- Elevance Health (Atlanta, GA)
- ** Medical Claims Data Integrity Consultant** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). This role ... position is not eligible for current or future visa sponsorship._ The ** Medical Claims Data Integrity Consultant** (Business Information Developer… more
- Axis (Alpharetta, GA)
- …taking part in the selection process. About the Team AXIS is hiring a Senior Claims Specialist - EPL and Fiduciary Claims for its North America Claim Team. ... This role involves managing primary and excess claims for various AXIS policy forms. How does this... adjusters. Supporting underwriting and actuarial teams by maintaining data and analytics. Maintaining and developing relationships with senior… more
- Axis (Alpharetta, GA)
- …taking part in the selection process. About the Team AXIS is hiring a Claims Specialist - Primary Casualty for its North America Claim Team. This role involves ... managing primary claims for AXIS US Primary Casualty policies. How does...for a comprehensive and competitive benefits package which includes medical plans for you and your family, health and… more
- Waystar (Atlanta, GA)
- …Provided leadership on a team that designed, built, or used RCM Revenue Integrity products + Ability to interpret regulatory guidelines from CMS, Tricare, and ... Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data , and unparalleled client support to streamline workflows and improve… more
- CGI Technologies and Solutions, Inc. (Atlanta, GA)
- …review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity , and provider data management. * Leverage advanced analytics, ... review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity , and provider data management. Leverage advanced analytics,… more
- Elevance Health (Atlanta, GA)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Elevance Health (Atlanta, GA)
- …background. **Preferred Skills, Capabilities, and Experiences:** + Healthcare experience preferred; medical claims experience a plus. + Extensive hands-on ... **Application Architect Senior - Payment Integrity ** The **Application Architect Senior** creates architectural solutions that articulate the business context,… more
- Humana (Atlanta, GA)
- …and reporting. Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data . Maintain dashboards to communicate key ... trends to stakeholders. The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …Commercial third-party data assets, including Xponent Plantrak, DDD, HCOS, Claims Data , Specialty pharma, omnichannel data , SalesForce/Veeva ... **Job Summary** The Associate Director (AD), Commercial Data Management (CDM) within Data Enablement (DE) for Business Analysis (BA) is accountable for… more
- Elevance Health (Atlanta, GA)
- …scaling, and maintaining platforms for: + Medical Cost Management ( claims review, payment integrity , utilization management, risk adjustment). + Cost ... or healthcare technology company. + Experience in AI/ML, advanced analytics, and data platforms specific to medical cost optimization. + Strong knowledge… more