- 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
- Cognizant (Atlanta, GA)
- …established quality assurance instruments and standards + Verifying if the processed claims have all data updated accordance with accepted coverage guidelines, ... ** Claims Auditor** (remote) This is a remote position...+ High Attention to detail + High Level of Integrity and Ethical Behavior **Salary and Other Compensation:** Applications… 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
- Axis (Alpharetta, GA)
- …insurance and global reinsurance. The Management Liability team is an engaging team handling claims in a variety of financial lines. The strength of our team is ... with a team to investigate, analyze, and evaluate Third Party Liability claims , ensuring proper coverage determinations. Expertise will be developed in Directors &… 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)
- … medical guidance across multiple enterprise transformation initiatives, including: + ** Medical Cost Management** + **HealthOS and enterprise data platforms** ... payer, managed care, or healthcare leadership preferred. + Experience advising medical cost management, utilization management, payment integrity , or provider… more
- Norstella (Atlanta, GA)
- …querying and analyzing a wide range of healthcare data sources, including claims , lab results, electronic medical records (EMR), and other real-world data ... Norstella's newest service offerings leveraging Norstella's unified Real World Data asset, a combination of claims , lab,...data into structured formats suitable for analysis, ensuring data quality and integrity throughout the process… more
- Molina Healthcare (Atlanta, GA)
- …criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data … more
- Elevance Health (Atlanta, GA)
- …and Experiences:** + **Operating room and/or auditing experience highly preferred.** + ** Medical claims review with prior health care fraud audit/investigation ... accommodation is granted as required by law. Carelon Payment Integrity is a proud member of the Elevance Health...impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and… more
- Norstella (Atlanta, GA)
- …the demand for Norstella's newest service offerings leveraging Norstella's unified Real World Data asset, NorstellaLinQ, a combination of claims , lab, SDOH and ... databases, ensuring data accuracy and quality. *Perform in-depth analyses on healthcare data sources, including claims , lab, EMR/EHR, and SDOH data , to… more
- Otsuka America Pharmaceutical Inc. (Atlanta, GA)
- …lead the R&D audit program, engage with regulatory authorities, and maintain clinical data integrity . The leader will be responsible for providing a compelling ... authorities, facilitating Clinical and PV inspections and addressing any findings. + ** Data Integrity :** Ensure the accuracy, consistency, and reliability of… more
- Elevance Health (Atlanta, GA)
- **Investigator Senior** **Supports the Payment Integrity line of business** **Hybrid 1** : This role requires associates to be in-office **1-2** days per week, ... employment, unless an accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon… more
- CDM Smith (Atlanta, GA)
- …claims . This role is critical in evaluating and analyzing financial data related to disaster-related claims , including property damage, business interruption, ... investigations to identify discrepancies, detect potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting,… more
- ZOLL Medical Corporation (Marietta, GA)
- …innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and ... as well as support activities to promote consistent use (Local Medical Education Programs, Tradeshows, clinical symposiums and conferences). Call points include:… more