- Sedgwick (Jacksonville, FL)
- …Review Analyst plays a critical role in supporting the medical malpractice claims team by ensuring legal invoice accuracy, compliance, and defensibility. This ... AND RESPONSIBILITIES** + Reviews legal invoices associated with medical malpractice claims to verify accuracy, reasonableness, and adherence to established billing… more
- Justice, Bureau of Prisons/Federal Prison System (Coleman, FL)
- …under the Freedom of Information and Privacy Acts, Administrative Remedy Appeals, and claims submitted under the Federal Tort Claims Act, Civilian Employee ... Compensation and Bureau of Prisons Claims Acts (FTCA/CECA/BOPCA), and inmate property claims . Receives service of legal documents, reviews for correct form and… more
- Sedgwick (Orlando, FL)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of all ... claims to ensure information substantiates disability. + Provides clear...and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims… more
- Walmart (Lakeland, FL)
- …assigned area of work Creates action plans to address audit findings Validates claim records work with workers compensation case managers for investigation of ... claims Asset Protection Security Possesses knowledge of Asset protection policies practices and guidelines environmental health and safety laws and regulations To be… more
- CVS Health (Tallahassee, FL)
- …Summary** The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the ... metrics **Required Qualifications** + 3-5 years of experience in a medical claim background with demonstrated ability and strong understanding of benchmarking costs… more
- Highmark Health (Tallahassee, FL)
- …rates utilizing Company rating algorithms, adjusting accordingly to cover questionable claim patterns or unusual situations not otherwise contemplated within the ... Process Analyst role or experience in a related operational area (eg claims , billing, customer service, etc.) **Preferred** + Experience in a financial analysis,… more
- Cognizant (Tallahassee, FL)
- …teams. **In this role, you will:** . Perform comprehensive follow-up on hospital claims to resolve outstanding accounts receivable. . Analyze denial trends and root ... and insights to management using advanced Excel skills. . Recommend updates to claim edits and work queues to improve efficiency and reduce payment delays. **What… more
- Towne Park (Orlando, FL)
- …- 15% Understands and drives business metrics for forecasting, productivity, claims , customer service, and turnover. Ensures all associates accurately identify and ... for use in a safe and efficient manner + Knowledge of Towne Park's claim check, ticketing and key box training, policies and procedures + Knowledge of Towne… more
- MyFlorida (Land O' Lakes, FL)
- …employment history must be verifiable. Please attach any credentials you claim (degrees, certifications, etc.) to your application. Other Personnel Technician III ... not limited to job applications, hiring process, disciplinary actions, workers' compensation claims , Family Medical Leave Act (FMLA), new hires and terminations. +… more
- Molina Healthcare (Tampa, FL)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... the Medicaid and Medicare programs as well as Marketplace + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems +… more