- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- … Claims Examiner is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting claims ... necessary. Key Responsibilities: + Review, research, analyze and process professional claims by navigating multiple applications and platforms accurately. + Ensure… more
- Molina Healthcare (Orlando, FL)
- …types of complex claims . Procures all medical records and statements that support the claim . + Meets department quality and production standards. + Meet ... **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of … more
- Molina Healthcare (Miami, FL)
- …a caseload of claims . Procures all medical records and statements that support the claim . + Makes recommendations for further investigation or resolution. + ... **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of … more
- USAA (Tampa, FL)
- …documentation to support accurate outcomes. + Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides ... special and impactful. **The Opportunity** As a dedicated **Injury Examiner ** , you will be responsible to adjust complex...you will be responsible to adjust complex bodily injury claims , UM/UIM, and small business claims to… more
- Sedgwick (Tallahassee, FL)
- …and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on ... projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- CHS (Clearwater, FL)
- **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party ... organizations, insurance marketing organizations, and employers. One core service, claims administration, is where submissions for payment/reimbursement/sharing from medical… more
- CDM Smith (Orlando, FL)
- …and Evidence Gathering: Collect and organize all necessary documentation to support claim amounts. This includes gathering invoices, receipts, contracts, ... Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related… more
- Sedgwick (Tallahassee, FL)
- …medical recovery. + Provides recommendations for alternate clinical resources to support claim resolution. + Maintains client's privacy and confidentiality, ... support systems. + Effectively communicates and builds relationships with the claims ' examiner , client, injured worker, attorney and supervisor. + Identifies… more
- Veterans Affairs, Veterans Health Administration (Cape Coral, FL)
- …include but are not limited to: Collaborating with clinical and administrative support to provide timely, quality, coordinated care. Utilizes and promotes approved ... clinical background. Preferred experience as Medical Review Officer, Certified medical examiner for commercial motor vehicle drivers, and certification as an… more
- Prime Therapeutics (Tallahassee, FL)
- …with a high level of detail and accuracy, to clearly and concisely support conclusions and recommendations. + MISCELLANEOUS DUTIES: + Provide backup support ... Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the...terms and policy interpretation. + CFE - Certified Fraud Examiner credential preferred. + Bachelor's degree preferred. + Prefer… more