loss claims in accordance with plan policies and reinsurer specifications. Monitors stop loss reimbursement amounts to ensure timely receipt from carriers. Responsibilities Compiles the information necessary for the filing and reimbursement of stop loss routine to mod...
Manager, TPA Information Systems
Medical Mutual - Brooklyn, OH
Optimizes a significant suite of Specialty TPA Systems, technology platforms, vendors and infrastructure that are key to enabling the Specialty TPA customer experience. Manages the operations and staff responsible for Specialty TPA customer care integrated systems, automated processes, and related vendor relationships. Acts as the primary liaison with IT to implement process improvements max...
Business Systems Specialist I
Medical Mutual - Brooklyn, OH
Works with management, external vendors, and Information Systems to define, develop, test, audit and implement new business systems and processes. Identifies and solves production issues, which may require system changes. Communicates system changes to users and Training. Responsibilities Audits and identifies technical impacts for business requirements. Drives c...
Senior Staff Accountant
Medical Mutual - Cleveland, OH
Performs complex general accounting activities, including journal entries, account reconciliations and account analysis, to maintain company's general ledger and support the preparation of the financial statements. Responsibilities: Assists in preparing components of the corporate forecast, financial statements, regulatory reporting and/or audit schedules.
