Qureos Mentor

Medical Mutual of Ohio

<div>**Medical Mutual employees must submit their applications through MySource.

Note: This is a hybrid role requiring 3 days per week on-site in our Brooklyn, Ohio office. Seeking applicants that reside within a 50-mile radius of the Brooklyn, Ohio office.

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 1.2 million members 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 individual plans.

Supervises staff, workflow, and quality of Clinical Appeal and Claim Review operations. Ensures compliance with government regulations and Company policies and procedures. Identifies operational issues, makes recommendations for improvements, and aids in implementation of procedural and systemic changes.
Responsibilities:
<ul>
<li>Supervises clinical and support staff evaluating medical claims and/or appeal cases and associated records to assess the appropriateness of service provided, length of stay and level of care. May review sensitive or more complex cases.</li>
<li>Reviews production and quality data to ensure accuracy and consistent application of policies and procedures. Conducts quality audits of cases reviewed by staff. Reviews quality of documentation provided to physician review or other external review. May collaborate directly with physician team on escalated reviews</li>
<li>Supervises and assigns workflow and handles escalated issues. Monitors and evaluates the effectiveness of programs and procedures. Identifies operational inefficiencies and recommends improvements. Develops, tests, and implements system and process changes</li>
<li>Participates in staffing, performance management and training and development of staff.</li>
<li>Ensures staff keeps up to date on utilization management regulations, policies and practices, including applicable coding, and that policies and procedures are updated accordingly.</li>
<li>Ensures timely and accurate written status of review to providers, members, and regulatory entities advising of status. Monitors and ensures compliance with accreditation and regulatory requirements.</li>
<li>Acts as a resource to the provider community, explaining processes for accessing health plan to perform clinical review, identifying appropriate community resources, or otherwise interacting with health plan programs and services. Collaborates with providers, members and various internal departments to ensure that members are getting appropriate care at the most appropriate time</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor&rsquo;s Degree preferred.</li>
<li>7 years progressive experience as a Registered Nurse, which includes experience as a Senior Clinical Appeals Nurse or equivalent relevant experience in the health insurance industry</li>
<li>Relevant experience leading teams or projects (formally or informally)</li>
</ul>
Professional Certification(s):
<ul>
<li>Registered Nurse with current State of Ohio unrestricted license.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Comprehensive clinical knowledge and understanding of health care delivery processes.</li>
<li>Comprehensive knowledge of medical terminology and managed care processes.</li>
<li>Comprehensive knowledge of clinical claim management including ICD 10, CPT, HCPC, and revenue codes and ability to apply advanced concepts</li>
<li>Comprehensive knowledge of health care regulations applicable to health insurance industry and ability to apply to Company policies and procedures.</li>
<li>Computer navigation and keyboarding proficiency; Intermediate Microsoft Office skills.</li>
<li>Coaches for results.</li>
<li>Ability to facilitate change and produce results.</li>
<li>Business acumen and cost awareness.</li>
<li>Knowledge of change management and quality improvement fundamentals</li>
</ul>
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:
<ul>
<li>We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.</li>
<li>Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.</li>
<li>On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.</li>
<li>Discounts at many places in and around town, just for being a Medical Mutual team member.</li>
<li>The opportunity to earn cash rewards for shopping with our customers.</li>
<li>Business casual attire, including jeans.</li>
</ul>
Excellent Benefits and Compensation:
<ul>
<li>Employee bonus program.</li>
<li>401(k) with company match up to 4% and an additional company contribution.</li>
<li>Health Savings Account with a company matching contribution.</li>
<li>Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.</li>
<li>Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.</li>
<li>Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.</li>
<li>After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.</li>
</ul>
An Investment in You:
<ul>
<li>Career development programs and classes.</li>
<li>Mentoring and coaching to help you advance in your career.</li>
<li>Tuition reimbursement up to $5,250 per year, the IRS maximum.</li>
<li>Diverse, inclusive and welcoming culture with Business Resource Groups.</li>
</ul>
About Medical Mutual:

Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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 individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing. #LI-JT1</div>

Supervisor, Clinical Operations

<div>**Medical Mutual employees must submit their applications through MySource.

Note: This is a hybrid role requiring 4 days per week on-site in our Brooklyn, Ohio office. Seeking applicants that reside within a 50-mile radius of the Brooklyn, Ohio office.

