- Cognizant (Atlanta, GA)
- ** Claims Quality Review ** ( remote ) This is a remote position open to any qualified applicant that lives in the United States. **Summary:** Our ... quality standards, processes and procedures and policies + Ensures the claims processing reps adhere to predetermined quality assurance standards and the… more
- Sedgwick (Atlanta, GA)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Adjuster - Workers Compensation ( Remote - Southeast State exp needed) ... best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing… more
- Cognizant (Atlanta, GA)
- ** Claims Process Executive ( remote )** **JOB PURPOSE:** Claim Processors will review claim submissions, verify information, adjudicate the claim as per claim ... the business requirements. **ESSENTIAL FUNCTIONS** : + Examining and entering basic claims for appropriateness of care and completeness of information in accordance… more
- Cognizant (Atlanta, GA)
- …and coverage guidelines and regulations + Experience in the analysis and processing of claims , utilization review / quality assurance procedures + Must be able ... to transform a variety of business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical** ** Claims … more
- 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...be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy and… more
- Sedgwick (Atlanta, GA)
- …+ Compiles reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, ... Financial Services & Insurance Team Leader - Liability | Remote **PRIMARY PURPOSE** : To supervise the operation of...authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated … more
- Molina Healthcare (Atlanta, GA)
- …care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk ... **Job Description** **Job Summary** The Analyst, Quality Analytics and Performance Improvement role will support...and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity… more
- Prime Therapeutics (Atlanta, GA)
- …requestors to resolve questions regarding requested software changes, and participate with Quality Assurance and UAT resources to review related test cases ... drives every decision we make. **Job Posting Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with an AI background?… more
- Prime Therapeutics (Atlanta, GA)
- …combined pharmacy and PBM experience to include: 1 year of work experience in claims processing in an operations, audit or quality assurance environment, and 1 ... decision we make. **Job Posting Title** Recovery & Resolution Analyst - Remote **Job Description** The Recovery & Resolution Analyst is responsible for recovering… more
- Molina Healthcare (Atlanta, GA)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... submitted, to ensure medical necessity and appropriate/accurate billing and claims processing. + Identifies and reports quality ...years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- CBRE (Atlanta, GA)
- Property Management Manager ( Remote ) Job ID 241052 Posted 06-Oct-2025 Service line GWS Segment Role type Full-time Areas of Interest Property Management Location(s) ... Remote - US - Remote - US...Vendor Management: Source, vet, and handle service providers, ensuring quality and cost-effectiveness. + Documentation: Maintain detailed records of… more
- Prime Therapeutics (Atlanta, GA)
- …every decision we make. **Job Posting Title** Data and Reporting Analyst Assoc- REMOTE **Job Description** The Associate Data & Reporting Analyst is responsible for ... of reporting requirements through intake and prioritization sessions + Recommend quality and system improvements by analyzing the data issues, maintaining and… more
- Prime Therapeutics (Atlanta, GA)
- …decision we make. **Job Posting Title** Deputy General Counsel, Litigation - REMOTE **Job Description** The Deputy General Counsel Litigation leads the company's ... + Select, manage, and evaluate external legal counsel to ensure high- quality representation + Oversee Prime's Records and Information Management (RIM) program,… more
- Prime Therapeutics (Atlanta, GA)
- …every decision we make. **Job Posting Title** Senior Strategy Consultant - Remote **Job Description** The Senior Strategy Consultant is responsible for the ... multiple projects simultaneously **Preferred Qualifications** + Experience with large sets of claims data + In-depth knowledge of PBM industry + Financial analyses… more
- Prime Therapeutics (Atlanta, GA)
- …every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance Analyst ... stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business partners… more
- Prime Therapeutics (Atlanta, GA)
- …decision we make. **Job Posting Title** Forecasting Principal - Finance - Remote **Job Description** The Treasury Analyst Principal is responsible for developing, ... Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions. **Responsibilities** + Develop, manage, and advance complex… more
- Bowman (Atlanta, GA)
- …reviewed by more senior staff to ensure application of sound techniques and principles. Review work produced by junior staff for quality assurance. **At the ... of values, various exhibits, partial and final liens. + Review , process, obtain approvals, code and accrue for subconsultant...that may arise as it relates to disputes, or claims + Act as liaison between operations and many… more
- Cardinal Health (Atlanta, GA)
- **_Hybrid or Remote Position Hours_** Monday - Friday, 8:00am - 4:30pm EST (or based on business need) **_What Contract and Billing contributes to Cardinal Health_** ... things done. **The Accounts Receivable Specialist is responsible for processing insurance claims and billing. They will work within the scope of responsibilities as… more
- Humana (Atlanta, GA)
- …you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in ... payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments....**Use your skills to make an impact** **WORK STYLE:** Remote /work at home. While this is a remote… more
- AECOM (Atlanta, GA)
- …in its East Region. This will be a hybrid position including a combination of both remote and in-office, and can be located in, but not be limited to: Atlanta, GA ... for engineering, construction, and other technical services. **Job Description:** + Review , draft, and negotiate contracts, and other legal documents relating to… more