- 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
- Mass Markets (GA)
- …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, ... Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse… more
- Dal-Tile Corporation (Macon, GA)
- …customer returns, and notifying management of damaged shipments for freight claims . + Operates forklift equipment. + Maintains clean and organized facility ... by sweeping, trash removal, restroom, general office maintenance, etc. + May wait on customers and prepare sales slips. + Maintains a safe working environment by obeying all safety rules outlined in the Safety Program and reporting all accidents, unsafe… more
- CGI Technologies and Solutions, Inc. (Atlanta, GA)
- …(PC or CC). * Strong understanding of P&C insurance operations (underwriting, billing, claims ). * Experience with Agile and hybrid delivery models. * Proficiency in ... tools such as JIRA, Confluence, Visio, and MS Office. * Ability to manage dependencies and communicate effectively across teams. * Familiarity with SQL and wireframing tools is a plus. * CCBA or CBAP certification preferred. Nice to Have: * Experience with… more
- BD (Becton, Dickinson and Company) (Covington, GA)
- …questions + Provide timely review and approval of product labeling and marketing claims for regulatory compliance + Update STED technical files for CE marking ... activities and notified body interaction to accomplish EU/MDR product + May direct Project Team personnel; may provide direction to assistant personnel **Education** Bachelor's degree in a Scientific field with 3-5 years of validated experience in the areas of… more
- Prime Therapeutics (Atlanta, GA)
- …to support clinical program using eligibility, medical, and pharmacy administrative claims . This position is responsible for performing work that includes study ... design, measurement and publishing results of complex pharmacy and medical health insurance clinical programs. **Responsibilities** + Design, develop and apply statistical theories and methods to solve complex technical problems + Define detailed report… more
- Samsung SDS America (Duluth, GA)
- …+ Investigate and report service failures, accidents, misconduct, security incidents, or claims to the appropriate departments for timely resolution. + Prepare and ... distribute daily, weekly, and monthly performance reports; brief team leaders on operational highlights and issues. + Lead daily management meetings to review previous day's performance and develop action plans for current operations. + Manage end-to-end… more
- Humana (Atlanta, GA)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... be able to work core business hours on EST time between (9am-5pm). + Willingness to travel up to 10% to conduct audits at site locations. + Ability to manage multiple or competing priorities and meet deadlines + Must be passionate about contributing to an… more
- Molina Healthcare (Augusta, GA)
- …advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. * Build and maintain efficient ... ETL pipelines to support ongoing reporting and analytics workflows. * Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets. * Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost… more
- Molina Healthcare (Augusta, GA)
- …experience working in Medicare + Must have experience analyzing claims . **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree and/or equivalent ... combination of education and Health Care related experience of 4+ years **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 4+ years experience in health care industry in related field **PREFERRED EDUCATION:** Bachelor's degree in healthcare related field… more