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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 org...
Database Analyst IV
Medical Mutual - Brooklyn, OH
Provides increasingly complex cross-functional strategic, analytical and technical support or database related activities while working under some supervision. Performs activities as directed by management and senior staff to support projects that require DBA staff involvement. Assist in problem identification and issue resolutions. As needed, work with IT project teams and...
Software Developer III (COBOL)
Medical Mutual - Strongsville, OH
Assists in 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 recommendatio...
Software Developer II*
Medical Mutual - Brooklyn, OH
External Notice Medical Mutual of Ohio seeking Software Developer I (GS) to translate user requirements and systems objections in logical systems design in Brooklyn, OH. Will develop and maintain existing application by writing code to meet security and governmental requirements. Requires Bachelors in Electronics or IT Engineering or related field deg...
Operations Specialist
Medical Mutual - Brooklyn, OH
Coordinates workflow in assigned 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. Responsibilities Provides analytical and technical expertise to as...
Manager, Actuarial Services
Medical Mutual - Cleveland, OH
Manages the work of a team to achieve company goals. Analyzes and reports on developing experience and proposals. RESPONSIBILITIES: Manages and trains team members. Proposes premiums that achieve company goals. Forecasts the future Trends. Reviews appropriateness of rating factors by plan, area, network, etc. Performs ad hoc analyses as ...
Associate Actuary
Medical Mutual - Cleveland, OH
Estimates current and future liabilities. Proposes premiums that achieve company goals. Works on an advanced level. *Medicare Supplement Insurance knowledge preferred. Responsibilities Estimates future claims. Estimates current claims (reserving: estimate unpaid claim liabilities) Analyzes historical experi...
Group Contract Specialist II
Medical Mutual - Cleveland, OH
Prepares fully insured large group health plan contracts and maintains signed contracts. Works with internal areas to review and respond to group-requested contract changes and prepares non-disclosure agreements for data requests from groups and consultants. Responsibilities Prepares, reviews and processes various non-disclosure agreements,...
Project Manager- Temporary Position
Medical Mutual - Cleveland, 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 P...
Senior Data Analyst
Medical Mutual - Cleveland, OH
Summary: Under minimal supervision, supports business decisions using data mining and analytics, identifying and resolving complex issues through the reconciliation of data sets, identifying areas for improvement and/or impact of initiatives and strategic plans, and presenting results to all levels of management. Serves as a subject matter, data analytics, and regulatory reporting expert...
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...
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 ...
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. ...
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...
