- Molina Healthcare (Macon, GA)
- **JOB DESCRIPTION** **Job Summary** JOB SUMMARY: The Sr. Analyst , Healthcare plays a critical role in supporting clinical and operational initiatives by translating ... healthcare business needs into technical solutions. This role works closely...queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and maintain… more
- Sysco (College Park, GA)
- …to work first and/or second shift.** **Job Summary:** The Leave of Absence Analyst is responsible for managing employee leave and return to work processes, ensuring ... and company policies. This role involves coordinating with HR, business leaders, colleagues, and our third party leave and...Work:** Review and audit Return to Work process for claims , including Return to Work transitional program, process with… more
- Regions Bank (Atlanta, GA)
- …be used for marketing purposes, sold, or shared outside of Regions unless required by law. Such information will be stored in accordance with regulatory requirements ... section of the system. **Job Description:** At Regions, the Fraud Strategy Analyst performs analysis and interpretation of fraud-based threats by gathering and… more
- CVS Health (Atlanta, GA)
- …to work EST time zone hours.** **Position Summary** We are hiring a Senior Analyst to support the Complaint, Grievances and Appeals (CG&A) team. This position will ... and answering ad-hoc requests + Work closely with analysts and other business partners to gather requirements and understand the reporting needs for ad-hoc… more
- 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 ... staff, and team members as more complex cases and strategies are developed. ** Required Qualifications** + 3-5 years of experience in a medical claim background with… 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
- 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 ... tracking system. - Prepares and presents referrals, both internal and external, in the required timeframe. - Facilitates the recovery of company lost as a result of… 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