- 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)
- …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
- Zurich NA (Atlanta, GA)
- …Responsibilities:** + Document claims file by accurately capturing and updating claims data/information in compliance with best practices for high exposure ... as appropriate. + Establish timely reserves and perform ongoing review throughout claims cycle within authority limit...the best interests of the insured. + Ensure legal compliance by following state and federal laws and regulations… 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
- CVS Health (Atlanta, GA)
- …thoroughness and accuracy of investigations aimed at preventing payment of fraudulent claims by insured individuals, providers, claimants, etc. + Analyze and prepare ... cases for clinical and legal review , ensuring all documentation meets required standards. + Document...federal, state, and local law enforcement agencies to ensure compliance and support the prosecution of healthcare fraud and… more
- Sedgwick (Atlanta, GA)
- …various specialized services such as subrogation, fraud evaluation or case management review to resolve claims . + Establishes and maintains effective ... client requirements; works constructively with client and legal representatives to resolve claims . + Ensures compliance and best possible outcomes by minimizing… 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
- 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
- Guardian Life (Atlanta, GA)
- …The FML Claims Case Manager II recognizes the importance of compliance and regulatory adherence, customer service, and the financial social and psychosocial ... medical or rehab evaluation **Partnering** + Proactively communicates with client companies to review case management and claims experience + Consult with Risk… 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
- Delta Air Lines, Inc. (Atlanta, GA)
- …workflows are effective and service goals are being achieved. + Ensure compliance with company's claims management best practices, performance standards, ... determining current claim management strategies for benefit trends, regulatory compliance and policy equity for all domestic employees. +...for all domestic employees. + Monitor disability and leave claims from the beginning to the end by ensuring… more
- Highmark Health (Atlanta, GA)
- …quality goals + Actively participates in bi-annual multi-disciplinary medical underwriting guideline review workgroup. + 5. Risk and Compliance + Understands and ... assessing the group's renewal rates and impact on future potential medical claims . And if applicable, completes referral requests for case/care management or… more
- United Therapeutics (Atlanta, GA)
- …letters, health economic related materials, social media posts + Assist with the review , drafting and/or revising of compliance related policies and standard ... and other orphan diseases. **How you'll contribute** The Senior Counsel, Regulatory & Compliance role is responsible for a broad range of legal, regulatory and … more
- Amentum (Atlanta, GA)
- …anticipation of a Business Development Task Order, Amentum is hiring a **Contracts/ Compliance Manager** . In addition to all the necessary qualifications of a ... A key member of the program management team, the Contracts Compliance Manager operates within a highly collaborative, cross-functional organization overseeing the… more
- PSSI (Atlanta, GA)
- …domain, including claims trends, safety issues, and injury patterns. + ** Claims Monitoring:** Track and review workers' compensation claims to ... compensation claims . Prepare periodic reports for senior management. + ** Compliance Oversight:** Ensure compliance with federal, state, and local regulations… more
- State of Georgia (Fulton County, GA)
- …Specific, additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT ... to whether proper diagnostic and procedure codes were used in submitting claims to the Georgia Medicaid Program. Maintains a comprehensive understanding of current… more
- Western Digital (Atlanta, GA)
- …insurance claims control function at all locations. + Continue review of existing safety, environment, loss prevention, employment and security programs as ... insured and uninsured, including recoveries and reserves set by insurance companies. + Review leases, contracts, sales and finance agreements in order to ascertain … more