Hybrid Pharmacy Claims Auditor - High-Cost Drugs & DME
Elevance Health
Elevance Health is seeking a Pharmacy Auditor to join our Payment Integrity and Clinical Audit team in Georgia. The role focuses on screening and auditing high-cost drug, home infusion therapy, dialysis, and DME claims to ensure accurate billing and contract compliance, with hybrid in-office and remote work. The ideal candidate has a BS in Pharmacy, at least five years of pharmacy claim auditing experience, and an active Pharmacist license. #J-18808-Ljbffr Elevance Health
- Elevance Health is seeking a Pharmacy Auditor to join our Payment... ...and Clinical Audit team in a hybrid in‑office role. The candidate... ...professional and facility claims, focusing on high‑cost drugs, home infusion therapy, renal claims, and DME, and will leverage audit tools...ClaimsWork at office
- Pharmacy Auditor - Payment Integrity Complex and Clinical Audit Location... ...that per our policy on hybrid/virtual work, candidates not... ...screening, selecting, and auditing high cost drug (HCD), home infusion... ...durable medical equipment (DME) claims to ensure they are billed accurately...ClaimsContract workTemporary workWork at officeLocal area2 days per week1 day per week
$38.46 - $52.4 per hour
...outcomes and reduce the cost of providing patient care... ...The Inpatient Coding Auditor will be responsible for... ...is initiated before the claim is rebilled to the insurance... ...denials. Maintains a high degree of professional... ...business. We endeavor to maintain a drug-free workplace....ClaimsHourly payPermanent employmentWork at officeLocal areaImmediate startRemote workFlexible hoursDay shift- Uber Technologies is seeking a US Claims Advocate to investigate and manage auto insurance claims within the Uber ecosystem... ...to detail, and the ability to navigate a fast‑paced, high‑volume environment with a hybrid office schedule. #J-18808-Ljbffr Uber TechnologiesClaimsWork at office
$126.72k - $190.08k
...Actuary (Medicare Pharmacy Trend Analytics) - CarelonRx Hybrid: This role requires... ...outcomes, control costs, and enhance each member... ...and performs highly complex actuarial studies... ...Part D and Part B drug spend and trend... ...marketing, product design, claims, premium, and...ClaimsFull timeTemporary workWork experience placementWork at officeLocal areaFlexible hoursShift work2 days per week1 day per week$84k - $112k
...Cost Manager As a Cost Manager at Linesight, you will work with highly experienced, culturally diverse, and passionate teams nurturing... ...disputes/loss and expense claims with transparency Resolve any... ...This role will primarily be a hybrid schedule of onsite/remote to...ClaimsContract workRemote work$95.46k - $136.51k
...Our Team?Are you an experienced claims professional with deep... ...skillsWhy This Role?Work on complex, high-value claims that challenge... ...and family care leaveFlexible & hybrid work arrangementsFitness center... ...programs. RLI covers the cost for most programs and employees...ClaimsFull timeWork at officeLocal areaFlexible hours$75k - $95k
...Senior Auditor - Hybrid Ideal for audit professionals with approximately 3–5 years of experience. Lead audit fieldwork and contribute to... ...work of junior staff Collaborate with team members to ensure high-quality audit results Maintain strong communication with clients...Work at officeLocal areaRemote work- Carelon / Elevance Health in Atlanta, GA is seeking a professional for internal audit to conduct complex clinical claims auditing and investigation support aimed at detecting and preventing healthcare fraud, waste, and abuse. The role emphasizes risk-based audit planning...Claims
$86.56k - $155.81k
...Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and... ...note that per our policy on hybrid/virtual work, candidates not within... ...Related Group (DRG) paid claims. How you will make an impact... ...HACs). Suggests and develops high quality, high value, concept...ClaimsFull timeWork at officeLocal area$111.2k - $185.3k
...choices at the lowest cost. Founded and operated by... ...purchasing prescription drugs. The Clinical... ...ability to work in office/hybrid but may consider a well... ...Requirements:Doctorate in Pharmacy from an accredited college... ...data files, pharmacy claim utilization, and data visualization...ClaimsFull timeTemporary workWork experience placementWork at officeLocal areaRemote work$75k - $100k
...required. Summary of Position (hybrid): Assists in the preparation,... ...filing including specifications, claims, abstracts, drawings and... ..., prosecution and maintenance costs. 9. Other tasks and projects as... ...Work occasionally requires a high level of mental effort and stress...ClaimsTemporary workWork experience placementWork at officeLocal area$30 - $42 per hour
...increasing access, lowering costs, and improving quality... ...upon your Doctor of Pharmacy education to develop... ...protecting their confidential drug informationComply with... ...complete any manual claim formsPerform all... ...Protected Veteran - we highly value and are committed...ClaimsFull timeWork experience placementInternshipWork at officeLocal areaRelocation packageNight shift- ...in the office and remotely or hybrid. In this role, the ideal candidate... ...correspondence Process claim and/or perform data entry in... ...requirements include: High school diploma or equivalent... ...Opportunity Employer (EOE) and Drug Free Workplace. In compliance...ClaimsWork at officeRemote workNight shift
