- Sedgwick (Atlanta, GA)
- …year of experience in construction management, restoration and/or insurance claims and customer service required. Chronicle software experience preferred. **Skills ... 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… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive ... legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,...will not be held liable or responsible for any claims , losses, damages or expenses resulting from job recruiting… more
- Prime Therapeutics (Atlanta, GA)
- …Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of ... data + Develop financial pricing models to monitor performance against pharmacy claims data and identify financial pricing opportunities to drive savings and/or meet… more
- CDM Smith (Columbus, GA)
- …and maintaining a project risk register. Claim management: Early support for claims and disputes on the project. Identify contractual requirements to maintain and ... prosecute claims , and assist project team in managing to those...Ensure that proper documentation is developed and maintained for claims . **Job Title:** Commercial Manager - Pacific **Group:** CCI… more
- Elevance Health (Columbus, GA)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses...document determinations and continue to next step in the claims lifecycle. + Researches new healthcare related questions as… more
- 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...claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying and developing enterprise-wide… more
- CVS Health (Atlanta, GA)
- …insurance premiums by analyzing data and estimating the expected costs of claims . + Conducting research on Actuarial market trends, competitor pricing, and ... organizes, and analyzes large volumes of data related to insurance policies, claims , demographics, and other relevant factors. + Develops and maintains Actuarial… more
- Aveanna Healthcare (Atlanta, GA)
- …any and all guarantors for services provided. This is inclusive of claims to commercial, Medicare, Medicaid and private pay accounts. Essential Job Functions ... Requests Bridge Tickets to correct and update EMR. Works with Biller to ensure claims are refiled and/or billed to the second insurance in a timely manner.… more
- RELX INC (Atlanta, GA)
- …including counseling employees on leave applications and ensuring timely adjudication of claims by the Third Party Administrator (TPA) + Entering leave data into ... policy and overseeing state-specific leave requirements + Administering Workers Compensation claims across all US divisions and ensuring timely submission of First… more
- PruittHealth (Norcross, GA)
- …and verification of required third party documentation for all Medicare bad debt claims on an annual cost reporting basis. Calculation of allowable Medicare bad debt ... claims based on third party documentation in accordance with...3. Adjust and/or correct Medicare Part A coinsurance crossover claims in the Medicaid web portal as needed. 4.… more