- Elevance Health (Atlanta, GA)
- …in order to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health insurance policies, ... health insurance claims handling and provider network contracting. **How will you...network contracting. **How will you make an impact:** + Claim reviews for appropriate coding, data mining, entity review,… more
- CVS Health (Atlanta, GA)
- …and share results of analysis with management. + Reserve Analysis: Analyze claim data and monitor reserve levels for appropriateness and demonstrate an understanding ... insurance premiums by analyzing data and estimating the expected costs of claims . + Conducting research on Actuarial market trends, competitor pricing, and… more
- Prime Therapeutics (Atlanta, GA)
- …to elicit, define, and document the requirements for changes to Prime's claims systems. **Responsibilities** + Ensure understanding of business requirements and IT ... and serve as subject matter expert and mentor for other members of Claims IT team, including cross-training assigned BSAs on system requirements phase of assigned… more
- Sedgwick (Atlanta, GA)
- …resolve issues and answer questions + . Accurately and efficiently enters new housing claims into the system. + Monitors inbound email for claim questions, ... completed and partial stays + Audit hotel folios and related claims for billing accuracy, compliance, and documentation **ADDITIONAL FUNCTIONS and RESPONSIBILITIES**… more
- Lowe's (Suwanee, GA)
- …+ Escalated customer concern resolution + Working alerts and queues + Inputting customer claims into the claim portal system + Responsible to support delivery ... with the third-party logistics partner to address and resolve claims (customer and cargo), updates Lowe's claims ...resolve claims (customer and cargo), updates Lowe's claims portal + Process vendor credit for items returned… more
- Sedgwick (Atlanta, GA)
- …& Insurance Contents Adjuster **PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + ... + Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim . + Consults police and hospital records and inspects property damage… more
- Banner Health (GA)
- …coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing ... of clinical documentation and correctness of billing codes prior to claim submission; to identify possible opportunities for improvement of clinical documentation… more
- BrightSpring Health Services (Valdosta, GA)
- …accounts list, code and comment prior to monthly Critical Account call.* Rebill claims for any outstanding AR that is collectible. Provide detail comment in aging ... and within the designated timeframe.* Timely follow up on insurance claim denials, exceptions or exclusions.* Reading and interpreting insurance explanation of… more
- Sedgwick (Atlanta, GA)
- …Determines objective, quantifiable, medically supported work restrictions for assigned claims . + Facilitates return-to-work (RTW) efforts through negotiation with ... or client directed documentation, notification or reporting; documents client contact in claim notes as per Sedgwick CMS standards; and assists case management staff… more
- Norfolk Southern (Atlanta, GA)
- …and processes throughout the department while also handling the appeals of claims and grievances and the defense of management's position in disputes involving ... to front line supervision. + Interacts with General Chairmen and handles claim conferences. + Identifies, justifies, and develops enhancements to or replacements for… more