- CVS Health (Atlanta, GA)
- …Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the negotiation ... benchmarking costs for medical services, supplies, and drugs. + Medical provider/ business office phone call handling history. + Strong mathematical skills.… more
- Molina Healthcare (GA)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- CVS Health (Atlanta, GA)
- …claim adjudication. **What you will do** + Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, ... and provides accurate claim information to support savings optimization for claims . Responds to customers on benefit inquiries. Maintains customer service standards.… more
- Highmark Health (Atlanta, GA)
- …in varied and complex data; and articulates analytic findings, business implications, and recommendations to realize identified opportunities. **ESSENTIAL ... strategic priorities, needs, plans and resources. + Serves as a strategic business partner to internal and external stakeholders as demonstrated by providing thought… more
- BrightSpring Health Services (Valdosta, GA)
- …Ensures all batches/checks, denials, and adjustments are keyed and posted within 2 business days of receipt. + Meets productivity standards for keyed payments and ... related in health care administrative, financial, or insurance customer services, claims , billing, call center or management regardless of industry. + Proficient… more
- CVS Health (Atlanta, GA)
- …setup, essential for online viewing and processing, related to customer service, claims , enrollment, billing, and reporting, in support of internal and external ... to minimize manual processing and disruption for the clients. + Uses business knowledge and experience to make plan design and processing recommendations when… more
- CVS Health (Atlanta, GA)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... tools, social media and internet research. + Ability to Travel for Business purposes. **Preferred Qualifications** + Certified Professional Coder (CPC), AHFI, CFE +… more
- CVS Health (Atlanta, GA)
- …in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases ... Provides input regarding controls for monitoring fraud related issues within the business units. - Exercises independent judgement and uses available resources and… more
- Prime Therapeutics (Atlanta, GA)
- …of individuals with 2+ years of work experience. + Prior experience as a Business Intelligence Developer/ Analyst or Data Analyst supporting business ... passion and drives every decision we make. **Job Posting Title** Business Intelligence Specialist - Sacramento, California market **Job Description** Delivers… more
- Molina Healthcare (Augusta, GA)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 7 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** ** Business Leadership & Operational Ownership**… more
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