- Zelis (FL)
- …Identify new DRG coding concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client turnaround time, and department ... across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with...plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official… more
- Sedgwick (Tampa, FL)
- …time frames, and claims status either by phone, written correspondence and/or claims system . + Reviews medical information to determine if the claimant meets ... and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims ...Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to… more
- Sedgwick (Orlando, FL)
- …time frames, and claims status either by phone, written correspondence and/or claims system . * Reviews medical information to determine if the claimant meets ... and/or client requirements for a qualifying condition. * Makes claim determinations to approve non-complex ADA claims ...Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to… more
- Sedgwick (Orlando, FL)
- …time frames, and claims status either by phone, written correspondence and/or claims system . + Reviews medical information to determine if the claimant meets ... and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims ...Makes claim determinations to approve non-complex ADA claims or makes a recommendation to team lead to… more
- City of Jacksonville (Jacksonville, FL)
- …the monitoring, reviewing, investigating, and processing of complex workers' compensation claims that include primarily lost time, permanent total disability, and ... workers' compensation laws, rules, and regulations and workers' compensation claims processing practices and procedures with substantial litigation experience… more
- Sedgwick (Orlando, FL)
- …information and claims status either by phone, written correspondence and/or claims system . **QUALIFICATIONS** + Education & Licensing: High school diploma ... naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes… more
- CVS Health (Tallahassee, FL)
- …technical direction and innovation of engineering projects that impact the Commercial Claim systems . As a Staff Software Engineer/Release Manager, you will: ... solutions that meet the evolving needs of our business. The Commercial Claim team handles complex project work that crosses many Aetna Technology… more
- Highmark Health (Tallahassee, FL)
- …supporting the Epic Resolute Hospital Billing application. Responsibilities include business/ systems analysis, requirements definition and documentation, system ... design, and problem resolution. The analyst communicates with system end-users to understand issues and implement solutions. **ESSENTIAL RESPONSIBILITIES** + Plans,… more
- Molina Healthcare (Tampa, FL)
- …maintain contract, benefit or reference table information into the claim payment system and other applicable systems . + Participates in defect resolution for ... claims databases. Synchronizes data among operational and claims systems and application of business rules...housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
- CVS Health (Tampa, FL)
- …will be responsible for designing, developing, and implementing digital solutions and systems . This role requires technical expertise to architect and code software ... applications, perform system testing and debugging, collaborate with cross-functional teams, and...and other IT partners. As part of the AT Claim Organization, you will be responsible for code deliverables… more