- AssistRx (Orlando, FL)
- …access to medications. + Collaborate with internal teams (eg, reimbursement, operations , account management) and external stakeholders to tailor copay programs to ... expertise. + Oversee staffing and resource planning to ensure efficient program operations and scalability. Client & Stakeholder Engagement: + Serve as the primary… more
- Cognizant (Tallahassee, FL)
- …satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify due process was followed. Determine if the appeal ... or Grievance is legitimate. A strong understanding of Claims , Appeals and Medical Benefits. Referring suspicious or complicated Claims to investigators.… more
- AdventHealth (Altamonte Springs, FL)
- …is essential. Additionally, working knowledge and understanding of major medical claims , insurance contracts, and the traditional actuarial functions, eg, claims ... may not be completely defined Beginner to intermediate experience with health care claims and related data and analysis (at least 1-2 years experience) Working… more
- Sedgwick (Tallahassee, FL)
- …great work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Manages overall clinical operations for more than 3 assigned teams/offices; develops and implements ... locations/offices; provides expert medical and product support to Sedgwick claims and clinical staff. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION Validate claims for billing purposes ensuring eligibility and referring questionable coding for review. ... Submit claims to 3rd party health Insurance Carriers, with knowledge...Act and the complaint process, visit Human Resources and Administration/ Operations , Security, and Preparedness (HRA/OSP) at The Fair Chance… more
- Prime Therapeutics (Tallahassee, FL)
- …industry guidelines, on both pre- and post-service requests. Coordinates with operations , clinical, medical, reporting and other internal departments as needed. ... + Available for consultation in pharmacy related questions to resolve claims submission related to medication edits. + Contacts physicians/prescribers to obtain… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …and execution through standardized dashboards. + Partner with Commercial Operations to **streamline reporting processes** and provide clear, actionable insights ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Molina Healthcare (FL)
- … operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms (eg, PMPM, ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (FL)
- … operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms (eg, PMPM, ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …regulatory team (GRL, regional leads, CMC-RA, labeling, medical writing, regulatory operations , etc.) to develop global regulatory plans, address global regulatory ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more