- Molina Healthcare (FL)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- The Hartford (Sunrise, FL)
- …in the RMS process - meeting with insured's, making presentations, working with claims and underwriting, etc. + Work with Risk Engineering Manager on special ... courses, and other approved educational sources such as CPCU/IIA (CPCU, ARM, Claims ), CIC etc. Industry Specific Knowledge and Safety: Have working knowledge of… more
- CVS Health (Tallahassee, FL)
- …bound calls to clients and payers, while working with other teams to resolve claims issues. + Documenting claims details into necessary tools. + Presenting data ... and accurately. **Required Qualifications** + 1+ years of experience working with medical claims with the understanding of how benefit levels are applied. + 1+ years… more
- Sedgwick (Tampa, FL)
- …demands, wages and benefits, and availability. + Thoroughly reviews contested claims . + Assists as needed with submission of accommodation recommendations to ... 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
- Elevance Health (Tampa, FL)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches...interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Assists with… more
- Sedgwick (Tallahassee, FL)
- …Determines objective, quantifiable, medically supported work restrictions for assigned claims . + Facilitates return-to-work (RTW) efforts through negotiation with ... 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
- AdventHealth (Altamonte Springs, FL)
- …to appropriately reconcile patient accounts. Resolves and resubmits rejected claims appropriately as necessary. Processes daily and special reports, unlisted ... and medical appeals, refunds, reinstatements, and rejections of insurance claims . + Consistently communications with team members to foster...and effectively in + Cerner Patient Accounting + SSI Claims Scrubber + Epic + Certified Revenue Cycle Rep… more
- Carnival Cruise Line (Miami, FL)
- …planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to duty. + ... to assess fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk and escalate to the… more
- Suddath (Jacksonville, FL)
- …**General position summary:** This position involves assisting and monitoring the claims resolution process, ensuring fair and accurate settlements based on carrier ... for Auto Accidents + Review and maintain data for Workers' Compensation claims and additional information gathering + Claim services such as reviewing estimates,… more
- Robert Half Office Team (Bradenton, FL)
- …analytical and administrative skills, along with the ability to manage claims and insurance-related processes effectively. Responsibilities: * Develop and implement ... across all departments. * Oversee the processing and resolution of claims , including workers' compensation, general liability, and auto liability, ensuring timely… more