- Pacer Staffing (Atlanta, GA)
- …and track timeliness of retrospective claims reviews to ensure compliance with required timelines. Identify questionable review decisions and escalate ... and supports both non-clinical and clinical staff on coding and retrospective medical claims review processes. Key Responsibilities: Perform claims coding… more
- MultiPlan (Atlanta, GA)
- …coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes. 4. Lookup and review medical claims in payer system to determine methods of payment and ... bright people come to shine! JOB SUMMARY: This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …HEDIS Clinical Measurement and Improvement Lead and other Company personnel to review medical records. The HEDIS Nurse Abstractor will abstract pertinent medical ... into a specified database to support HEDIS reporting. Daily Activities include review and abstraction of medical records, electronic data entry into project specific… more
- Prestige Staffing (Atlanta, GA)
- …bills for accuracy and completeness and obtain any missing information Prepare, review , and transmit claims using billing software, including electronic and ... guidelines, including HMO/PPO, Medicare, and state Medicaid Follow up on unpaid claims within standard billing cycle timeframe Check each insurance payment for… more
- MultiPlan (Atlanta, GA)
- …and provides suggestions for process efficiencies. Uses independent decision-making skills to review claims after business hours to meet deadlines. Apply ... as well as to monitor bills for accuracy and compliance . JOB ROLES AND RESPONSIBILITIES: Review and...national coding standards and regulations to claims billed. Research and review individual … more
- MultiPlan (Atlanta, GA)
- …for the electronic setup, testing and go-live of IT projects that involve Client Claims Processing. These claims may be received either via EDI (Electronic Data ... and to customize how they access/utilize MultiPlan Products using EDI and Web Services claims processing workflows. It includes but is not limited to the below *… more
- Northeast Georgia Health System, Inc (Dawsonville, GA)
- …treatment procedures following departmental policies and procedures and in compliance with third party payers guidelines. Accomplishes good clinical outcomes ... Rehabilitation Institute. The Athletic trainer is responsible to fill initial insurance injury claims to school accidental policy. The AT is to be the resource to… more
- MultiPlan (Atlanta, GA)
- …contribute to the Payment Integrity Reporting and Analytics ecosystem.2. Understand claims flow, savings identification, appeals processing, and fraud, waste, and ... to adapt them to new requirements and improve performance.6. Perform Technical Review of requirements, Analyze source data and provide gap analysis.7. Coordinate… more
- MultiPlan (Atlanta, GA)
- …fully prepares the cases for the Paralegals to successfully negotiate the liability claims . This role requires the incumbent be confident on the phone and ... members, and personal injury attorneys. JOB ROLES AND RESPONSIBILITIES: 1. Review , identify, and develop subrogation opportunities by gathering missing information… more
- Axis (Alpharetta, GA)
- …upon request for candidates taking part in the selection process. AXIS Capital Claims Compliance Specialist, Claims Shared Services- Job Description AXIS ... player with a can-do mindset focused on continuous improvement and will support claims compliance objectives and strategies in partnership with AXIS North… more
- AIG (Atlanta, GA)
- Claim Compliance Reviewer Join us as a Claims Compliance Reviewer to make more of your specialist expertise and experience. Make your mark in ... claim adjudication or claim operations experience for multi-line commercial claims . Claim Audit or file review experience...multi-line commercial claims . Claim Audit or file review experience is desirable. + Knowledge of key regulatory… more
- Sedgwick (Atlanta, GA)
- …reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... the authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated claims , serious vocational rehabilitation … more
- Sedgwick (Atlanta, GA)
- …$300,000). + Interprets policy and client guidelines on personal and commercial lines claims to ensure compliance . + Guides field colleagues on revisions as ... years at an advanced technical level as a file reviewer of personal and commercial claims , or...experience required. **Skills & Knowledge** + Strong knowledge of claims handling and file review practices and… more
- AIG (Atlanta, GA)
- …and leading efforts on various Global Claim initiatives. You will have oversight of Claims Compliance activities across the Globe, acting as the primary liaison ... between Enterprise Risk Management (ERM), Internal Audit Group (IAG), Compliance , External Auditors and the Claims organization. How you will create an impact +… more
- Travelers Insurance Company (Atlanta, GA)
- …This position is responsible for reviewing outside counsel's invoices for compliance with Travelers' Retention and Billing Policies, best practices and ... ensure charges are otherwise reasonable. Collaborates with Travelers colleagues managing claims or matters and interacts with outside counsel regarding changes to… more
- Elevance Health (Atlanta, GA)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and...control. + Review and conducts analysis of claims and medical records prior to payment. Researches new… more
- Highmark Health (Atlanta, GA)
- …+ Knowledge of operating systems specific to claim processing. + Ability to review claims and analyze critical data. + Reading benefits, investigating edits ... reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims . Determines… more
- AIG (Atlanta, GA)
- …needed and provide advice to staff to maximize recovery results or reduce expenses. + Review , vet, and publish reports for claims management as well as insured's ... as a Salvage Lead to grow your experience in Claims . Make your mark in Claims Our...of the salvage recovery specialists. + Manage performance and compliance with established SLAs. Monitors and controls case development… more
- AIG (Atlanta, GA)
- …the way we help customers to manage risk. Join us as a Principal Claims Investigator to play your part in that transformation. It's an opportunity to grow ... valued member of the team. Make your mark in Claims Our Claims teams are the proven...to include analyzing facts on issues in question, thorough review of interviews and statements of witnesses, employers, claimants… more
- UMB Bank (Atlanta, GA)
- …customer experience. + Review and decide high-value and complex card fraud claims . + Prepare regular reports on card fraud claims activity, including key ... **Duties & Responsibilities** The Manager, Card Fraud Claims , will oversee and manage the UMB card...Develop and implement tests and audits; monitor and ensure compliance with standards, policies, and procedures. + Work closely… more
