- Sharecare (Tallahassee, FL)
- …eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, ... resolution with providers, payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization...experience in healthcare, preferably helping members navigate benefits and claims , OR held one or more of the following… more
- MyFlorida (Fort Myers, FL)
- …service, sales of Lottery products, validation and payment of winning claims , preparation of promotional book inventory, and various administrative tasks. This ... office. + Pay/validation operator and assists players in completing claims for prizes greater than $599.00. + Primary or...or secondary ticket sales redemption. + Validates and processes claims and pays prizes. + Performs daily and weekly… more
- Molina Healthcare (St. Petersburg, FL)
- …including accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data within multiple claims systems ... Ensures that provider information is loaded accurately to ensure proper claims processing, outbound reporting and directory processes. **Required Qualifications** *… more
- Molina Healthcare (FL)
- JOB DESCRIPTION Job Summary Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating ... information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness… more
- Molina Healthcare (Tampa, FL)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Humana (Tallahassee, FL)
- …2 ensures contract compliance and performs analysis regarding pharmacy claims . Understands department, segment, and organizational strategy and operating objectives, ... 2 ensures contract compliance and performs analysis regarding pharmacy claims . Understands department, segment, and organizational strategy and operating objectives,… more
- Humana (Tallahassee, FL)
- …certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS + ... field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing experience + Experience in data analysis and trend… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive ... legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,...will not be held liable or responsible for any claims , losses, damages or expenses resulting from job recruiting… more
- Otsuka America Pharmaceutical Inc. (Gainesville, FL)
- …fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive ... legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,...will not be held liable or responsible for any claims , losses, damages or expenses resulting from job recruiting… more
- Humana (Tallahassee, FL)
- …encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a ... operational knowledge of core functional areas (care coordination, quality, billing, claims , and customer service). + Collaborate with each Insurance Operations… more