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Jobs at Medical Mutual

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Senior Payment Integrity Analyst

Medical Mutual - Brooklyn, OH

Under limited supervision, leverages payment integrity program output to increase accuracy of claims payments and efficiency while minimizing associated program costs for the Company and its self-funded groups. Compares internal payment integrity program output to that of outsourced vendors and generates program benchmarks. Partners with management team to present analytical findings a...

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&nbsp...

Actuarial Assistant

Medical Mutual - Cleveland, OH

Estimates current and future liabilities. Proposes premiums that achieve company goals. Works under supportive supervision. *Medicare Supplement Insurance knowledge preferred. Responsibilities Estimates future claims Estimates current claims (reserving: estimates unpaid claim liabilities). Analyzes historical ...

Underwriting Manager - Superior Dental Care

Medical Mutual - Centerville, OH

Compiles data and analyzes risk in group dental benefit proposals to produce rates for new and renewing business using rating model. *Superior Dental Care (SDC) is a subsidiary of Medical Mutual. Responsibilities Supervises and monitors duties of Risk Analyst position, ensuring that all responsibilities are properly documented for training purp...

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...

Software Developer III

Medical Mutual - Brooklyn, 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 recommendations for issu...

Provider Relations Specialist

Medical Mutual - Cleveland, OH

Manages provider relations initiatives and projects ensuring consistent delivery in messaging to both external and internal customers. Serves as the liaison between Corporate and the contracting teams throughout the state. Serves as a resource and subject matter expert when new initiatives are being developed or existing operations are reassessed. Responsibilities

Provider Contracting Representative- Job Family

Medical Mutual - Cleveland, OH

Job Summary: 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: Negotiates non-standard contracts. Requires minimal assistance with non-sta...

Clinical Intervention Pharmacist

Medical Mutual - Cleveland, OH

Job Summary: Develops strategies and engages members and/or providers to conduct clinically and financially meaningful interventions that impact member drug therapy. These interventions are aimed at improving pharmaceutical care of our members, reducing total cost of drug therapy and improving pharmacy related quality measures such as Medicare STARS and HEDIS. Responsibilities:...

Software Developer I*

Medical Mutual - Strongsville, OH

Medical Mutual of Ohio seeking multiple Software Developer I (Data Engineering) to design and develop data lake, data warehouse and data marts for intelligence dashboards and visualizations in Strongsville, OH. Will profile data, develop data transformation processes, measuring data quality, design evaluate and test data models. Requires Master of Science in IT or related field d...

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...

Manager, Server, Web Application and Cloud Infrastructure

Medical Mutual - OH

Job Summary: This role is currently work at home but will be located in our new facility in Brooklyn once we return to the office. This position oversees the advancement and operation of the Server, Web Application and Cloud Infrastructure department. The Manager, Server, Web Application and Cloud Infrastructure is primarily responsible for: 16 Direct Reports p...

Provider Analyst

Medical Mutual - Cleveland, OH

Provides analytical support during contract negotiation process. Assists contracting in building tools that model rate. Provides understanding of financial impact based on history. Performs claims repricing, discount analyses, etc. to support group sales efforts and RFPs. Measures accuracy of projections. In the forefront of managing and tracking medical costs for senior leadership team by impl...

RN Case Manager

Medical Mutual - Cleveland, OH

Under limited supervision, evaluates and provides support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician and community. Responsibilities

Manager, Provider Contracting

Medical Mutual - Cleveland, OH

Facilitates the management of provider networks. Formulates and recommends the strategic direction for Managed Care Networks. Responsibilities Interacts on various projects, administration of policies and procedures with various areas in managed care operations; including credentialing, network performance, care management, and provider registration. Identifies opp...