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 1.2 million members 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 individual plans.
Provides strategic and operational leadership for the Clinical Review &amp; Recovery program within Payment Integrity. Manages Itemized Bill Reviews (IBRs), DRG validation, clinical coding audits, payment policy application, and post payment clinical claim reviews to ensure accurate reimbursement, regulatory compliance, and optimal recovery outcomes. Evaluates review results and policy effectiveness to drive continuous improvement, operational efficiency, and cost savings. Collaborates with internal partners and external vendors to align clinical review operations with evolving reimbursement models, regulatory requirements, and future-state strategy.

Responsibilities:
<ul>
<li>Manages the review and analyses of clinical coding and medical policies and procedures and the impact to claim payments.</li>
<li>Provides leadership and oversight for the Clinical Review &amp; Recovery teams to strengthen the effectiveness of the clinical coding and claims payment auditing program and provides clinical coding and clinical review expertise for the Medical Policy and Clinical teams.</li>
<li>Monitors and analyzes department specific data reports, outcomes, and resource utilization, and leads the technical roadmap to refine business processes and optimize cost savings.</li>
<li>Creates audit programs that identify issues with medical spending. Recommends and implements cost saving methodologies.</li>
<li>Manages vendor relationships specific to clinical coding and claims payment audits, ensuring adherence to contractual limits, validating alignment between vendor deliverables and internal MMO activities to avoid duplication, and assessing cost effectiveness to ensure maximum value from vendor services.</li>
<li>Creates and maintains policies and procedures to be followed in all clinical coding and claims payment audits by both internal staff and recovery vendors.</li>
<li>Monitors production data to stay abreast of trends and alters the direction of audits accordingly.</li>
<li>Performs other duties as assigned.</li></ul> 


Qualifications:

Education and Experience
<ul>
<li>Bachelor&rsquo;s Degree in Nursing, Healthcare Administration or similar field.</li>
<li>8 years progressive experience in health insurance operations, 3 years which are in a supervisory or project management capacity.</li>
<li>3 years of experience in clinical coding and claims payment auditing.</li></ul> 


Professional Certification(s):
<ul>
<li>Registered Nurse with current license required.</li>
<li>Certified Professional Coder (CPC) or similar designation preferred.</li>
<li>Certified Professional Medical Auditor (CPMA) preferred.</li>
<li>Registered Health Information Administrator/Technologist (RHIA/RHIT) preferred.</li></ul> 


Technical Skills and Knowledge:
<ul>
<li>Comprehensive knowledge of all facets of claims, medical procedures, terminology and payment analysis and the ability to apply concepts to claim payment processes and auditing programs.</li>
<li>Strong Microsoft Office and health insurance operations systems skills.</li>
<li>Strong vendor management skills.</li></ul> 


Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:
<ul>
<li>We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.</li>
<li>Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.</li>
<li>On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.</li>
<li>Discounts at many places in and around town, just for being a Medical Mutual team member.</li>
<li>The opportunity to earn cash rewards for shopping with our customers.</li>
<li>Business casual attire, including jeans.</li>
</ul>
Excellent Benefits and Compensation:
<ul>
<li>Employee bonus program.</li>
<li>401(k) with company match up to 4% and an additional company contribution.</li>
<li>Health Savings Account with a company matching contribution.</li>
<li>Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.</li>
<li>Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.</li>
<li>Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.</li>
<li>After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.</li>
</ul>
An Investment in You:
<ul>
<li>Career development programs and classes.</li>
<li>Mentoring and coaching to help you advance in your career.</li>
<li>Tuition reimbursement up to $5,250 per year, the IRS maximum.</li>
<li>Diverse, inclusive and welcoming culture with Business Resource Groups.</li>
</ul>
About Medical Mutual:

Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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 individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing. #LI-JT1</div>

Manager, Clinical & Coding Payment Integrity

<div>**Medical Mutual employees must submit their applications through MySource.

**We are seeking candidates who are currently based in Ohio for this role.

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 1.2 million members 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 individual plans.

