- Highmark Health (Tallahassee, FL)
- ** Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This job requires 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 retrospective claim… 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 ... ** Company :** Highmark Inc. **Job Description :** **JOB...and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES**… 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 ... physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability plan; to make… more
- Sedgwick (Tallahassee, FL)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more
- Zelis (FL)
- …Identify new DRG coding concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client turnaround time, and department ... clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA… more
- Elevance Health (Tampa, FL)
- …AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company , for all lines of ... and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside...a number of legitimate, non-discriminatory factors set by the Company . The Company is fully committed to… more
- Sedgwick (Tallahassee, FL)
- …& Insurance Adjuster Regional Marine **PRIMARY PURPOSE** **:** To handle losses or claims regionally unassisted up to $10M, including having the ability to address ... and non-complex National Accounts. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines claim forms and other records to determine insurance coverage. +… more
- CVS Health (Orlando, FL)
- … claims , provide new hire training, resolve escalations and claim payment denials while demonstrating excellent customer service to patients, healthcare ... passionate about transforming health care. As the nation's leading health solutions company , we reach millions of Americans through our local presence, digital… more
- Sedgwick (Orlando, FL)
- …**PRIMARY PURPOSE** **:** To investigate and adjust property and casualty claims , both residential and commercial, with little to no supervision. **ESSENTIAL ... FUNCTIONS and RESPONSIBILITIES** + Inspects claims and contacts involved parties in a timely manner....parties in a timely manner. + Investigates circumstances of claim (s) as required for coverage determination, cause, and compensable… more