- 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
- 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
- CVS Health (Atlanta, GA)
- …and provides accurate claim information to support savings optimization for claims . Responds to customers on benefit inquiries. Maintains customer service standards. ... Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to… 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
- CVS Health (Atlanta, GA)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM or… more