- Molina Healthcare (FL)
- …Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. + Provide actionable insights and ... care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of… more
- Highmark Health (Tallahassee, FL)
- …dental offices. Formally present and effectively communicate UCD's administrative and claim guidelines and policies, benefits of participation, fee schedules, plan ... ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer. Collaborate with… more
- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- City of Lakeland (Lakeland, FL)
- …the following areas: risk determination and evaluation, oversight of claims administration, city-wide contract administration regarding insurance requirements and ... initiatives/clinic. Responsibilities include directly supervising Safety, Health Benefits, and Claims Team Leaders; Risk Management support staff and Wellness… more
- Cognizant (St. Johns, FL)
- …expertise in FileNet P8 technologies and domain skills in Medicare and Medicaid Claims . The candidate will play a crucial role in designing and implementing ... solutions that enhance our claims processing systems. This hybrid role requires strong technical...solutions using FileNet P8 + Workplace XT to optimize claims processing systems. + Collaborate with cross-functional teams to… more
- The Hartford (Lake Mary, FL)
- …are looking for a Vocational Rehabilitation Case Manager to support our disability claims team. The selected individual shall serve the needs of individuals whom may ... requests, short term, as well as long term disability claims for possible case management involvement. The focus of...returning to work. This individual will also assist the claim examining staff in evaluating vocational information to determine… more
- CVS Health (Tallahassee, FL)
- …analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory & ... to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in SQL & Python...fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with… more
- BrightStar Care (Naples, FL)
- …into a database using this set medical protocol to produce a statement or claim . * Investigate rejected claims , verify this information with the health provider, ... of billing and payroll.. Managing Authorizations , appeals and re- submission of claims . Posting cash etc. Must be detail oriented and organized . Ability… more
- Sedgwick (Tallahassee, FL)
- …to manage a team of adjusters and surveyors and to produce quality claim handling and services. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Builds and maintains ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- The Hartford (Lake Mary, FL)
- …the state. The selected individual will be required to work closely with our claim centers and insureds to deliver the best possible result in pending litigation. ... and co-counsel with professional diplomacy and discretion. + Participate in claims file reviews. + Independently conduct trials, depositions, arbitration, and… more