- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Point32Health (FL)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Molina Healthcare (Jacksonville, FL)
- …+ Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains Point of Sale claims adjudication, state, NCQA, and CMS ... member and providers with initiating oral and written coverage determinations and appeals . + Records calls accurately in call tracking system. + Maintains specific… more
- CVS Health (Tallahassee, FL)
- …we do it all with heart, each and every day. **Description** -Customer Service Representative is the face of Aetna and impacts members' service experience by manner ... new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates providers on our self-service… more
- Cardinal Health (Tallahassee, FL)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- CVS Health (Tallahassee, FL)
- …new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with credentialing/re-credentialing and ... contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. + Work hours will be… more
- MyFlorida (Tallahassee, FL)
- …(relocation benefits are not available for this position) OPS Employment Security Representative II This position will be used for multiple vacancies. OPEN ... from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission....You Will Do: This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department… more
- MyFlorida (Fort Lauderdale, FL)
- …(relocation benefits are not available for this position) OPS Employment Security Representative II This position will be used for multiple vacancies. OPEN ... from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission....You Will Do: This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department… more
- MyFlorida (Orlando, FL)
- …(relocation benefits are not available for this position) OPS Employment Security Representative II This position will be used for multiple vacancies OPEN ... You Will Do: This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department...from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission.… more
- Highmark Health (Tallahassee, FL)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more