- Sedgwick (Orlando, FL)
- …department projects within the unit. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Maintains claim caseload; analyzes mid and higher-level disability claims to ... Services & Insurance WFA Team Lead **PRIMARY PURPOSE** : To assist with claims examiner workload management; to provide guidance, training and mentoring to claims… more
- CDM Smith (Orlando, FL)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting, auditing, and investigative… 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
- 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
- Zelis (St. Petersburg, FL)
- …on supervising a team of Clinician's performing clinical reviews of facility claims , including UB's, Itemized Bills and medical records, to verify billing accuracy ... performance to ensure savings are maximized and captured timely through proper claim handling. Effective and proven leadership experience is a must as… 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
- Travelers Insurance Company (Orlando, FL)
- …through local expertise and outstanding client service. We handle litigation arising from claims asserted against policyholders or the company and take cases ... you do and where you do it. **Job Category** Claim , Legal **Compensation Overview** The annual base salary range...20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program… more
- Lincoln Financial (Tallahassee, FL)
- …be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you will act as a clinical resource for ... Group Protection benefit specialists and claim professionals. You will evaluate medical information to clarify...this role you will provide coaching and guidance to claims regarding medical management. **What you'll be doing** *… 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)
- …criteria; to provide leadership within the dedicated team of clinician and claim professionals in support of the dedicated program through training and ... reviews on cases where the nurse is seeking treatment plan clarification, claim denial, disability certification or duration management for return to work guidance.… more