- 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 ... to travel and participate in legal proceedings, arbitrations, depositions, etc. ** Preferred Qualifications** 1-3 years experience working on health care fraud,… more
- Elevance Health (Atlanta, GA)
- …** Preferred Skills, Capabilities, and Experiences:** + Scaled Agile Framework Training preferred . + 5+ years of claims editing experience with healthcare ... payers and/or claims editing software vendors, strongly preferred . + Billing, coding, revenue cycle, and claims...claims adjudication and application of NCCI editing and claims payment rules. + Ability to interpret claim… more
- Molina Healthcare (Augusta, GA)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** +… more
- Molina Healthcare (Atlanta, GA)
- …and financial outcomes for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance ... a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...At least 7 years of experience as a Business Analyst or Program Manager in a Managed Care Organization… more
- The Hartford (Alpharetta, GA)
- …Agile environment. + Excellent communication, stakeholder management, and leadership skills. Preferred Qualifications: + Deep understanding of Claims processes ... leader to oversee the development and maintenance of our Claims application ecosystem. This role is pivotal in driving...lead a team of Tech Leads, Senior Developers, Business Analyst , and Scrum Master, and will be responsible for… more
- Highmark Health (Atlanta, GA)
- …work closely with the section's Accountant, Accounting Coordinators, Associate Analyst , providing, guidance, feedback, training, motivation, and support. This team ... for non-payment, Completing write-offs as appropriate, Coordinating AR issues affecting claims or inquiry processing with Membership and Billing personnel.Lead or… more
- AIG (Atlanta, GA)
- …from product capabilities What we are looking for + Master's in business administration preferred + Claims or Insurance background is preferred + Gen ... GenAI Product Manager with Claims ExperienceBe part of something groundbreakingAt AIG, we...key part of that transformation. As a GenAI Product Analyst you will have the opportunity to make a… more
- Prime Therapeutics (Atlanta, GA)
- …years of work experience. + Prior experience as a Business Intelligence Developer/ Analyst or Data Analyst supporting business intelligence, reporting, analytics ... that may be in use in a Pharmacy Benefit Management setting ( Claims Processing, Prior Authorization, Telephony, Membership, etc.). + Consideration will be given… more
- UIC Government Services and the Bowhead Family of Companies (Kingsland, GA)
- …Technician, an Electronics Technician, a Logistics Specialists and a Program Analyst . + Develops, plans and establishes objectives and priorities; plans, presents, ... levels of employees and outside contacts + PMP certification preferred Physical Demands: + Must be able to lift...characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq.,… more
- Quality Technology Services, LLC (Duluth, GA)
- …in the "day in the life" of a corporate Strategic Financial Analyst /Strategist. While working across multiple projects, your responsibilities can include but aren't ... Critical thinking and problem-solving abilities. + Must be a US Citizen ** PREFERRED QUALIFICATIONS:** + Current full-time enrollment in one of QTS's partner… more
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