• Adjudicator, Provider Claims (LTSS Call Center)

    Molina Healthcare (GA)
    …as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as ... required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina… more
    Molina Healthcare (08/27/25)
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  • Business Architect Sr - Claims Systems

    Elevance Health (Atlanta, GA)
    …& CIW; WEBSTRAT; Authorization Overwrite Tool (AO Tool) .Net UI; Claims Workstation Pega UI. + Have sound claims process and data knowledge including: Claims Train ... data, CAST Train data; CAST Lights On mgmt., E2E claim lifecycle Vetting; FICR; MGCT# Post adjudication; CPEC-Claims Payment Extract and Capitation; CIFT, CFE; GBD IT Pre/Post-Adjudication; COPS; UM MATCH LOGIC; PROVIDER/PRICING CONFIG utilization. + Data &… more
    Elevance Health (08/21/25)
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  • Lead Product Manager, Next Best Action Decision…

    Humana (Atlanta, GA)
    …Qualifications** + Experience with NBA or personalization platforms such as PEGA , Salesforce Interaction Studio, Adobe Journey Optimizer, or similar + Familiarity ... with healthcare regulations (eg, HIPAA) and responsible data usage practices. + Experience working in highly regulated industries or with enterprise AI governance frameworks + Master's degree **Additional Information** **This role is a 100% remote role… more
    Humana (08/20/25)
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  • Sr. IT Principal Architect- Remote

    Prime Therapeutics (Atlanta, GA)
    …SAS + Experience with industry models and standards (HL7, FHIR, NCPDP, Pega Foundation for Healthcare, Salesforce Health Cloud) + Experience working with regulatory ... compliance requirements (HIPAA and/or PCI) + Previous experience in PBM / health care industry + Strong experience with software development life cycle and project management principles + In-depth knowledge of two or more architectural domains (application,… more
    Prime Therapeutics (08/14/25)
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  • Senior Architect - Cloud

    Highmark Health (Atlanta, GA)
    …+ Data Warehousing + COBAL + Visual Basic + C + C++ SAS + Java/JavaScript Framework + PEGA + CSS3 + Mobile + JSON + Cognos + Hadoop + SQL + J2EE + HTML5/XML + ... Waterfall + Agile **Language (other than English)** None **Travel Requirement** 0% -25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-Based Teaches / trains others regularly Frequently Travel regularly from the office to various… more
    Highmark Health (07/22/25)
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