- 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
- Axis (Alpharetta, GA)
- …and Legal Bill Review , partnering with Vendor's in support of ensuring compliance with billing guidelines, as well as compliance with legal and ethical ... with key AXIS stakeholders + Collaborating and coordinating with Claims Quality Assurance and Compliance to implement...various software and insurance platforms and systems including Bill Review systems such as Legal Exchange and claims… 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
- 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
- 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
- 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
- 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
- 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
- Evolent (Atlanta, GA)
- …interact with coordinators who set up the appeal, physicians and other clinicians who review the appeal, the claims department to review provider ... procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, and a customer-centric approach,… 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
- Travelers Insurance Company (Alpharetta, GA)
- …Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to ... Under moderate supervision, fulfill Bond & Specialty Insurance (Bond) Claims mission by conducting thorough investigation, analysis, evaluation and disposition… more
- Oglethorpe Power (Tucker, GA)
- …vendor qualifications and monitoring vendor performance. + Assist in resolving any claims that may arise concerning vendor invoicing, performance, or other issues. + ... + Promote fair, ethical, and reasonable supply chain business principles. + Review Contract Terms. + Manage amendments of existing documents when language is… more