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Operations Quality Specialist-TPA
Medical Mutual - Brooklyn, OH
Evaluates routine to complex transactional work of claims and/or customer service staff, assessing and documenting adherence to service level agreements and corporate service philosophy and standards. Identifies and reports on trends and makes recommendations to improve overall quality and direct training focus. Works with management as a change agent to implement process improvements. ...
Membership Billing Representative
Medical Mutual - Brooklyn, OH
Under limited supervision, provides administrative support in the membership and billing areas. Maintains member health plan records and sends monthly invoices to clients for administration fees associated with their employee benefit plan. Functions as the first point of contact for internal clients, groups and brokers regarding routine to varied and/or complex eligibility and billing inquir...
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 experti...
Business Systems Analyst II
Medical Mutual - Brooklyn, 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 review/produces specifications for any change to technology applications. Works with the systems development team throughout the project life cycle to ensure t...
Automation Developer I
Medical Mutual - Brooklyn, OH
Partners with other automation developers, business systems analysts, and liaisons to translate user processes into a logical, efficient and optimal process designs. Develops and maintains new and existing automations by building UI maps, creating process flows and writing code based on the design to ensure that business rules, security standards and government regulations are met. Esc...
Senior Population Health Program Liaison
Medical Mutual - OH
Partners with key employer groups and provider teams to help advance care management and population health programs focused on improving quality and cost of care performance for population. Supports overall relationship in a consultative capacity to assist in the development, coordination and implementation of strategic and clinical initiatives defined in clients' contract. ...
Customer Experience Project Manager
Medical Mutual - Brooklyn, OH
Facilitates and supports system/process/people improvement projects involving the member experience across the Company's lines of business with an emphasis on government and/or commercial health plans, anticipating risks, managing expectations and providing change management support. Responsibilities Facilitates projects to enhance the member expe...
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...
Contracting Coordinator
Medical Mutual - Rossford, OH
Assists Contractors and Management by maintaining familiarity with each account and their designated representative(s), understanding provider contracts, and fielding calls/concerns that occur. In addition, prioritizes and researches problems affecting providers and maintains up to date contract and contract management files and documentation. Responsibilities
Chief Growth Officer- Bravo Wellness
Medical Mutual - Cleveland, OH
*This position is for Bravo Wellness and can be located anywhere in the U.S.* Summary Identifies and delivers new revenue opportunities in the wellness market; growing revenue from developing relationships for new business, ensuring client satisfaction and contracts renew, lead generation and marketing campaigns and being a voice of the customer collaborating w...
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...
Account Administrator
Medical Mutual - Brooklyn, OH
Provides administrative support to assigned 51 group sales and/or service team in a fast-paced environment. Serves as the first line of communication between the client, prospect, broker or consultant for questions and inquiries. Responsibilities Performs sales and service administrative tasks (i.e. Benefits Quote Requests, new business quotes...
IT QA Tester/Quality Analyst IV
Medical Mutual - Brooklyn, OH
Works on a dedicated scrum team to assure projects meet quality standards by planning, designing and executing appropriate test plans. Participates in estimating user stories, daily stand ups, and sprint planning sessions. Collaborates with the Product Owner (PO) to write acceptance criteria. Collaborates with developers on continuous user story delivery with fast feedback ...
Manager, Ancillary Product Operations
Medical Mutual - Brooklyn, OH
Manages the operations and administration of the Consumer Driven Health Plan (CDHP) which includes Health Savings, Flexible Spending, and Health Reimbursement Accounts (HSA, FSA, HRA), including contact center, enrollment, claim processing and account management. Coaches and develops staff towards attainment of department goals to minimize organizational risk and support the customer experie...
Business Systems Acceptance Coordinator
Medical Mutual - Brooklyn, OH
Develops and executes test plans and matrices according to plan specifications and requirements. Verifies the quality, accuracy and integrity of new systems and/or system enhancements. Responsibilities Develops test conditions creating a detailed summary of each test case including expected results. Executes test cases according to test plan and ...
