- Molina Healthcare (Macon, GA)
- …Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation pertinent to investigations. + Detects ... Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts… more
- Actalent (Atlanta, GA)
- …coordinators, case managers, SNF/Rehab care coordinators, members, providers, Customer Service, Claims , Contracts and Benefits - Appeals, and Risk Management. ... Essential Skills + Registered Nurse (RN) with a valid license in GA or Compact. + 1+ years of experience in Utilization Management (UM). + 1+ years of experience in managed care. Additional Skills & Qualifications + Experience with MCG or Interqual is… more
- CVS Health (Atlanta, GA)
- …- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which ... including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management plan. -… more
- Molina Healthcare (Atlanta, GA)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts… more
- HUB International (Atlanta, GA)
- …and employee benefits brokers, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management ... and/or assists Communications with Benefit Summaries. + Assists clients with escalated claims , billing, and/or policy issues. Documents all in Benefit Point. +… more
- Elevance Health (Atlanta, GA)
- …complex and chronic care needs by screening, assessing, stratifying risk , planning, implementing (care coordination), following up, transitioning (transitional ... care management treatment plans. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management… more
- Republic Finance, LLC (Lawrenceville, GA)
- …the success of the branch, including evaluating loan applications, performing risk analysis, making credit decisions, administering loan closings, and processing ... insurance claims . Your management abilities shine as you assist the Branch Manager with recruiting and training as well as developing and implementing plans to meet… more
- CVS Health (Atlanta, GA)
- …services to team member. + May assist in the research and resolution of claims payment issues - Supports the administration of the hospital care, case management and ... accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. + Protects the confidentiality… more
- Aflac (GA)
- …develop, enhance, and deliver actuarial and financial models that effectively evaluate risk . + Project Management - Basic Can effectively lead projects, including ... Modeling, and/or Experience Analysis/Management concepts; conducts fact gathering and claims analysis; reviews and analyzes statistical data, including morbidity,… more
- Elevance Health (Atlanta, GA)
- …be innovative and assess potential AI or predictive tools to assist in risk identification and/or scoring methods to guide pricing decisions preferred. + Small group ... statisticians and actuaries preferred. + Experience working with large health claims datasets or gathering datasets. Experience with evaluation of provider quality… more