- Sedgwick (Atlanta, GA)
- …Managers! Required to have a minimum of** **1.5 years of prior Workers Compensation experience in order to be considered.** **PRIMARY PURPOSE OF THE ROLE:** Sedgwick ... required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Humana (Atlanta, GA)
- …appeals experience + Prior experience interpreting Member Benefits and Medical Claims + Previous experience processing medical authorizations + Bilingual (English ... + Prior experience with Medicare + Experience with the Claims Administration System (CAS) + Knowledge of medical terminology...be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… 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
- Evolent (Atlanta, GA)
- …- Payer side, Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1 years of experience in ... assurance and database testing, medical benefits, provider, enrollment, and / or claims data. + Demonstrable experience with Testing, Writing Test cases, Test Plans,… more
- Sedgwick (Atlanta, GA)
- …#medicaresetaside _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency ... in job postings. Actual compensation is influenced by a wide range of factors...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Evolent (Atlanta, GA)
- …accounts + Strong knowledge of health plan operations, care/utilization management, claims processing, value-based care, and the levers to optimize financial ... be leveraged to identify opportunities and actions (including EMR, clinical, authorization, claims , SDoH, etc.); understanding of how to translate data and insights… more
- Humana (Atlanta, GA)
- …operations for higher quality and operational efficiency. + Ensure enrollment and claims processes comply with regulatory requirements and guidelines. + Partner with ... Enrollment Period (AEP). + Utilize tools such as Availity to streamline claims submission, eligibility verification, and authorization processes. + Directly lead a… more
- Molina Healthcare (GA)
- …models to support analytical and operational use cases, including healthcare claims and utilization data. * Collaborate with cross-functional teams, including data ... * Prior experience working in the healthcare industry with familiarity in clinical, claims , or care management data. * Experience with cloud platforms (AWS, Azure)… more
- Evolent (Atlanta, GA)
- …You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population ... with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including prior authorization data… more
- UIC Government Services and the Bowhead Family of Companies (Fort Gordon, GA)
- …and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... based on the provisions contained within The Alaska Native Claims Settlement Act. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. All… more