- Zurich NA (Tallahassee, FL)
- Sr. Claims Specialist - Complex Construction 126105 Zurich North America is seeking a skilled and experienced Senior Claims Specialist to join our Complex ... team. This role is essential in managing complex, high-exposure construction, and litigation claims , while supporting the New York Labor team to ensure claims … more
- Sedgwick (Tallahassee, FL)
- …Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim denial, disability certification or duration management for return to ... Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20 hours...provide leadership within the dedicated team of clinician and claim professionals in support of the dedicated program through… more
- Wounded Warrior Project (Jacksonville, FL)
- …started, we're ready for you. The Wounded Warrior Project (WWP) National Service Director leads and develops a team of benefits professionals who support warriors, ... (VBA) and Veterans Health Administration (VHA). The National Service Director sets priorities, upholds standards, and enforces accountability to ensure… more
- Humana (Tallahassee, FL)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Community Health Systems (Naples, FL)
- The **System Director of Risk Management** is a key leader responsible for overseeing risk management, patient safety, and regulatory compliance across Physicians ... Safety Officer or collaborate with one to support quality and safety initiatives. ** Claims & Litigation Management** + Oversee legal claims processes, including… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …in support of domestic and international clinical development initiatives. The Senior Director , GCD works in a multidisciplinary matrix environment and supports the ... on the large global clinical trials and regulatory filing activities. The Senior Director , GCD is responsible for all the clinical development activities for the… more
- Humana (Tallahassee, FL)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- CVS Health (Jacksonville, FL)
- …the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director ... clinical teams. Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple… more
- Centene Corporation (Tallahassee, FL)
- …perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement ... of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to improve quality… more
- Molina Healthcare (St. Petersburg, FL)
- …activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
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