- Travelers Insurance Company (Fort Lauderdale, FL)
- …information to uncover potentially fraudulent activity. The investigator, supporting a Claim Center, will investigate claims deemed suspicious in nature ... Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is… more
- USAA (Miami, FL)
- …accurately manages claims outcomes. + Maintains accurate, thorough, and current claim file documentation throughout the claims process. + Advance knowledge ... and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes… more
- Sedgwick (Orlando, FL)
- …MN 55344 **PRIMARY PURPOSE** : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan ... and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations;… more
- Sedgwick (Tallahassee, FL)
- …of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Acts as a backup for ... Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- Sedgwick (Orlando, FL)
- …system documentation.** **Coordinates investigative efforts to ensure thorough and appropriate claim reviews.** **Identifies when claims require external support ... **_caring counts-and so do you._** **We're not just a global leader in claims management; we're a team driven by empathy, expertise, and impact. Right now,… more
- MetLife (Tampa, FL)
- …performing claim adjudication with the focus on Decisional, Financial, Claims Coding and Compliance Accuracy in accordance with the Customers' plan/policy and ... goals and objectives. * Identify, remove, and challenge barriers related to claims management. Escalate to senior leaders in the organization as appropriate along… more
- Highmark Health (Tallahassee, FL)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... claim rejection and the proper action to complete the...effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of… more
- Sedgwick (Orlando, FL)
- …under ADA, state, and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims or makes a recommendation ... Drive Eden Prairie, MN 55344 **PRIMARY PURPOSE** **:** To process claims and determine accommodation options following written guidelines and procedures pursuant… more
- Sedgwick (Orlando, FL)
- …naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes ... professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability...disability offsets; and to ensure the ongoing processing of claims . **ARE YOU AN IDEAL CANDIDATE?** We are looking… more
- Highmark Health (Tallahassee, FL)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more