- Molina Healthcare (Macon, GA)
- …overpayment recoveries in a managed care or payer environment. + In-depth knowledge of medical and hospital claims processing , including CPT/HCPCS, ICD, and ... requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role… more
- Humana (Atlanta, GA)
- …where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may be needed ... + Maintain knowledge of TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements **Use your skills to make an… more
- Walmart (Valdosta, GA)
- …ensuring parts are retained in accordance with warranty guidelines and creating and processing warranty claims to ensure proper credit is received in accordance ... interior walls floors doors and accessories eg bulkheads evaporator guards and remote controller operating transport refrigeration unit TRU in normal diagnostic and… more
- GuideOne Insurance (Atlanta, GA)
- …that leverage large language models (LLMs), Generative AI, and natural language processing (NLP) to enhance customer and agent experiences. This includes developing ... smart, impactful tools that make a real difference. Responsibilities: Multimodal Data Processing and Automation + Ingest and preprocess diverse file types: PDFs,… more
- Humana (Atlanta, GA)
- …Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing , prior authorization, formulary management and clinical ... first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes… more
- Public Consulting Group (Atlanta, GA)
- …+ Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + ... workers for work authorization, including H-1B sponsorship** . \#LI \#LI-LR1 \#LI- remote **Compensation:** Compensation for roles at Public Consulting Group varies… more
- Guardian Life (Atlanta, GA)
- …AI. + Apply AI/ML to unstructured data sources such as insurance contracts, medical records, sales notes, and customer service logs. + Deliver solutions that enhance ... underwriting risk assessment, claims auto-adjudication, and customer servicing. Operational Excellence + Establish scalable processes, frameworks, and governance… more
- Stantec (Savannah, GA)
- …applicants to be based in our one of the office locations listed, or remote in Savannah, GA to support projects in the surrounding areas. Your Key Responsibilities ... the project. - Evaluate, advise on and assist in resolving disputes and claims - Traditionally reports to project executive or principal. Your Capabilities and… more