- Elevance Health (Atlanta, GA)
- …healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, ... and claim systems for review of facility, professional and pharmacy claims . + Responsible for identifying and developing enterprise-wide specific healthcare… more
- Elevance Health (Atlanta, GA)
- …be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. + Schedules review with provider, ... analyzes data to select claims to be reviewed, conducts review using medical charts,...and provider contracts. + Conducts exit interview with provider management team by presenting preliminary review results. + Verifies… 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...and/or state. + May interface internally with Senior level management and legal department throughout investigative process. + May… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …working with Business Analysis to enhance field intelligence capabilities. + **Compliance Management :** Must comply with all state and federal laws, regulations and ... expertise in business analytics, business operations, sales support, and resource management within a commercial pharmaceutical organization. + Ability to focus on… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …teams while aligning with CoE training efforts + **Performance & Risk Management :** + Provide regular updates on the performance and effectiveness of omnichannel ... processes. + Strong matrix team-building skills, a team-oriented approach, and supportive management style. + Solid written and oral communication skills as well as… more
- AON (Atlanta, GA)
- …looking for a leader who is responsible for the day-to-day, strategic account management of Aon's largest and most complex client relationships (often Global). You ... global insurance programs and can develop a global risk management programs across all lines of business. + Secures...to support clients in unusual circumstances such as large claims , etc. Skills and experience that will lead to… more
- Norstella (Atlanta, GA)
- …offerings leveraging Norstella's unified Real World Data asset, NorstellaLinQ, a combination of claims , lab, SDOH and EMR data. You will be joining an organization ... accuracy and quality. *Perform in-depth analyses on healthcare data sources, including claims , lab, EMR/EHR, and SDOH data, to uncover actionable insights and drive… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …+ Work with bioanalytical team members on activities related to sample management , pharmacogenomics and biomarker development and provide analysis support related to ... states and local laws. **Company benefits** : Comprehensive medical, dental , vision, prescription drug coverage, company provided basic life,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Elevance Health (Columbus, GA)
- …SPECIALIST III** is responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the following in relation to ... **How you will make an impact:** + Audits paid claims for overpayments using various techniques including systems-based queries,...reporting, or other research. + Interacts with staff and management from other departments on a regular basis to… more
- RELX INC (Atlanta, GA)
- …as necessary Requirements + Have proven experience in leave administration, including with Claims Management . + Have an exceptional attention to detail + Be ... including counseling employees on leave applications and ensuring timely adjudication of claims by the Third Party Administrator (TPA) + Entering leave data into… more