- Centene Corporation (Tallahassee, FL)
- …business needs. + **Design and maintain** attribution models based on claims data, member selection, contractual arrangements, and regulatory requirements. + ... **Monitor and improve** attribution accuracy through audits, root cause analysis, and continuous process refinement. + **Lead change management** efforts for attribution logic updates, system enhancements, and policy changes. + **Support strategic… more
- AdventHealth (Tampa, FL)
- …Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient ... care/observation stays and referral services. The Physician Advisor is an important contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies. This individual also serves as the subject matter expert, providing… more
- Marriott (Fort Lauderdale, FL)
- …* Works with the unemployment services provider to respond to unemployment claims . * Attends unemployment hearings and ensures property is properly represented. * ... Ensures employees are treated fairly and equitably. * Ensures Guarantee of Fair Treatment policy is consistently followed and proper documentation is maintained on all disciplinary issues. * Ensures employees are treated fairly and equitably and that issues… more
- Centene Corporation (Tallahassee, FL)
- …scale initiatives required required Operations experience preferred **Experience leading a claims payable function at a large scale highly preferred** **Experience ... managing vendor relationships highly preferred** **Detailed understanding of the 835 process highly preferred** **Experience leading provider payments highly preferred** **Finance experience highly preferred** Pay Range: $145,100.00 - $268,800.00 per year… more
- Molina Healthcare (Orlando, FL)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions. + Monitors and enforces compliance with… more
- Mass Markets (FL)
- …736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service, ... Digital Experience Provider (DXP), Account Receivables Management (ARM), Application Software Development, Managed Services, and Technology Services, to mid-market, Federal & enterprise partners. MCI now employs 10,000+ talented individuals with 150+ diverse… more
- Kyndryl (Tallahassee, FL)
- …Partner with CCaaS architects to build future-proof architectures with EHR, CRM, and claims system integrations. The compensation range for the position in the US is ... $159,240 to $286,560 based on a full-time schedule. Your actual compensation may vary depending on your geography, job-related skills and experience. For part time roles, the compensation will be adjusted appropriately. The pay or salary range will not be… more
- Molina Healthcare (Tampa, FL)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- The Hartford (Lake Mary, FL)
- …& Property Claims Performance Analytics, The Hartford Reporting to the Director of Auto and Property Claims Performance Analytics, this Senior Performance ... the evaluation of operational and financial trends underlying homeowners' claims . You will partner with claims , product,...labor and material costs, impact of storm intensity on claim severity, etc.) . Work as a thought-partner to… more
- Marriott (Lake Buena Vista, FL)
- …* Works with the unemployment services provider to respond to unemployment claims ; reviews provider reports for accuracy and corrects errors. * Prepares, audits ... and distributes unemployment claim activity reports to property management. * Attends unemployment...the Department Manager for resolution or escalated to the Director of Human Resources/Multi-Property Director of Human… more