- Prime Therapeutics (Atlanta, GA)
- …Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the ... or residency sponsorship. **Additional Qualifications** + 3+ years' fraud investigations/ claims experience. + Ability to manage workload while simultaneously working… more
- HNTB (Atlanta, GA)
- …and databases + Consults with the project team or client/owner related to potential claims , claims avoidance, and claims support. + Prepares reports and ... performance dashboards for a variety of project controls metrics, analyzes data and creates and/or participates in client presentations. + Develops and maintains project risk register. Escalates project risks and partners with the project team to create and… more
- Elevance Health (Atlanta, GA)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Humana (Atlanta, GA)
- …appeals experience + Prior experience interpreting Member Benefits and Medical Claims + Previous experience processing medical authorizations + Bilingual (English ... English and Spanish + Prior experience with Medicare + Experience with the Claims Administration System (CAS) + Knowledge of medical terminology + Ability to manage… more
- Sedgwick (Atlanta, GA)
- …for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The ... advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With… more
- Molina Healthcare (Savannah, GA)
- …software and medical record vendors, and other Molina departments, such as Claims , Enrollment, IT etc,. to get appropriate responses and manage contracts and ... + Maximizes use of information from multiple sources, including claims /encounters, pharmacy, utilization management, clinical indicators, industry benchmark, and/or… more
- Walgreens (Columbus, GA)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Walgreens (Savannah, GA)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Elevance Health (Atlanta, GA)
- …expertise, as well as single point of service support (eg, calls and claims ) to key client contacts (HR, Benefit Administrators, client key decision makers, etc.) ... a HS diploma or equivalent and a minimum of 5 years related claims /customer service experience; or any combination of education and experience which would provide… more
- Elevance Health (Atlanta, GA)
- …analysis; and reporting of statistical results. + Analyze health care data, including claims , clinical data, national survey data, and other large datasets using R ... preferred. + Experience with health plan administrative databases (pharmacy and medical claims ) and/or other big datasets is preferred. For candidates working in… more