- Molina Healthcare (Augusta, GA)
- …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- CVS Health (Atlanta, GA)
- …**Required Qualifications** + 3-5 years of data interpretation and analysis experience. + Healthcare background. + Experience with internal claims data and ... healthcare coding. + Must be able to travel to provide testimony if needed. + Experience with Excel. **Preferred Qualifications** + Certified Professional Coder + Knowledge of CVS/Aetna's policies and procedures + Excellent verbal and written communication… more
- Molina Healthcare (GA)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical Terminology,… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Familiarity with interdisciplinary team collaboration is essential, particularly in healthcare or psychiatric environments. The primary role of this position ... as a provider on record for appropriate managed care intervention claims with responsibility for appropriate documentation, implementation, and monitoring of autism… more
- Travelers Insurance Company (Alpharetta, GA)
- …Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to ... (REMOVE WHEN POSTING) Commercial Surety: Travelers' Commercial Surety Team handles claims on non-construction surety bonds; mitigates exposures on commercial surety… more
- Highmark Health (Atlanta, GA)
- …CrewAI) and Generative AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management, claims processing, member ... cutting-edge applications of Generative AI (GenAI) and Agentic AI within the healthcare payer domain. The intern will work alongside AI Engineers, Data Scientists,… more
- VetsEZ (GA)
- …platforms, we enable smarter decisions, seamless patient engagement, and more efficient claims management. Together, we are shaping a healthcare ecosystem that ... and deploy scalable, AI-enabled microservices using AWS, Node.js, and Python to power healthcare platforms that handle high-volume clinical and claims data. +… more
- Humana (Atlanta, GA)
- …**Preferred Qualifications** + Bachelor's Degree + Prior experience working within the healthcare field + Previous experience with medical claims + Project ... benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also...our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions… more
- Sedgwick (Atlanta, GA)
- …Review Analyst plays a critical role in supporting the medical malpractice claims team by ensuring legal invoice accuracy, compliance, and defensibility. This ... billing guidelines, industry standards, and customary legal practices specific to healthcare litigation. The Analyst contributes to cost containment efforts and… more
- Waystar (Atlanta, GA)
- …THIS POSITION** Waystar is a market-leading provider of cloud-based healthcare payments software. Our mission-critical platform simplifies the complex revenue ... We process billions of transactions annually, leveraging a massive dataset of claims , remittances, and patient data to drive outcomes. With Waystar AltitudeAI (TM)… more