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Jobs at Medical Mutual

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Displaying results 1 - 15 of 38

Infrastructure Engineer

Medical Mutual - Brooklyn, OH

Ensures reliability and stability of assigned platforms and systems. Completes technical tasks, troubleshoots issues, provides input on methods and systems, provides off hours support (on-call) as a part of a rotation, under general supervision. Responsibilities Completes service requests and maintenance support in ...

Assistant Medical Director (Remote in OH)

Medical Mutual - OH

This position can be remote within the state of Ohio. Responsibilities Medical Mutual has an immediate need for an Assistant Medical Director to join our team of physician reviewers. A General/Internal Medicine or Psychiatrist/Behavioral Health is highly preferred. Provides clinical expertise to the utilization review process and determinations.

Senior Clinical Auditor

Medical Mutual - OH

Working under limited supervision, audits typically more complex outpatient, inpatient and professional claim irregularities, overpayments and provider appeals from a clinical coding perspective, applying coding guidelines. Analyzes provider billing for abnormalities, questionable billing practices and proper coding combinations from a clinical and coding perspective and documents deni...

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 Service Desk Representative III

Medical Mutual - Brooklyn, OH

The IT Service Desk Rep will spend the majority of time on the phone resolving technical issues on first contact. Efficiently and effectively answers incoming phone calls from subscribers, providers, and staff, by resolving technical issues identified as Tier 1 and Tier 2 level support. Monitors Tier 1 and Tier 2 tools and scripts to ensure accuracy. Resolves the majority ...

Sr Risk Adjustment Programs (RAPs) Analyst

Medical Mutual - Cleveland, OH

Under limited supervision, serves as a primary liaison between all areas of the RAPs department including Information Services, Chart Retrieval, Medical Coding and Analytics. Supports the complete and accurate capture of conditions for members enrolled in government programs, ensuring the Company receives the appropriate reimbursement to help cover the conditions of enrollees. Identifi...

Director, Medicare Compliance

Medical Mutual - Cleveland, OH

Medicare subject matter expert who oversees and conducts various compliance-related activities for the Company's Medicare Advantage (Part C) and Prescription Drug (Part D) health plan programs. Serves as a business partner/consultant with health plan operational areas and assists in maintaining and understanding of and compliance with regulatory and legal requirements as well as the or...

Bravo-Sr Software Quality Assurance Analyst (Remote)

Medical Mutual - United States of America

Working closely with the rest of the Scrum team, the Senior SQA Specialist is responsible for creating and executing test plans and test cases to ensure the quality of Bravo's software products. Responsibilities Build test cases and test plans that ensure consistent and repeatable testing. Execute test cases to ensure the software meets functiona...

Risk Assessment Analyst - 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. Note: This position can be located in Cleveland or Centerville. Responsibilities Calculates premium rates for new groups using rating model with actuarial and statistical information. Calculates premium rate ren...

Benefit Services Assistant

Medical Mutual - Brooklyn, OH

Monitors multiple email boxes for incoming work. Updates departmental databases and distributes incoming work to staff members. Offers general support for group installation processes. Provides clerical support to all staff as needed. Responsibilities Monitors email boxes, logs and distributes incoming work. Maintains dat...

Employer Group Consulting Analyst Job Family (Level I, II, Senior or Lead)

Medical Mutual - Cleveland, OH

Design and execute analyses and reports for clients and their representatives that identify actionable opportunities to improve appropriate use of care, lower total costs of care and increase receipt of high quality, evidence-based care. Examines and identifies distributions and drivers of population health and health care utilization. Collaborating with Sales and Account Management, clients...

SDC - Dental Network Specialist

Medical Mutual - Centerville, OH

Work with the Supervisor of Network Development to build and strengthen the company's dental networks in the marketplace. Requires coordination of efforts with multiple teams including Claims, Sales, Account Services, Marketing, and Information Systems. Responsibilities Prepare provider applications for Credentials Committee review. Includes v...

Senior Actionable Insights Analyst

Medical Mutual - Brooklyn, OH

JOB SUMMARY : Provides complex analysis by working across departments (product development, pricing, finance, operations, provider management, etc.) to develop analyses that become the foundation for practical recommendations and actions to improve business performance. What you will be doing… Measure performance, validate...

Supervisor, Provider Credentialing & Data

Medical Mutual - Cleveland, OH

Supervises the daily workflow of the Credentialing and Provider Data departments, ensuring efficiency and accuracy of work and compliance with all organizational, regulatory and accrediting body standards and policies. Collaborates with management and staff to develop training programs, policies, and procedures. Supervises the integrity of the provider data contained in the provider data man...

RN Case Manager II

Medical Mutual - 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. Note: This position will be a work at home...