- Molina Healthcare (Orlando, FL)
- …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other ... necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary… more
- Avnet (Orlando, FL)
- …metrics. + Ensures that good customer relations are maintained and customer claims and complaints are resolved fairly, effectively and in accordance with consumer ... laws. + Maintains and updates electronic and/or hard copy records as required. + Other duties as assigned. **Job Level Specifications:** + Acquired and applies working knowledge of the organization, job, practices and procedures to be proficient in all aspects… more
- Molina Healthcare (Jacksonville, FL)
- …setting. **Required Experience** + 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed ... healthcare administration and/or Provider Services. + 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ie, physician, group and hospital contracting, etc. + Working… 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
- 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
- Mass Markets (Tampa, 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
- 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
- Highmark Health (Tallahassee, FL)
- …solve complex problems representative of a broad range of service and claim scenarios. + Other duties as assigned. Including, but not limited to additional ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the … more
- Highmark Health (Tallahassee, FL)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- Polk County Public Schools (Bartow, FL)
- …to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill and ability required. Reasonable accommodations may ... in administering the various insurance plans. Develops and supervises loss and claim processing procedures for all types of losses, accidents, and injuries. Reviews… more