- 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
- Zurich NA (Atlanta, GA)
- …for: + Documenting claims files by accurately capturing and updating claims data/information in compliance with best practices for commercial property ... escalating issues as appropriate. + Establishing timely reserves and performing ongoing review throughout claims cycle within authority limit by estimating 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
- Zurich NA (Atlanta, GA)
- …include:** + Updating claims file by accurately capturing and updating claims data/information in compliance with best practices for personal or commercial ... as appropriate. + Establishing timely reserves and perform ongoing review throughout claims cycle within authority limit...the best interests of the insured. + Ensuring legal compliance by following state and federal laws and regulations… 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
- AIG (Atlanta, GA)
- …reimagining the way we help customers to manage risk. Join us as a Dir Field Claims WC to play your part in that transformation. It's an opportunity to grow your ... valued member of the team. Make your mark in Claims Our Claims teams are the proven...customers and business partners. + Evaluates and measures operational compliance in concert with Claim Handling Guidelines in meeting… 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
- Zurich NA (Atlanta, GA)
- Claims Fraud and Investigations Manager 117871 Zurich North America is seeking a Claims Fraud and Investigations Manager to support our Zurich Claims ... your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct… more
- Sedgwick (Atlanta, GA)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Environmental Claims Specialist **Job Description Summary** To analyze complex or technically ... difficult environmental claims ; to provide resolution of highly complex nature and/or...Conducts or assigns full investigation to include complete coverage review and provides report of investigation pertaining to new… 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
- Zelis (Atlanta, GA)
- The Regulated Claims Settlement Coordinator supports the Claims Settlement Team through leading the review and response to disputed claims submitted ... through state and federal arbitration processes. The Regulated Claims Settlement Coordinator will be responsible for supporting Zelis' settlement offers and pricing… more
- Elevance Health (Atlanta, GA)
- …testing. + Validation of Formulary, Utilization Management & Drug List setup using Test Claims /Query testing. + Review & provide the testing timelines to be ... with cross functional teams that are globally dispersed. + Ensure the compliance with mandates and project implementations. + Provide the latest status and… more
- WTW (Atlanta, GA)
- …response to day-to-day service issues and questions (eligibility, carrier coverage and claims issues, compliance , etc.) + Preparing for and facilitating client ... strategies + Engaging subject matter experts to address client needs + Conducting review of client deliverables to ensure alignment to client objectives, leverage of… more
- WTW (Atlanta, GA)
- …to day to day service issues and questions (eligibility, carrier coverage and claims issues, compliance , etc.) + Preparation for client meetings (prepare agendas ... benefit plan analysis, design, cost savings and funding strategies + Conducting review of client deliverables to ensure alignment to client objectives, leverage of… more
- Humana (Atlanta, GA)
- …at the Inpatient level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national clinical ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Axis (Alpharetta, GA)
- …with various stakeholders and functional areas across AXIS, including underwriting, legal and compliance , actuarial, claims and IT. The ideal candidate for this ... enhancements. + Analyze state-specific regulatory requirements. + Work with legal and compliance , underwriting, actuarial, claims and operations staff to ensure… more
- Sedgwick (Atlanta, GA)
- …to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Technical Standards and Compliance Advisor **PRIMARY PURPOSE** **:** To ensure product quality and ... compliance with regulatory requirements and serve as a resource...consistent with these objectives. + Participates in round table review of claim strategy and makes recommendations that are… more