• Risk Adjustment Audit Operations Analyst

    Molina Healthcare (Augusta, GA)
    …+ Exposure to Databricks, Spark, or similar data platforms + Familiarity with Medicare Advantage or Medicaid programs + Awareness of CMS audit processes ... **Job Description** **Job Summary** The Junior Analyst will play a supporting role on the...senior analysts. + Document data sourcing steps, methodologies, and business rules to promote traceability and team learning. +… more
    Molina Healthcare (08/08/25)
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  • Analyst , Business Quality (Remote)

    Molina Healthcare (Macon, GA)
    …etc. **PREFERRED EXPERIENCE:** + SQL expertise + Excel expertise + Medicare , Medicaid , Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment ... **Job Description** **Job Summary** Assist business teams with developing requirements for major projects...+ Fields direct questions from Molina Operations Staff regarding business , technical and operations rules. + Develops technical solutions… more
    Molina Healthcare (08/24/25)
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  • Actuarial Analyst 2, General

    Humana (Atlanta, GA)
    …actuarial and business needs for specific product lines. The Actuarial Analyst 2, General work assignments are varied and frequently require interpretation and ... community and help us put health first** The Actuarial Analyst 2, General provides actuarial support across a broad...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
    Humana (08/13/25)
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  • Compliance and Reporting Analyst (State…

    State of Georgia (Fulton County, GA)
    …or one (1) year of experience required at the lower level Compliance Business Analyst 2 (RCP031) or position equivalent. Additional Information + Agency ... Compliance and Reporting Analyst (State Based Exchange) Georgia - Fulton -...Coordinate with division staff to collect required Centers for Medicare and Medicaid Services (CMS) required financial… more
    State of Georgia (08/08/25)
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  • Sr. Compliance Analyst - Remote

    Prime Therapeutics (Atlanta, GA)
    …a healthcare or PBM organization, or other highly regulated industry, including experience with Medicare , Medicaid , and the Affordable Care Act (ACA) + Must be ... and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance… more
    Prime Therapeutics (08/14/25)
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  • RFP Analyst

    Waystar (Atlanta, GA)
    …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... **ABOUT THIS POSITION** The RFP Analyst will own and coordinate the creation of...You'll Need** + Bachelor's degree in Communications, English, Marketing, Business Administration, or related field. + 2+ years' experience… more
    Waystar (07/23/25)
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  • Senior Analyst , Quality Management

    CVS Health (Atlanta, GA)
    …communicate to multiple internal and external stakeholders **Preferred Qualifications** * Medicaid and/or Medicare managed care experience **Education** * ... sound data presentation * Converts results of data analysis into meaningful business information to disseminate conclusions about the overall function of the… more
    CVS Health (08/24/25)
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  • Lead Analyst , Claims/ Regulatory…

    Molina Healthcare (Atlanta, GA)
    …experience on researching, presenting and documenting is required, + Experience with Medicare , Medicaid and Marketplace is required. + Medical coding experience ... data among operational and claims systems and application of business rules as they apply to each database. Validate...to be housed on databases and ensure adherence to business and system requirements of customers as it pertains… more
    Molina Healthcare (06/18/25)
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  • Senior Analyst , Special Investigative Unit

    CVS Health (Atlanta, GA)
    …+ Pharmacy Investigative experience + Marketplace Broker Investigative experience + Medicaid and Medicare experience **Education** + Bachelor's degree in ... tools, social media and internet research. + Ability to Travel for Business purposes. **Preferred Qualifications** + Certified Professional Coder (CPC), AHFI, CFE +… more
    CVS Health (08/24/25)
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  • Payment Integrity Program Manager - Health Plan

    Molina Healthcare (Atlanta, GA)
    …synthesize complex information. **PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid , and Marketplace lines of business . + Certified ... and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State...+ At least 7 years of experience as a Business Analyst or Program Manager in a… more
    Molina Healthcare (08/14/25)
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