- CVS Health (Tallahassee, FL)
- …to work EST time zone hours.** **Position Summary** We are hiring a Senior Analyst to support the Complaint, Grievances and Appeals (CG&A) team. This position will ... and answering ad-hoc requests + Work closely with analysts and other business partners to gather requirements and understand the reporting needs for ad-hoc… more
- CVS Health (Tallahassee, FL)
- …Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the negotiation ... benchmarking costs for medical services, supplies, and drugs. + Medical provider/ business office phone call handling history. + Strong mathematical skills.… more
- LogixHealth (Dania, FL)
- …management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting dashboards for ... Location: On-Site in Dania, FL $500 Signing Bonus This Role: As a Reimbursement Analyst at LogixHealth, you will work with the department management teams to provide… more
- Molina Healthcare (Tampa, FL)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network… more
- MUFG (Tampa, FL)
- …US compliance regulation checks/screening/data entry; and (h) acceptances/payments, Reimbursement claims . To assist the Section in achieving its planned objectives, ... Laws)/FEFTA /Red flags/vessels/shipping lines/ports/country violations relating to trade finance documents/ claims /transactions. **Transaction Processing in Trade 360 System** : Prepare… more
- MUFG (Tampa, FL)
- …US compliance regulation checks/screening/data entry; and (c) acceptances/payments, Reimbursement claims . To assist the Section in achieving its planned objectives, ... Laws) /Red flags/vessels/shipping lines/ports/country violations relating to trade finance documents/ claims /transactions. **Transaction Processing in Trade 360 System** : Prepare… more
- Highmark Health (Tallahassee, FL)
- …in varied and complex data; and articulates analytic findings, business implications, and recommendations to realize identified opportunities. **ESSENTIAL ... strategic priorities, needs, plans and resources. + Serves as a strategic business partner to internal and external stakeholders as demonstrated by providing thought… more
- CVS Health (Tallahassee, FL)
- …setup, essential for online viewing and processing, related to customer service, claims , enrollment, billing, and reporting, in support of internal and external ... to minimize manual processing and disruption for the clients. + Uses business knowledge and experience to make plan design and processing recommendations when… more
- CVS Health (Tallahassee, FL)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... tools, social media and internet research. + Ability to Travel for Business purposes. **Preferred Qualifications** + Certified Professional Coder (CPC), AHFI, CFE +… more
- CVS Health (Tallahassee, FL)
- …in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases ... Provides input regarding controls for monitoring fraud related issues within the business units. - Exercises independent judgement and uses available resources and… more