- Humana (Atlanta, GA)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... with Optum WebStrat or PSI applications + Experience reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Elevance Health (Columbus, GA)
- …conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing ... of 3 years experience working in grievances and appeals, claims , or customer service; or any combination of education...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- RxBenefits (Atlanta, GA)
- …is well suited for someone who thrives at the intersection of healthcare and technology-translating clinical logic, medical guidelines, and business rules into ... actionable intelligence across patient and claims data. Candidates with experience in PBM pricing, claims rules engines, clinical optimization, or pharmacy spend… more
- Walgreens (Canton, GA)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- UNUM (Atlanta, GA)
- …Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product lines. The ... and internal workflow standards as set forth in the Benefits Center Claims Manual, underwriting manual, and associated documentation. The incumbent adheres to… more
- BrightSpring Health Services (Valdosta, GA)
- …report out. + Complete follow up process to ensure full adjudication of claims . + Identifies adjustments throughout the month for assigned Operations. + Timely ... equivalent, Associate's degree or higher preferred. + At least 2 years healthcare billing, private insurance and/or federally funded programs, researching aging and … more
- Insight Global (Kennesaw, GA)
- …business unit to drive IT strategy and execution across underwriting, claims , digital transformation, analytics, and technical services. This leader delivers ... manager level leadership * 5+ years in any type of insurance, healthcare payer, healthcare provider, insurance brokerage, managing large cross-functional… more
- Cardinal Health (Atlanta, GA)
- …team to ensure timely and accurate resolution of outstanding insurance claims . This role leads strategy development, performance monitoring, and process improvement ... workflows. + Serve as the point of escalation for complex or high-dollar claims . + Stay current with payer policy changes, compliance regulations, and industry best… more
- Oracle (Atlanta, GA)
- **Job Description** Oracle Health is dedicated to transforming healthcare by driving innovation, operational efficiency, and better outcomes through world-class ... Our teams power the Oracle Health is dedicated to transforming healthcare by driving innovation, operational efficiency, and better outcomes through world-class… more
- Medtronic (GA)
- …can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You'll lead with purpose, breaking down ... Clinical Expert + Translates complex technical messaging, dispels competitive claims , resolves complex technical issues, and maintains customer relationships through… more