- Elevance Health (Atlanta, GA)
- …of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management ... policies and procedures. **Minimum Requirements:** + Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted… more
- CVS Health (Atlanta, GA)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality. Additional responsibilities to include but not limited to the following: - Responsible… more
- Molina Healthcare (Columbus, GA)
- …**Required Experience** + 2 - 3 years customer service, provider service, or claims experience in a managed care setting. + Working familiarity with various managed ... healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation, and various forms of risk, ASO, etc. **Preferred Education** Bachelor's Degree. **Preferred… more
- Molina Healthcare (Savannah, GA)
- …focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... + Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the… more
- Molina Healthcare (Columbus, GA)
- …setting. **Required Experience** + 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed ... healthcare administration and/or Provider Services. + 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ie, physician, group and hospital contracting, etc. + Working… more
- Walmart (Woodstock, GA)
- …up orders are filled. Oversees assigned area of responsibility by handling claims and returns; zoning the area; arranging and organizing merchandise; identifying ... shrink and damages; organizing and maintaining availability of carts/flatbeds; assisting members with transporting items; utilizing cart retrieval equipment according to company policies and procedures; and maintaining parking lot cleanliness. Completes… more
- Robert Half Legal (Marietta, GA)
- …initiatives. * Resolve disputes involving insurance defense and personal injury claims . * Advise on the legal implications of consumer-facing marketing and ... business strategies. * Ensure compliance with all applicable laws and regulations affecting the organization. Requirements * 8-10+ years of experience in corporate law and business legal matters. * Proven expertise in drafting and negotiating commercial… more
- Kemper (Alpharetta, GA)
- …charts. + Evaluate risk using vendor information (medical records, Rx data, claims history, criminal checks, inspection reports, MVRs, paramedical exams, labs). + ... Make underwriting decisions (issue, new app required, or decline). + Generate decline or post-notification letters as applicable. + Communicate with agents and Policy Service. + Maintain detailed and accurate case file notes. + **Response to Underwriting… more
- Walmart (Atlanta, GA)
- …Floor in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and ... identifying shrink and damages. * Maintaining a clean, sanitized, and member-ready area The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a… more
- ASRC Industrial Services (Milledgeville, GA)
- …Corporation (ASRC), an Alaska Native Corporation (ANC) established under the Alaska Native Claims Settlement Act of 1971. As part of an ANC, AIS Infrastructure is ... a Minority Business Enterprise. Their AIS BCSS group is also a certified 8(a) business, offering further contracting advantages to government agencies. These designations help clients meet their diversity spending objectives, while also providing sustainable… more