- Trustmark (Atlanta, GA)
- …the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner ... in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments.… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...member PHI / HIPAA information + This is a remote position\#LI- Remote **Scheduled Weekly Hours** 40 **Pay… more
- Merck (Atlanta, GA)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages ... questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific Congress Support, and… more
- Zurich NA (Atlanta, GA)
- …public company Director 's and Officer's (D&O), Fiduciary and transactional risk claims of moderate to high value and complexity. The ideal candidate will have ... Legal Claims Professional - Public D&O 119736 At Zurich...AM - Addison, AM - Atlanta, AM - Parsippany Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered:… more
- EPAM Systems (Atlanta, GA)
- **This Remote Position Cannot be Performed in New York City.** You are a natural leader and a proven operator at the most senior levels of clients in the insurance ... - go-to-market, sales, engagement delivery and practice development. As a **Managing Director - Insurance Advisory** , you will lead the demand generation, pursuit,… more
- Prime Therapeutics (Atlanta, GA)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Director Account Management, PACE - Remote **Job Description** + Owns overall ... Management Centers (CMC) and Shared Services, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis… more
- Takeda Pharmaceuticals (Atlanta, GA)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...around the world. This position is currently classified as " remote " in accordance with Takeda's Hybrid and Remote… more
- Two95 International Inc. (Atlanta, GA)
- Job Title: Director , Health Plan Analytics Job type : Remote Work Type : 6+ Months Contract with extension Rate : $Market /Hour Requirements Position Summary: As ... the Director of Analytics, you will lead a team of...including but not limited to enrollment, finance, call center, claims , Case Management and Utilization Management * 5+ years… more
- Caris Life Sciences (GA)
- **Position Summary** The Director , Market Access Medical Policy is the expert in Caris Life Science Products and their clinical application for the Market Access ... needs to the internal clinical development team in order to improve product claims to obtain payer coverage. + Assist in collaborative efforts on health economic… more
- Molina Healthcare (Augusta, GA)
- …and other end users for operational and strategic analysis. **Knowledge/Skills/Abilities** The Director of Reporting & Analytics is a key leader within the ... BI_** + **_Clinic Systems experience - CCA_** + **_Experience with CM, UM, Claims , or Authorizations_** To all current Molina employees: If you are interested in… more
- US Foods (Fairburn, GA)
- …technical and regulatory HSE guidance, as well as responds to issues. This position is remote with up to 70% travel in the Southeast region of the United States. ... interfaces and collaborates with leaders; Legal, HR, Risk Management/ Claims Specialists; Operations leadership. **External:** Key HSE Vendors, Outside Counsel,… more
- United Therapeutics (Atlanta, GA)
- …the pharmaceutical and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code, the Sunshine ... Compliance departments related to the Food Drug and Cosmetic Act, the False Claims Act, Anti-Kickback Statute, the Sunshine Act and other healthcare related laws and… more
- Molina Healthcare (GA)
- …* Provides assessments and business rules to Corporate Configuration for COB tables and Claims edits logic in the QNXT system as well as maintenance to the internal ... Payment Integrity Tracking databases. * Ensures CMS and state regulatory requirements are met, for Pre-pay Edits, Overpayment Recovery, COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational… more
- Molina Healthcare (GA)
- …deliver effective customer service for all service needs including benefits, claims , billing inquiries, service requests, suggestions and complaints. Directly and ... through team members resolves both member and provider inquiries and complaints fairly and effectively. Provides direction and coordination to deliver accurate product and service information to members and providers, and identifies opportunities to increase… more
- Western Digital (Atlanta, GA)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... requirements. + Insure the proper and efficient handling of claims as they relate to workers' compensation insurance requirements....to be performed in California, Colorado, New York or remote jobs that can be performed in California, Colorado… more
- HomeSafe Alliance (Atlanta, GA)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… more
- Celestica (Atlanta, GA)
- …ID: 124191 Region: Americas Country: USA State/Province: New Hampshire City: Remote Employee US **General Overview** **Functional Area:** Supply Chain Management ... (SCM) **Career Stream:** Supply Chain Management (SCM) **Role:** Director 1 (DR1) **Job Title:** Director , Strategic...ensure capacity is installed as needed. + Supports E&O claims , shortage management and follow up escalations with customers… more
- Humana (Atlanta, GA)
- …The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Prime Therapeutics (Atlanta, GA)
- …decision we make. **Job Posting Title** Manager, Reporting & Analytics - Remote **Job Description** The Manager, Reporting and Analytics is responsible for ... + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data...to adjust focus **Reporting Structure** + Reports to a Director or Sr Director in the Operations,… more
- Prime Therapeutics (Atlanta, GA)
- …we make. **Job Posting Title** Senior Business Integration Consultant - Remote **Job Description** The Senior Business Integration Consultant is responsible for ... efforts + Proficiency in one or more of the following areas: claims , eligibility, prior authorization, accumulators, and/or benefits + Previous PBM or healthcare… more