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Certificate Development Specialist II

Medical Mutual - Cleveland, OH

Prepares and revises varied and/or non-standard documents (certificate books) describing benefits for less complex self-funded to moderately complex fully insured health plans. Responsibilities Develops certificate language in understandable terms, while ensuring it meets the customers' needs and complies with all state and federal laws. Re...

Certificate Development Specialist I

Medical Mutual - Cleveland, OH

Participates in an on-the-job training program in order to prepare routine and/or standard documents (certificates of coverage) describing benefits for fully insured health plans. Responsibilities Receives extensive training on the Company's products and related certificates of coverage and the certificate publis...

Group Underwriting Systems Analyst

Medical Mutual - Cleveland, OH

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individ...

Acute & Post Acute Nurse Reviewer (Behavioral Health)

Medical Mutual - Cleveland, OH

Under limited supervision, applies medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Applies evidence-based discharge planning so that patients have a safe and timely transition to next appropriate level of care. Note: This position will primarily be focused on ...

Software Developer IV

Medical Mutual - Brooklyn, 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 o...

Clinical Appeal & Claim Review Nurse II

Medical Mutual - OH

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individ...

Supv, Operations Technicians

Medical Mutual - Brooklyn, OH

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individ...

Director, Data Strategy (Remote)

Medical Mutual - United States of America

The Director, Data Strategy is responsible for ensuring that Bravo has a comprehensive set of policies and procedures for the governance of our various sources of data; also working with business leaders to identify the optimal methods to integrate multiple data sources and retrieve meaningful information from disparate data sets. Responsibilities In cons...

Acute & Post Acute Nurse Reviewer II

Medical Mutual - Cleveland, OH

Under limited supervision, applies medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Applies evidence-based discharge planning so that patients have a safe and timely transition to next appropriate level of care. Responsibilities Ev...

Director, Actuarial Services

Medical Mutual - Cleveland, OH

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individ...

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 requir...

Manager, Group Underwriting

Medical Mutual - Cleveland, OH

Manages the administration of individual, small group, and/or large group underwriting for new business, renewals of existing business, and stop loss insurance for third party administration. Supports corporate sales and profitability initiatives by executing strategy to determine equitable rate structure for health plans through recognized risk and loss management techniques.

Software Developer III

Medical Mutual - Brooklyn, OH

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and indivi...

Manager, Business Systems Administration

Medical Mutual - Brooklyn, OH

Manages the operations and staff responsible for claims adjudication systems and processes, and external vendor processing. Ensures the development, testing, implementation and maintenance of effective, efficient systems. Responsibilities Manages and controls the progress of corporate/divisional system projects and is accountable for ensuring project obje...