- Molina Healthcare (Atlanta, GA)
- …Operations teams . Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... SKILLS & ABILITIES: . 2-5 years of experience in medical claims processing, research , or a related field . Demonstrates familiarity in a variety… more
- CAI (Atlanta, GA)
- …claims and appeals in compliance with regulatory standards, while performing claims research , authorization lookups, and maintaining case assignments. **Job ... claims and appeals in compliance with regulatory standards, while performing claims research , authorization lookups, and maintaining case assignments. This is… more
- Molina Healthcare (Atlanta, GA)
- …processing issues + Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... cross functionally across multiple business areas. **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing… more
- Molina Healthcare (Atlanta, GA)
- …+ Must have experience in research , review and audits for adjudication rates of claims + Must be able to work in cross functional teams + Must have experience ... accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes… more
- Elevance Health (Atlanta, GA)
- **Title: Grievance/Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of ... our PulsePoint locations. The **Grievance/Appeals Analyst I** is an entry level position in the...with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear,… more
- Sumitomo Pharma (Atlanta, GA)
- …and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into ... assets, and in-house advanced technology capabilities, we aim to accelerate discovery, research , and development to bring novel therapies to patients sooner. For… more
- Evolent (Atlanta, GA)
- …Stay for the culture. **What You'll Be Doing:** **Job Posting: Senior Analyst , Performance Analytics** **Location: Remote** Evolent is seeking a Senior Analyst ... with a quantitative major (eg actuarial, statistics, biostatistics, operations research , mathematics, economics) or healthcare major (health administration, epidemiology,… more
- Elevance Health (Atlanta, GA)
- **Business Information Analyst Sr. - Cost of Care** **Location:** This position will work a hybrid model (remote and in office 1 - 2 days per week). Candidates must ... 50 miles of one of Elevance's Pulse Point locations. **The Business Information Analyst Sr. - Cost of Care** is responsible for providing utilization management… more
- Molina Healthcare (Atlanta, GA)
- …ability to work independently, self-navigate organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, ... and existing health plans. + Completes analysis on retroactive claims reports + Pre and post validation of complex...Requires assistance with schema from Tech resource or Lead Analyst . + Writes Requirements for BRDs/FRDs and Reports. +… more
- Prime Therapeutics (Atlanta, GA)
- …our passion and drives every decision we make. **Job Posting Title** Health Data Analyst Sr- REMOTE **Job Description** The Senior Health Data Analyst provides ... **Additional Qualifications** + Advanced troubleshooting skills, including in-depth client data research , which may involve research and drivers of utilization;… more
- Prime Therapeutics (Atlanta, GA)
- …program manuals are effectively followed and/or maintained. Works independently to research and resolve regulatory inquiries/complaints related to claims , ... and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Regulatory Complaints & Inquires) - Remote **Job Description** The Regulatory… more
- Regions Bank (Atlanta, GA)
- …section of the system. **Job Description:** At Regions, the Enterprise Risk Testing Analyst is a second line of defense risk management function that ensures the ... to mentor and train junior associates + Ability to research , analyze data, and derive facts + Ability to...skills + Strong work ethic and self-motivation + This analyst will serve as Fraud subject matter expert in… more
- Elevance Health (Atlanta, GA)
- **Provider Contract/CofC Analyst Sr.** **Location:** This position will work a hybrid model (remote and in-office, 1 - 2 days per week). Candidates must live within ... miles of one of Elevance's Pulse Point locations. The **Provider Contract/Cost of Care Analyst Sr.** is responsible for analytical support to the Cost of Care and/or… more
- Molina Healthcare (Atlanta, GA)
- **Job Description** **Job Summary** The Sr Analyst , Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs ... to suport Molina's Prospective and Retrospective Interventions. Assist with research , development,and completion of special projects. **Knowledge/Skills/Abilities** + Assist… more
- Molina Healthcare (Atlanta, GA)
- **Job Description** **Job Summary** The Sr. Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... and Identifying targeted Interventions and tracking outcome. Assist with research , development, and completion of special performance improvement projects.… more
- Bank of America (Kennesaw, GA)
- Fraud Analytics and Innovation Senior Analyst Newark, Delaware;Plano, Texas; Richmond, Virginia; Fort Worth, Texas; New York, New York; Boston, Massachusetts; ... in managing competing priorities **Desired Qualifications:** + Fraud and/or Claims background with focus on Account Takeover a plus...+ Data and Trend Analysis + Innovative Thinking + Research **_It is unlawful in Massachusetts to require or… more
- Bank of America (Kennesaw, GA)
- Fraud Analytics and Innovation Senior Analyst Newark, Delaware;Plano, Texas; Richmond, Virginia; Fort Worth, Texas; New York, New York; Boston, Massachusetts; ... degree in a quantitative discipline such as mathematics, statistics, operations research , finance, or business ▪ Advanced analytical and quantitative skills with… more
- Highmark Health (Atlanta, GA)
- …subject matter expert in strategy development for new strategic programs. + Research claims processing problems, perform initial problem identification and ... effectively to explain technical benefits, application of medical policy, and claims processing capabilities and functionality. + Work independently or a team… more
- Molina Healthcare (Atlanta, GA)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... of assigned reports, document reporting processes and procedures. + Assist with research , development and completion of special projects as requested by various… more
- Molina Healthcare (Atlanta, GA)
- …other end users for operational and strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** + Performs research and analyses on a variety of topics related to the overall ... audits, compliance, recoveries, coordination with other departments. + Consolidates research and analyses into summarized findings and may develop recommendations… more