- Humana (Atlanta, GA)
- …a part of our caring community and help us put health first** The Claims Research & Resolution Representative 2 manages claims operations that involve customer ... contact, investigation, and settlement of claims for and against the organization. Approves all claim...forward to next round of interviews. This is a remote position \#LI- Remote **Scheduled Weekly Hours** 40… more
- CVS Health (Atlanta, GA)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. This is a full-time telework position.… more
- Humana (Atlanta, GA)
- …to drive improvements in quality and/or reductions in total cost of care + Scorecard creation and reconciliation of provider performance based on contractual ... Qualifications:** + Bachelor's Degree + 3-5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care +… more
- Marriott (Atlanta, GA)
- …as injured worker advocate assisting them to set goals and participate in their care . + Recommend referral to Associate Resource Line as needed. + Coordinate ... **Additional Information** Nurse CARE Manager ( CARE - Coordinated Action...jurisdiction. This position is responsive to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health… more
- Humana (Atlanta, GA)
- …hands-on experience with healthcare data such as medical, behavioral, pharmacy claims data, financial, social and demographic data; demonstrated innovative and ... experience in health insurance domain, familiarity with products, providers and claims processing. + Experience with Data Warehousing (Azure/SQL/Synapse), ETL (Azure… more
- Humana (Atlanta, GA)
- …more years of experience with CMS and/or AHCA compliance + 2 or more years Claims experience + 2 or more years Audit and/or Financial Recovery experience + SQL ... structure and design **Preferred Qualifications** + Direct experience working with Medicare claims + Working knowledge of CPT, ICD10 and HCPC + Provider contract… more
- Humana (Atlanta, GA)
- …to business & customers we serve using the latest in software technology? Our claims services team is best positioned in building modernized claims eco systems ... space lacking ongoing interruptions to protect member PHI / HIPAA information \#LI- Remote **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below… more
- Elevance Health (Atlanta, GA)
- …Practice Enablement Clinician** **Location** : This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles from one ... key strategic solutions that involve practice collaboration and enablement to improve member care quality and value. Serves as a strategic solution lead for Oncology… more
- Humana (Atlanta, GA)
- …**Preferred Qualifications** + Appeals/Utilization Review/Quality Management experience + Previous claims experience + Experience working with MCG guidelines + ... HCPCS, DRG use + Experience with TRICARE contracts and/or the military health care delivery system + Knowledge of TRICARE policies and programs + Bachelor's degree… more
- Humana (Atlanta, GA)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products...protect member PHI / HIPAA information This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- Humana (Atlanta, GA)
- …+ Intermediate to advanced experience in programming, analytical work, and with claims data. + Familiarity or prior experience with data governance and literacy. ... requirements and guidelines. **Additional Information** + **Travel** : None + **Workstyle:** Remote + **Core Workdays & Hours:** Typically, 8-5 pm Monday - Friday;… more
- Humana (Atlanta, GA)
- …volumes of data + Good understanding of healthcare data eg, member, provider, claims and clinical data + Experience and understanding of data governance practices ... **Location/Work Style:** Hybrid Office in Louisville, KY is preferred but open to Remote US as well **Why Humana?** At Humana, we know your well-being is… more
- Humana (Atlanta, GA)
- …for complex accounts + Experience analyzing a wide variety of health or claims related data **Additional Information** **Why Humana?** At Humana, we know your ... space lacking ongoing interruptions to protect member PHI / HIPAA information \#LI- Remote **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below… more