$60 - $70 per hour
...expertise to design and implement pharmacy programs, evaluate drug utilization, and support... ...safe, effective, and cost-conscious medication use.... ...medical information and pharmacy claims to identify gaps in care,... ...optimization. Maintain a high level of productivity,...ClaimsRemote jobContract workTemporary work$72k - $141k
...under broad authority to manage commercial claims of high complexity and exposure within the... ...accounts. This position offers a flexible, hybrid work schedule, requiring 2 days in a CNA... ...strategy accordingly. Effectively manages loss costs and claim expenses.Manages all types of...ClaimsFull timeWork experience placementWork at officeFlexible hours$129.3k - $177.8k
...analyses, and develop cost-effective solutions. This... ...trends, medical claims drivers, and the organization... ...ability to provide a high-speed DSL or cable modem... ...Requirements: To ensure Home or Hybrid Home/Office employees'... ..., hospice and retail pharmacy, CenterWell is focused...ClaimsFull timeTemporary workFor contractorsApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...member-centered, lasting pharmacy care. CarelonRx... ...Based Care model to drive Cost of Care savings by closing... ...materials. Resolves complex claims, benefit, and... ...~ Pharmacy background highly preferred. Job Level... ...Elevance Health operates in a Hybrid Workforce Strategy....ClaimsContract workTemporary workLocal area1 day per week
- ...Senior Auditor Employment Type: Full Time, Mid-level CGS is seeking a Senior Auditor... ...district legal staff by conducting medical claims data analysis, forensic investigations,... ...voluminous and complex. CGS brings motivated, highly skilled, and creative people together to...ClaimsFull timeRemote workFlexible hours
$70k - $95k
Workers' Compensation Specialist - Hybrid Location: Atlanta Metro Reports To: VP of HR Compensation... ...Owns end-to-end workers’ compensation claims management for an injury-prone EMS... ...insurers. Actively manage claim duration and costs. Lead return-to-work and light-duty...ClaimsFull time$19.01 - $23.72 per hour
...organization based in Atlanta is looking for a Pharmacy Technician. This role offers front... ...requests and ensuring compliance with drug benefit designs. The ideal candidate should have a high school diploma, experience in pharmacy claims, and excellent communication skills....ClaimsHourly pay- ...is seeking an individual contributor to manage commercial claims with moderate to high complexity. You will verify policy coverage, conduct investigations... ...customer service to insureds and claimants. This hybrid role requires strong analytical and investigative skills,...Claims
- ...a leading health services company, seeks a Clinical Provider Auditor II to evaluate fraud and abuse risks in claims and medical records, ensuring compliance with billing guidelines. This role supports hybrid in-office and remote collaboration within a dynamic healthcare...ClaimsWork at officeRemote work
- Performs complex clinical claims auditing and investigation support to detect and prevent healthcare fraud, waste, and abuse. Evaluates... ...Investigation Units on fraud This role is based in Atlanta, GA on a hybrid schedule. Local candidates benefit from being close to Carelon /...ClaimsWork at officeLocal areaRelocation package
- GenStar Insurance Services, LLC is seeking a Claims Executive to manage litigated and non-... ...to closure. The role emphasizes high-level claim handling, coverage analysis,... ...clients and management. The position is hybrid, based in multiple U.S. offices, including...Claims
$97.5k - $199.5k
...The AI Gigascale Construction Cost Senior Manager (OCI) provides end... ...Evaluate change orders and claims: pricing, entitlement, schedule... ...with executive-level judgment High ownership in ambiguous, fast-moving... ...health mandates, and/or drug testing requirements. Range...ClaimsContract workTemporary workFlexible hoursShift work$136.62k - $199.12k
...Principal Duties & Responsibilities-Handle claims proactively to achieve optimum payout... ...communitiesParental and family care leaveFlexible & hybrid work arrangementsFitness center discounts... ...educational programs. RLI covers the cost for most programs and employees typically...ClaimsFull timeWork at officeLocal area$130k - $160k
...are seeking a Senior Mechanical Cost Manager to join our team in... ...management, cost optimization, and claim avoidance initiatives... ...business, or a related field is highly preferred. 15+ years of relevant... ...alis is an equal opportunity, Drug-Free employer EOE/Veteran/Disability...ClaimsContract workTemporary workFor contractorsFlexible hours$125k - $140k
...$125,000 - $140,000,Category: Claims & UnderwritingCompany: Munich... ...OverviewThis is a senior position for a highly experienced Long-Term Care (... ...High Deductible).Prescription drug coverage (included in your... ...coverages provided at no cost to you, such as basic life insurance...ClaimsTemporary workWork experience placementRemote workShift work- ...Professional Coding Auditor & Educator The Professional Coding Auditor & Educator works... ...Supervisor to ensure clinical documentation in high-risk areas is consistent and complete... ...billing lifecycle and appealing denied claims Strong critical thinking Experience...ClaimsFlexible hours
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