- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** Aetna is recruiting for a Senior Manager, Actuarial who will support the Medicare Network. They will work ... this important line of business. This is an entirely Medicare focused role surrounding delivering on our overarching ...Medicare focused role surrounding delivering on our overarching Medicare network strategy. **You will make an impact by:**… more
- Humana (Atlanta, GA)
- …situations or data requires an in-depth evaluation of variable factors. The Group Medicare Senior Data and Reporting Professional integrates data from multiple ... first** An exciting opportunity exists to join Humana's Group Medicare Underwriter team as a Senior Data...Humana's Group Medicare Underwriter team as a Senior Data and Reporting Professional. This position generates ad… more
- Molina Healthcare (Columbus, GA)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... support executive decision-making. + Research and develop reports and analysis for senior management; effectively communicate results. + Assist in the preparation of… more
- Molina Healthcare (Atlanta, GA)
- …business analysis, task and workflow analysis. + Subject matter expert of Medicare and Healthcare enrollment 834 files. + Interpret customer business needs and ... translate them into application and operational requirements + Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as… more
- Molina Healthcare (Macon, GA)
- …License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare ... Administration, etc. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine). **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate.… more
- Molina Healthcare (Macon, GA)
- …**Job Summary** Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in ... development of MHI's business process improvement methodology and in the implementation of a business process improvement capability. **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for most complex process analysis, design, and simulation. + Requires highest… more
- CVS Health (Atlanta, GA)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This role requires a strong… more
- Elevance Health (Columbus, GA)
- ** Medicare Risk Adjustment Advanced Analytics Consultant** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Consultant** is responsible for employing advanced… more
- Molina Healthcare (Savannah, GA)
- …gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior individual contributor with the charter to build a focused CTM ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (Augusta, GA)
- …findings to management; Supports management with presenting results and recommendations to Senior Leadership and department staff. * Recommends new or updated job ... aids/, work flows, reporting, controls, staffing needs, process, and/or technology changes based on audit results. * Develops on-going oversight, data validation audits, Corrective Action Plans, and monitoring/tracking functions based on external regulatory… more