- 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
- 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)
- …are reimagining the way we help customers to manage risk. Join us as a Claims Investigator to play your part in that transformation. It's an opportunity to grow your ... valued member of the team. Make your mark in Claims Investigation Our Claims teams are the...to include analyzing facts on issues in question, thorough review of interviews and statements of witnesses, employers, claimants… 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
- 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
- Guardian Life (Atlanta, GA)
- …superior customer service to all internal and external customers. This position will review claims for Short Term Disability and requires consistent and ... **Position Summary** The STD/Absence Claims Case Manager I (CM) is responsible for...preferred or other equivalent work experience. + Regulatory and Compliance experience is a plus + Ability to provide… 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
- The Coca-Cola Company (Atlanta, GA)
- …to substantiate potential claims and build scientific dossiers for new claims and ingredients to ensure regulatory compliance with different regulations. Key ... Global SRA Community . * Scientific Dossiers for New Claims and Ingredients: o Review scientific literature...ingredients o Support in building scientific dossiers for new claims and ingredients to ensure compliance with… more
- CVS Health (Atlanta, GA)
- …Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data is important. If this background describes ... Receivable Associate will be responsible for: Managing a high volume of medical claims that have denied by refuting the denials within payer guidelines through… more
- General Motors (Atlanta, GA)
- …You'll Do** + Completes onsite audits and electronic audits as assigned + Determines the compliance of these claims with the rules and policies + Constructs a ... and procedures as provided in the Dealer Sales and Service Agreement. This review may include dealership practices relative to sales incentive claims and… 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
- Sedgwick (Atlanta, GA)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Careworks Bill Review - Product Owner **PRIMARY PURPOSE** **:** Directs the independent bill ... review product for clients and external partners providing project...partners. **Market Analysis and Product Development** . Works with compliance to analyze changing market factors, including legal, competitive,… more
- Prime Therapeutics (Atlanta, GA)
- …passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Regulatory Compliants & Inquires) - Remote **Job Description** The ... Regulatory Inquiry & Complaints Senior Compliance Analyst assists in the implementation of Prime's compliance programs and may lead some initiatives within their… more