- Travelers Insurance Company (Orlando, FL)
- …Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is ... beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to… more
- ICW Group (Orlando, FL)
- …best interest of all parties and providing benefits as prescribed by law. + Ensures claim files are properly documented and claims coding is correct. + Refers ... and further education as required. _California Only:_ California Workers' Compensation Claims Administration (WCCA) and Workers' Compensation Claim Professional… more
- Sedgwick (Orlando, FL)
- …efforts to ensure thorough and appropriate claim reviews.** **Identifies when claims require external support and arranges referrals to vendors for services ... **_caring counts-and so do you._** **We're not just a global leader in claims management; we're a team driven by empathy, expertise, and impact. Right now,… more
- Zelis (St. Petersburg, FL)
- …Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence to proper coding ... and billing guidelines. They will work closely with Expert Claim Review and Concept Development staff to efficiently identify billing errors and adhere to policies… more
- Sedgwick (Tallahassee, FL)
- …ensure accurate and sufficient information is received by employees and providers to support the claim request and documents decision rationale. + Completes ... of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Acts as a backup for… more
- Cognizant (Tallahassee, FL)
- …United States. Regardless of your working arrangement, we are here to support a healthy work-life balance through our various wellbeing programs. **Location:** ... you will make an impact by managing and resolving physician claim denials through advanced problem-solving, including identifying root causes and implementing… more
- Molina Healthcare (Tampa, FL)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with ... is required. **Job Duties** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which… more
- MetLife (Tampa, FL)
- …form with customer service proven through internal and external interactions. * Drives Claim Management Accuracy and customer experience through support of the ... performing claim adjudication with the focus on Decisional, Financial, Claims Coding and Compliance Accuracy in accordance with the Customers' plan/policy and… more
- CDM Smith (Jacksonville, 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
- Modernizing Medicine (Boca Raton, FL)
- …and large language models (LLMs) to derive insights from claim data, evaluate claim states, and support the development of AI-driven decision support ... data. + Apply LLM and NLP techniques to extract insights, classify claim states, and recommend operational actions. + Support model serving, deployment,… more