Medicare Pharmacy Coordinator I

Job Summary:
Working under general supervision, administers typically more standardized or routine daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical drug) benefit programs. Configures, implements, maintains, and services Medicare and Individual pharmacy benefits, with a strong focus on member experience.
Responsibilities:
<ul>
<li>Coordinates pharmacy reject review and resolution either directly or forwards/escalates to other departments or PBM. Monitors paid claims for accuracy including for transition supply oversight. Ensures timely communication to members on coverage determination and prescriptions with timeframe restrictions, assesses coverage review accuracy, and triages as needed.</li>
<li>Assists in outbound calls to members, providers, and pharmacies to initiate coverage determinations/appeals, prescription refills, and switch members to lower cost therapeutic alternatives based on discussions with providers. Documents all attempts in tracking software.</li>
<li>Collaborates with Clinical Intervention Pharmacists on Medicare Stars and other quality initiatives, with a strong focus on member experience. Conducts outreach to Pharmacy Benefit Manager (PBM) for refills, claim reprocessing and to members to provide status of intervention.</li>
<li>Tracks and coordinates daily issue/response files with PBM for claim resolution. Outreaches to pharmacy/prescriber as needed.</li>
<li>Generates reports from pharmacy system and reviews production metrics. .</li>
<li>Supports operational oversight overflow and any additional requests. Responds to Part D and Part B benefit questions, updates tracking documents, and ensures effectuation of claims.</li>
<li>Builds and maintains knowledge of new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals, Grievances, and Medicare marketing material requirements.</li>
<li>Assists in internal and external audits and projects of the Medicare Part D (pharmacy) and Part C (medical drug) programs as needed.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Associate Degree in Business Administration, Healthcare, or related field or equivalent combination of experience, training, and education.</li>
<li>4 &ndash; 5 years of experience in a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare &amp; Medicaid Services (CMS) guidelines, preferably Part D.</li>
</ul>
Professional Certification(s):
<ul>
<li>Certified Pharmacy Technician (CPhT) preferred.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Knowledge of CMS guidelines and Medicare Part D (pharmacy).</li>
<li>Knowledge of pharmacy claims processing through retail or mail pharmacy.</li>
<li>Intermediate Microsoft Office skills (Excel, Word, Power Point).</li></ul> 


Medicare Pharmacy Coordinator II

Job Summary:
Working under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part C (medical drug) benefit programs. Configures, implements, maintains, and services Medicare and Individual pharmacy benefits, with a strong focus on member experience.
Responsibilities:
<ul>
<li>Coordinates pharmacy reject review and resolution either directly or forwards/escalates to other departments or PBM. Monitors paid claims for accuracy including for transition supply oversight. Ensures timely communication to members on Part D coverage determination, all levels of appeal, re-openings (case re-decision) and Part C organization determination, and prescriptions with timeframe restrictions, assesses coverage review accuracy, and triages as needed.</li>
<li>Coordinates remediation efforts for Hospice and End Stage Renal Disease (ESRD) processes.</li>
<li>Supports Medicare Pharmacy Specialists in the research and review of Part D and Part B inquiries, grievances, and CTMs, updating tracking documents, audit research items, and marketing material reviews.</li>
<li>Assists in outbound calls to members, providers, and pharmacies to initiate coverage determinations/appeals, prescription refills, and switch members to lower cost therapeutic alternatives based on discussions with providers. Documents all attempts in tracking software.</li>
<li>Collaborates with Clinical Intervention Pharmacists on Medicare Stars and other quality initiatives, with a strong focus on member experience. Conducts outreach to Pharmacy Benefit Manager (PBM) for refills, claim reprocessing and to members to provide status of intervention.</li>
<li>Generates reports from pharmacy system and reviews production metrics. Conducts Part D Explanation of Benefits (EOB) audit.</li>
<li>Tracks and coordinates daily issue/response files with PBM for claim resolution. Outreaches to pharmacy/prescriber as needed. Supports operational oversight overflow and any additional requests. Responds to Part D and Part B benefit questions, updates tracking documents, and ensures effectuation of claims.</li>
<li>Maintains knowledge of new or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals, Grievances, and Medicare marketing material requirements. Assists in internal and external audits and projects of the Medicare Part D (pharmacy) and Part C (medical drug) programs as needed.</li>
<li>Assists more junior level with any oversight process questions.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Associate Degree in Business Administration, Healthcare, or related field or equivalent combination of experience, training, and education.</li>
<li>1-2 years of experience as a Medicare Pharmacy Coordinator or equivalent 5-6 years of experience in a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare &amp; Medicaid Services (CMS) guidelines, specifically Part D.</li>
</ul>
Professional Certification(s):
<ul>
<li>Certified Pharmacy Technician (CPhT) preferred.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Strong knowledge of CMS guidelines and Medicare Part D (pharmacy).</li>
<li>Strong knowledge of pharmacy claims processing through retail or mail pharmacy.</li>
<li>Intermediate Microsoft Office skills (Excel, Word, Power Point).</li></ul> 


Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:
<ul>
<li>We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.</li>
<li>Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.</li>
<li>On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.</li>
<li>Discounts at many places in and around town, just for being a Medical Mutual team member.</li>
<li>The opportunity to earn cash rewards for shopping with our customers.</li>
<li>Business casual attire, including jeans.</li>
</ul>
Excellent Benefits and Compensation:
<ul>
<li>Employee bonus program.</li>
<li>401(k) with company match up to 4% and an additional company contribution.</li>
<li>Health Savings Account with a company matching contribution.</li>
<li>Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.</li>
<li>Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.</li>
<li>Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.</li>
<li>After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.</li>
</ul>
An Investment in You:
<ul>
<li>Career development programs and classes.</li>
<li>Mentoring and coaching to help you advance in your career.</li>
<li>Tuition reimbursement up to $5,250 per year, the IRS maximum.</li>
<li>Diverse, inclusive and welcoming culture with Business Resource Groups.</li>
</ul>
About Medical Mutual:

Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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 individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

#LI-CS1 #LI-REMOTE</div>

Medicare Pharmacy Coordinator

<div>**Medical Mutual employees must submit their applications through MySource.

**This is a hybrid‑remote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated in‑office days each week.
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 1.2 million members 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 individual plans.

Actuarial Analyst I

Job Summary:
Estimates current and future liabilities. Proposes premiums that achieve company goals. Works under close supervision.
Responsibilities:
<ul>
<li>Estimates future claims.</li>
<li>Estimates current claims (reserving: estimate unpaid claim liabilities).</li>
<li>Analyzes historical experience.</li>
<li>Reviews appropriateness of rating factors by plan, area, network, etc.</li>
<li>Proposes premiums that achieve company goals.</li>
<li>Forecasts the future.</li>
<li>Loads and tests premiums.</li>
<li>Performs ad hoc analyses as needed.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Bachelor's degree in Business Administration or related field.</li>
</ul>
Professional Certification(s):
<ul>
<li>Has passed Society of Actuaries Course 1. Is on track to pass Course 2 towards attainment of the Associate of the Society of Actuaries (ASA) designation.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Intermediate Microsoft Office skills, including Access.</li>
</ul>
Actuarial Analyst II

Job Summary:
Estimates current and future liabilities. Proposes premiums that achieve company goals. Works under supportive supervision.
Responsibilities:
<ul>
<li>Estimates future claims.</li>
<li>Estimates current claims (reserving: estimates unpaid claim liabilities).</li>
<li>Analyzes historical experience.</li>
<li>Reviews appropriateness of rating factors by plan, area, network, etc.</li>
<li>Proposes premiums that achieve company goals.</li>
<li>Forecasts the future.</li>
<li>Loads and tests premiums.</li>
<li>Performs ad hoc analyses as needed.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Bachelor's Degree in Business Administration or related field.</li>
<li>1 year experience in health actuarial work.</li>
<li>1 year of experience in Medicare actuarial work if assigned to the Medicare area.</li>
</ul>
Professional Certification(s):
<ul>
<li>Has completed 3 courses and is on track to attain the Associate of the Society of Actuaries (ASA) designation.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Intermediate Microsoft Office Skills, including MS Access.</li>
</ul>
Actuarial Analyst III

Job Summary:
Estimates current and future liabilities. Proposes premiums that achieve company goals. Works under minimal supervision.
Responsibilities:
<ul>
<li>Estimates future claims.</li>
<li>Estimates current claims (reserving: estimate unpaid claim liabilities).</li>
<li>Analyzes historical experience.</li>
<li>Reviews appropriateness of rating factors by plan, area, network, etc.</li>
<li>Proposes premiums that achieve company goals.</li>
<li>Forecasts the future.</li>
<li>Loads and tests premiums.</li>
<li>Performs ad hoc analyses as needed.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Bachelor's Degree in Business Administration or related field.</li>
<li>3 years experience in health actuarial work required; 4 years preferred.</li>
<li>1 year of experience in Medicare Advantage or Medicare Supplement if assigned to Medicare area.</li>
</ul>
Professional Certification(s):
<ul>
<li>Has passed 4 courses and is on track to attain the Associate of the Society of Actuaries (ASA) designation.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Intermediate MS Office Skills, including MS Access.</li>
</ul>
Actuarial Analyst IV

Job Summary:
Estimates current and future liabilities. Proposes premiums that achieve company goals. 


