- Axis (Alpharetta, GA)
- …for its North America Claim Team. This role involves managing primary and excess healthcare liability claims for AXIS US policies. How does this role contribute ... to our collective success? You will handle highly complex healthcare liability claims by verifying coverage, conducting investigations, developing resolutions,… more
- Molina Healthcare (Macon, GA)
- …and work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant… more
- Molina Healthcare (Savannah, GA)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more
- Molina Healthcare (Augusta, GA)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more
- Molina Healthcare (GA)
- …Experience working on SQL, PowerBI, databricks. + Experience on ETL , healthcare specifically claims is highly preferred. **JOB QUALIFICATIONS** **Required ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Cognizant (Atlanta, GA)
- …you will make an impact by leading the implementation and optimization of Facets Claims solutions for healthcare clients. You will be a valued member of ... **Product Consultant - Facets Claims & Payer Domain** **Work Model: Remote** **Employment...help you stand out** + Certified Facets Professional + Healthcare Payer Professional Certification + Experience driving Agile practices… more
- Baylor Scott & White Health (Atlanta, GA)
- … Claims , MMR, MOR, MAO-002, MAO-004 and RAPs/EDS data + Experience with Healthcare claims , enrollment and pharmacy data is preferred + Knowledge of ACA, ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …certification + **Preferred Skills, Abilities, & Knowledge** : + Experience with healthcare incident reporting and claims management systems (eg, RLDatix, ... **Overview** **Be inspired. Be rewarded. Belong. At Emory Healthcare .** At Emory Healthcare we fuel your professional journey with better benefits, valuable… more
- Molina Healthcare (Columbus, GA)
- …trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Humana (Atlanta, GA)
- …implement data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization ... that align with customer needs and objectives + Deep understanding of healthcare claims taxonomy (service categories, such as LTSS) **Additional information**… more