- Lowe's (Pompano Beach, FL)
- …with third-party logistics (3PL) partners to address and resolve delivery claims * Maintain strong, professional relationships with vendors, liquidation partners, ... BDC, and outlet teams * Resolve customer and cargo issues, and ensure claims are updated in Lowe's systems Minimum Qualifications * High School diploma Preferred… more
- Molina Healthcare (Orlando, FL)
- …likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge ... specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program… more
- Centene Corporation (Tallahassee, FL)
- …role preferred. Experience in emerging trend analysis, financial modeling, claims pricing, contract/network analysis, and/or ROI evaluation preferred. Familiarity ... with claims payment, utilization management, provider/vendor contracts, risk adjustment for government sponsored healthcare desired. Pay Range: $105,600.00 -… more
- Prime Therapeutics (Tallahassee, FL)
- …writing SQL queries + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience implementing ... quality process improvement efforts + Experience in agile Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual… more
- AON (Tampa, FL)
- …medical plans for PEO clients. + Analyze data such as census information, claims experience, and premium history to calculate insurance premiums. + Collaborate with ... medical plans for PEO clients. + Analyze data such as census information, claims experience, and premium history to calculate insurance premiums. + Collaborate with… more
- Prime Therapeutics (Tallahassee, FL)
- …platforms and products + Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data; highly ... analytical Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures… more
- AdventHealth (Orlando, FL)
- …PA role is responsible for providing physician review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation ... and reporting. Reviews and makes recommendations on appealed provider claims . Provides support, shares administrative call, and maintains collaborative relations… more
- UIC Government Services and the Bowhead Family of Companies (Jacksonville, FL)
- …and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... based on the provisions contained within The Alaska Native Claims Settlement Act. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. All… more
- AdventHealth (Minneola, FL)
- …The CRM identifies potential compensatory events and works collaboratively with claims management coordinators to mitigate litigation. The CRM is responsible for ... in hospital setting + 3 years of risk management or claims field preferred + Experience in process improvement/patient safety/clinical risk management/quality… more
- RxBenefits (Jacksonville, FL)
- …medical guidelines, and business rules into actionable intelligence across patient and claims data. Candidates with experience in PBM pricing, claims rules ... engines, clinical optimization, or pharmacy spend management will be especially strong fits. Success in this position requires balancing strong business acumen with product thinking and deep technical and data fluency, delivering tangible features in a… more