- UIC Government Services and the Bowhead Family of Companies (Miami, FL)
- …required. + Extensive computer/PC knowledge required including; spreadsheet software, word processing software and knowledge of MS Office Suite. + Must be ... and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual… more
- Molina Healthcare (Jacksonville, FL)
- …as the Provider Online Directory, Utilization Management, Customer Experience, Enrollment, and Claims Payment and Processing . + Develop and enforce operating ... and business leaders to enable enterprise wide capabilities. Synchronizes data among multiple claims systems and application of business rules as they apply to each… more
- CVS Health (Tallahassee, FL)
- …Quality, CPHQ preferred. + Background in Managed Care. + Familiarity with claims processing workflows. + Experience with quality improvement, PIPs, ANE ... requirements. + Apply clinical criteria and policies to member/provider claims and coordinate clinical resolutions with MD support. **Performance Improvement… more
- Sedgwick (Tampa, FL)
- …is passionate about shaping strategy through insights rather than simply processing numbers. The ideal candidate is proactive, detail-oriented, forward-thinking, and ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- Lowe's (Pompano Beach, FL)
- …(RTM) program, ensuring accurate documentation, vendor communication, and credit processing * Process and disposition damaged, discontinued, defective, special ... with third-party logistics (3PL) partners to address and resolve delivery claims * Maintain strong, professional relationships with vendors, liquidation partners,… more
- ChenMed (Miami, FL)
- …+ Participate and provide support in the review and investigation of any claims , actions, or lawsuits filed against the Company, by assisting in developing defense ... strategies, evaluating the strength of the claims , conducting risk analyses and evaluating resolution opportunities. + Assist and manage outside counsel as directed… more
- Elevance Health (Tampa, FL)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and ... fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions as… more
- MyFlorida (Ocoee, FL)
- …implementation of policies and rules. Responsible for providing legal representation in claims and litigation against and by the Department in all phases, including ... for providing support to Department attorneys representing the Department in claims and litigation against and by the Department, as assigned. Responsible… more
- LCEC (North Fort Myers, FL)
- …liability, workers' compensation, cyber, and auto coverage. Oversee insurance renewals, claims processing , broker relationships, and cost analysis + Manage ... management skills (Required) + Experience working with insurance markets and claims processes. (Required) + Knowledge of risk assessment methodologies, internal… more
- Norstella (Tallahassee, FL)
- …to extract meaningful insights from **real-world data (RWD)** sources, including ** claims , laboratory results, billing codes, and electronic health records (EHRs)** ... teams to develop and refine database queries, data pipelines, and processing workflows, incorporating AI/ML methodologies for advanced analytics. + Partner with… more