• Senior Claims Specialist

    Axis (Alpharetta, GA)
    …available upon request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims...Assurance - Comply with best practices measured by monthly Quality Assurance and Management Initiated Audit scores… more
    Axis (06/25/25)
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  • Healthcare Process Risk Senior Associate…

    Grant Thornton (Atlanta, GA)
    As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... include but are not limited to co-sourced and outsourced internal audit , internal control assessments, enterprise risk management program assessments, tests of… more
    Grant Thornton (08/22/25)
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  • Claims Manager - Global Claims

    CRC Insurance Services, Inc. (GA)
    …5. Train claims staff on new policies or procedures. 6. Oversee and audit claims process ensuring proper documentation was created in the system and/or ... Coordinators reviewing allocation of staff to ensure productivity and quality standards meet or exceed expected goals. 4. Review,...order to provide account loss ratios and claims history to senior management.… more
    CRC Insurance Services, Inc. (08/20/25)
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  • Senior Reporting Analyst

    CVS Health (Atlanta, GA)
    …an exciting opportunity to join our PBM Customer Reporting group as a Senior Reporting Analyst within our Compliance Pharmacy Payments. CVS Health strives to ... a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and...reporting using SQL and SAS. You will continuously improve quality controls and accuracy of reported data, looking for… more
    CVS Health (08/16/25)
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  • Executive Director of R&D Global Quality

    Otsuka America Pharmaceutical Inc. (Atlanta, GA)
    …Summary** We are seeking an experienced and dynamic Executive Director of R&D Global Quality to join our team. This pivotal role will be responsible for leading a ... global team focused on R&D Quality . This global role includes direct reports in the...oversee clinical trial and submission support, lead the R&D audit program, engage with regulatory authorities, and maintain clinical… more
    Otsuka America Pharmaceutical Inc. (08/14/25)
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  • Claim Governance and Control Lead

    AIG (Atlanta, GA)
    …Management (ERM), Internal Audit Group (IAG), Compliance, External Auditors and the Claims organization. How you will create an impact + Drive a strong control ... ensure necessary changes to controls are made based upon audit feedback (self-audits, internal audits, PwC audits). + Drive...plus. + Ability to influence and collaborate effectively with senior managers across claims . + Excellent written… more
    AIG (08/18/25)
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  • Human Resources Manager

    Sunrise Senior Living (Acworth, GA)
    **When you join Sunrise Senior Living, you will be able to use your unique skills to empower residents to live longer, healthier, and happier lives. Not only will ... and shed light on meaningful ways to serve, grow, and shine together.** **Sunrise Senior Living was again certified as a Great Place to Work(R) by Activated… more
    Sunrise Senior Living (08/02/25)
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  • Director, Operational Oversight (Medicare/Duals)…

    Molina Healthcare (Augusta, GA)
    …and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer ... grievances, and member communications. * Exposure to downstream domains: Enrollment, Claims , Pharmacy/PDE, Network, Stars quality metrics. * Proven record… more
    Molina Healthcare (08/19/25)
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  • Sr Compliance RCM & Coding Auditor

    Humana (Atlanta, GA)
    …a part of our caring community and help us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about ... 340+ senior focused primary care centers in 15 states. The...that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across… more
    Humana (08/23/25)
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  • SIU Specialist - Pharmacy Tech - Remote in…

    Prime Therapeutics (Atlanta, GA)
    …in accordance with procedures or to present to management to recommend for audit or investigation. Serves as a corporate resource on fraud, waste and abuse ... Provide backup support to team members (SIU Coordinator and Senior SIU Specialist) in the performance of job duties...Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the… more
    Prime Therapeutics (06/24/25)
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