Responsibilities:
<ul>
<li>Estimates future claims.</li>
<li>Estimates current claims (reserving: estimates unpaid claim liabilities).</li>
<li>Analyzes historical experience.</li>
<li>Reviews appropriateness of rating factors by plan, area, network, etc.</li>
<li>Proposes premiums that achieve company goals.</li>
<li>Forecasts the future.</li>
<li>Performs ad hoc analyses as needed.</li>
<li>Loads and tests premiums.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Bachelor's Degree in Business Administration or related field.</li>
<li>4 years experience in health actuarial work required; 5 years preferred.</li>
<li>2 years of experience in Medicare Advantage or Medicare Supplement if assigned to the Medicare area.</li>
</ul>
Professional Certification(s):
<ul>
<li>Has passed 5 courses and is on track to attain the Associate of the Society of Actuarials (ASA) designation.</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Intermediate MS Office Skills, including MS Access.</li>
</ul>
Associate Actuary

Job Summary:
Estimates current and future liabilities. Proposes premiums that achieve company goals. Works on an advanced level.

Responsibilities:
<ul>
<li>Estimates future claims.</li>
<li>Estimates current claims (reserving: estimate unpaid claim liabilities).</li>
<li>Analyzes historical experience.</li>
<li>Reviews appropriateness of rating factors by plan, area, network, etc.</li>
<li>Proposes premiums that achieve company goals.</li>
<li>Forecasts the future.</li>
<li>Loads and tests premiums.</li>
<li>Performs ad hoc analyses as needed.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Bachelor's Degree in Business Administration or related field required.</li>
<li>Master's Degree in Business Administration or related field preferred.</li>
<li>5 years experience in health actuarial work required.</li>
</ul>
Professional Certification(s):
<ul>
<li>Associate of the Society of Actuaries (ASA)</li>
<li>Member American Academy of Actuaries (MAAA)</li>
<li>Completed 7 Actuarial Courses</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Intermediate MS Office Skills, including MS Access.</li>
</ul>
Actuary

Job Summary:
Estimate current and future liabilities. Propose premiums that achieve company goals. Works on an advanced level and may train others.
Responsibilities:
<ul>
<li>Estimate future claims.</li>
<li>Estimate current claims (reserving: estimate unpaid claim liabilities).</li>
<li>Analyze historical experience.</li>
<li>Review appropriateness of rating factors by plan, area, network, etc.</li>
<li>Propose premiums that achieve company goals.</li>
<li>Forecast the future.</li>
<li>Load and test premiums.</li>
<li>Perform ad hoc analyses as needed.</li>
<li>Performs other duties as assigned.</li>
</ul>
Qualifications:

Education and Experience:
<ul>
<li>Bachelor's Degree in Business Administration or related field required.</li>
<li>Master's Degree in Business Administration or related field preferred.</li>
<li>6 years experience in health actuarial work required.</li>
</ul>
Professional Certification(s):
<ul>
<li>Fellow of the Society of Actuaries (FSA)</li>
<li>Member of the American Academy of Actuaries (MAAA)</li>
<li>Completed all 9 Actuarial Courses</li>
</ul>
Technical Skills and Knowledge:
<ul>
<li>Intermediate MS Office Skills, including MS Access.</li></ul> 


Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:
<ul>
<li>We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.</li>
<li>Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.</li>
<li>On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.</li>
<li>Discounts at many places in and around town, just for being a Medical Mutual team member.</li>
<li>The opportunity to earn cash rewards for shopping with our customers.</li>
<li>Business casual attire, including jeans.</li>
</ul>
Excellent Benefits and Compensation:
<ul>
<li>Employee bonus program.</li>
<li>401(k) with company match up to 4% and an additional company contribution.</li>
<li>Health Savings Account with a company matching contribution.</li>
<li>Excellent medical, dental, vision, life and disability insurance &mdash; insurance is what we do best, and we make affordable coverage for our team a priority.</li>
<li>Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.</li>
<li>Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.</li>
<li>After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.</li>
</ul>
An Investment in You:
<ul>
<li>Career development programs and classes.</li>
<li>Mentoring and coaching to help you advance in your career.</li>
<li>Tuition reimbursement up to $5,250 per year, the IRS maximum.</li>
<li>Diverse, inclusive and welcoming culture with Business Resource Groups.</li>
</ul>
About Medical Mutual:

Medical Mutual&rsquo;s status as a mutual company means we are owned by our policyholders, not stockholders, so we don&rsquo;t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There&rsquo;s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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 individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We&rsquo;re not just one of the largest health insurance companies based in Ohio, we&rsquo;re also the longest running. Founded in 1934, we&rsquo;re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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Actuarial Analyst

Join Medical Mutual of Ohio and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Medical Mutual of Ohio

About Company

Supervisor, Clinical Operations

Manager, Clinical & Coding Payment Integrity

Medicare Pharmacy Coordinator

Actuarial Analyst