- Zurich NA (Atlanta, GA)
- …experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an Associate Degree and 5 or more years of experience ... and industry. + Administer and monitor underwriting rules and guidelines, insurance laws and regulations, and rating manuals. Basic Qualifications, AVP Level:… more
- Actalent (Ellabell, GA)
- …the operation plan to ensure part quality specifications, managing field claim analyses, supplier management, and part inspections. Additionally, you will analyze ... + Execute operation plans to ensure part quality specifications. + Manage field claim analyses, supplier management, and part inspections. + Analyze causes of part… more
- Elevance Health (Atlanta, GA)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you ... potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment auditing. + Correlates review findings with… more
- Elevance Health (Atlanta, GA)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5… more
- Evolent (Atlanta, GA)
- …fostering trust, expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate ... raw unadjudicated claims data. **Qualifications Required and Preferred:** + Bachelor's degree,...Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are… more
- Elevance Health (Atlanta, GA)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …in ERP system. + Manage 3PL processes for inventory, returns and claims , recall activities and reporting, and product destructions. + Manage inventory reporting ... basic life, accidental death & dismemberment, short-term and long-term disability insurance , tuition reimbursement, student loan assistance, a generous 401(k) match,… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …third-party data assets, including Xponent Plantrak, DDD, HCOS, Claims Data, Specialty pharma, omnichannel data, SalesForce/Veeva (Call/Sample/Detail), etc. ... basic life, accidental death & dismemberment, short-term and long-term disability insurance , tuition reimbursement, student loan assistance, a generous 401(k) match,… more
- Ortho Sport and Spine Physicians (Atlanta, GA)
- …Translate patient information and alphanumeric medical code entries. Electronic "clean" claims submissions to Insurance Carriers. Collect, post, and manage ... denied claims for denial reasons and provide resolution. Investigate insurance fraud and report if found. Collect information regarding patient treatments,… more
- Humana (Atlanta, GA)
- …looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and ... provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters… more