- Humana (Atlanta, GA)
- …us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... Qualifications** + Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient… more
- Elevance Health (Atlanta, GA)
- …procedures. + Develops and analyzes business performance reports (eg for claims data, provider data, utilization data) and provides notations of performance ... with a preference for those who have experience in healthcare data, particularly in claims , case management, or HEDIS data. + A strong grasp of statistics, modeling,… more
- Humana (Atlanta, GA)
- …us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate ... + Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient… more
- Sedgwick (Atlanta, GA)
- …and relatively complex National Account. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies, claims , and other records to determine ... insurance coverage. + Administers and reconciles complex catastrophic claims for property. + Interviews, telephones, or corresponds with claimant(s) and witnesses… more
- Elevance Health (Atlanta, GA)
- …be licensed in multiple states in a timely basis. + Knowledge of health insurance /benefits strongly preferred. + Transplant experience strongly preferred. Please ... The **Transplant Nurse II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn and take… more
- Highmark Health (Atlanta, GA)
- …all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** Are you...to uncovering society's most complex challenges? Do you see medical records not just as disparate facts, but as… more
- Trinity Health (Greensboro, GA)
- …organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or ... being friendly, professional and respectful, to guarantee the flow of accurate medical , insurance and demographic information throughout the system. **What you… more
- Elevance Health (Atlanta, GA)
- …Capabilities and Experiences** + Medical terminology training and experience in medical or insurance field preferred. For candidates working in person or ... make an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for… more
- Highmark Health (Atlanta, GA)
- …**EXPERIENCE** **Required** + 3 years of relevant, progressive experience in the health insurance industry and/or healthcare fraud investigations **Preferred** + ... prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. +...in Financial Analysis in an acute care hospital or health insurance setting + 1 year in… more
- Delta Air Lines, Inc. (Atlanta, GA)
- …in Access, Excel, MS Office suite of products, andSAP. + Ability to use Insurance Carrier/TPA data and claims managementsystems to analyze claim data. + ... Understanding of technical claims procedures, medical protocols andInsurance Industry Best...areeligible for 2-weeks of paid parental leave + Comprehensive health benefitsincluding medical , dental, vision, short/long term… more