- Regions Bank (Atlanta, GA)
- …section of the system. **Job Description:** At Regions, the Fraud Strategy Analyst performs analysis and interpretation of fraud-based threats by gathering and ... data and analytics capabilities + Previous experience with fraud claims is highly preferred for this role + Experience...highly preferred for this role + Experience with fraud claims from intake to final decision + Understanding of… more
- Molina Healthcare (GA)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of… more
- Lockheed Martin (Kings Bay, GA)
- …\(EACs\) in the Earned Value Management tool \(COBRA\)\. In addition, you will claim performance Budget Cost of Work Performed \(BCWP\) monthly\. \- You will utilize ... the Earned Value Management system to measure cost and schedule performance, as well as prepare variance reports on a monthly basis\. \- You will be responsible for coordination of monthly diagnostics, including taking corrective action\. \- You will develop… 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 ... partners. + Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans, rather than standard offerings. + Develops and executes implementation strategy consistent with client expectations; ensures strategy is… more
- Molina Healthcare (Macon, GA)
- …+ SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting ... and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made… 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 ... prepares cases for clinical and legal review. + Documents all appropriate case activity in case tracking system. + Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law. + Facilitates the recovery… 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 ... for clinical and legal review. - Documents all appropriate case activity in case tracking system. - Prepares and presents referrals, both internal and external, in the required timeframe. - Facilitates the recovery of company lost as a result of fraud matters.… more
- Highmark Health (Atlanta, GA)
- …5 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 3 years of project leadership ... in a complex, matrixed environment (payer and/or provider preferred) + 3 years of providing analytical consultation to clinical, administrative, operational and financial stakeholders **Preferred** + None **LICENSES or CERTIFICATIONS** **Required** + None… more
- BrightSpring Health Services (Valdosta, GA)
- …related in health care administrative, financial, or insurance customer services, claims , billing, call center or management regardless of industry. + Proficient ... computer skills and knowledge of Microsoft Office ADD and above average Excel skills. + Proficient 10 key skills. + Possess the technical aptitude required to understand flow of data through systems as well as system interactions. + HCHB (Home Care Home Base)… more
- Elevance Health (Atlanta, GA)
- …CPB. + Experience in claims adjudication and application of NCCI editing and claims payment rules. + Ability to interpret claim edit rules and references. + ... meet financial and operational targets. As a Clinical Content Analyst , you'll research and interpret CMS, CPT/AMA and other...Solid understanding of claims workflow including the interconnection with claim … more