- Elevance Health (Miami, FL)
- …is responsible for investigating assigned cases, collecting, researching and analyzing claim data in order to detect fraudulent, abusive or wasteful ... **How you will make an impact:** + Using appropriate system tools and databases for analysis of data and...analysis of data and review of professional and facility claims to detect fraudulent, abusive or wasteful healthcare insurance… more
- University of Miami (Miami, FL)
- …experience required. Working knowledge of information technology, particularly how systems and applications integrate with business processes and operations ... + Risk financing, legal, and regulatory operations. + Healthcare operations including claims and litigation. + Patient safety culture, leadership, and advocacy. +… more
- Kemper (Doral, FL)
- …SIU Investigator will conduct field as well as desk investigations of insurance claims referred to and accepted for investigation by the Special Investigative Unit. ... Miami and surrounding areas. Basic functions include: Investigation of claims , analysis and development of facts and evidence, and...in a thorough timely manner. + Maintains a diary system on all assigned files. Diary system … more
- AdventHealth (Wesley Chapel, FL)
- …assisted procedures, reporting the need for updates and corrections for accurate claim submission. Reports any unresolvable practice or system issues resulting ... admission dates, and postoperative days to ensure timely billing of claims . Organizes information needed for appropriate billing, including operative, pathology, and… more
- CVS Health (FL)
- …regulatory updates are operationalized. This role requires a thorough knowledge of claim adjudication, internal MAC & non-MAC related processes, and being a leader ... science, and information technology. + Execute process improvements and system enhancements, including coordinating activates across diverse departments and ensure… more
- HCA Healthcare (Pensacola, FL)
- …apply now. What you will do in this role: + You will transmit claims to billing vendors, process/ correct insurance rejects, process re-bills, and work unbilled ... and update required information, insurance requirement edits, and follow-up on pending claims + You will attach i-bills or implants invoices to paper billing… more
- MyFlorida (West Palm Beach, FL)
- …Refugee Assistance programs, and have expertise in the use of the Florida computer system and other on-line systems . The person occupying this position works to ... - 60025069 Date: Jan 16, 2026 The State Personnel System is an E-Verify employer. For more information click...THE FOLLOWING: + Experience working with State Attorney overpayment claims + Experience with problem-solving techniques within a work… more
- Cummins Inc. (Tampa, FL)
- …and tools. - Completing required documentation, such as service worksheets, timesheets, warranty claims via handwritten forms or business system input screens. - ... claims , quality documents via handwritten forms or business system input screens. Completes training in line with skill...has been resolved; documents results of troubleshooting in business systems to communicate what has been done for payment… more
- Cognizant (Tallahassee, FL)
- …closely with configuration analysts and other operational stakeholders to maintain and improve claims reimbursement systems . **In this role, you will:** + Review ... standards (CPT, CCI, CMS). + Manage and update the Claims Reimbursement database to ensure edit rules and tables...with CPT, CCI, CMS, or health plan-specific rules for claim payment. + Knowledge of health plan/provider contracting and… more
- Humana (Tallahassee, FL)
- …outcomes. **Key Responsibilities:** + Lead large-scale product efforts focused on improving claims processing and related systems , ensuring these efforts support ... with provider networks and external partners impacted by changes in claims adjudication systems **Use your skills to make an impact** **Required Qualifications**… more