- 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)
- …with disabilities. If you believe you need a reasonable accommodation, please send an email to ###@aig.com . Functional Area: CP - Compliance AIG Claims , Inc. ... Director of Claim Regulatory Compliance Who we are American International Group, Inc....Claim Legal. + Align and strengthen controls for AIG Claims to ensure consistency and effective best practices. +… more
- Zurich NA (Atlanta, GA)
- …motions to dismiss, and other legal filings + Maintain accurate and up-to-date claims documentation, ensuring compliance with best practices for high-complexity ... AVP, Medical Bill Review Litigation 119916 Zurich Insurance is seeking an....Line of Business. + Develop strategies for resolving complex claims , ensuring proper and timely reserving. + Work with… more
- Zurich NA (Atlanta, GA)
- …include:** + Updating claims file by accurately capturing and updating claims data/information in compliance with best practices for personal or commercial ... as appropriate. + Establishing timely reserves and perform ongoing review throughout claims cycle within authority limit...the best interests of the insured. + Ensuring legal compliance by following state and federal laws and regulations… 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
- ABM Industries (Atlanta, GA)
- …TPA . Play a strategic role in telephonic claim reviews, directing the strategy . Review all new claims reported to ensure appropriate assignment to TPA . ... **Overview** The objective for the ** Claims Associate:** To mitigate financial exposures and ensure cost-effective claims resolution through collaboration with… 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
- Prime Therapeutics (Atlanta, GA)
- … claims , educating Prime's network pharmacies and driving contract compliance , and supporting downstream claim corrections and eliminate potential waste. ... with pharmacies to drive timely and accurate documentation receipt and review + Analyze pharmacy claims to identify those at the highest risk for error; utilize… more
- Ryder System (Atlanta, GA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking HERE. (https://ryder.com/job-applicant-privacy-policy)\_ **SUMMARY** This position handles small ... to medium 3rd party property damage and cargo claims under Ryder's self-insured, self-administered liability program. **ESSENTIAL FUNCTIONS** Investigates, evaluate… 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
- 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
- Travelers Insurance Company (Atlanta, GA)
- …serious and complex Life Science medical products, clinical trial and pharmaceutical bodily injury claims , as well as General Liability Coverage B claims and E&O ... reserving, litigation management, negotiation, and resolution) including maintaining full compliance with internal and external quality standards and state specific… 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