• Claims Specialist, Audit…

    LogixHealth (Dania, FL)
    Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...and respond to carrier and/or arbitrator inquires + Submit claims through state arbitration portals Qualifications : To perform… more
    LogixHealth (07/11/25)
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  • Claims Manager - Global Claims…

    CRC Insurance Services, Inc. (FL)
    …5. Train claims staff on new policies or procedures. 6. Oversee and audit claims process ensuring proper documentation was created in the system and/or ... Responsible for overseeing, managing and supporting all activities of the claims employees and operations of the department. **ESSENTIAL DUTIES AND… more
    CRC Insurance Services, Inc. (08/20/25)
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  • Claims Team Lead (Bodily Injury + PIP)

    Sedgwick (Tallahassee, FL)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead (Bodily Injury + PIP) **PRIMARY PURPOSE** : To supervise a team… more
    Sedgwick (09/05/25)
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  • Claims Team Lead, General Liability

    Sedgwick (Tallahassee, FL)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead, General Liability **PRIMARY PURPOSE** : To supervise a team of… more
    Sedgwick (08/22/25)
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  • Appeals Specialist - Fully Remote

    TEKsystems (Jacksonville, FL)
    …insurance follow up, root cause analysis, EHR, EMR, EPIC, Cerner, medical billing, claims audit , appeals process, appeals letter, denials, insurance follow ups ... possible) 1. heavy research - will be assigned an audit of varying volume of accounts will either be...phone to communicate and solve problems - determine why claims are denied - determine where to send appeals… more
    TEKsystems (09/05/25)
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  • Provider Reimbursement Adm-Certified Professional…

    Elevance Health (Miami, FL)
    …claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers ... eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
    Elevance Health (09/04/25)
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  • Claims Manager

    CHS (Clearwater, FL)
    **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party ... organizations, insurance marketing organizations, and employers. One core service, claims administration, is where submissions for payment/reimbursement/sharing from medical… more
    CHS (08/08/25)
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  • VP Internal Audit

    Sedgwick (Jacksonville, FL)
    …to Work(R) Fortune Best Workplaces in Financial Services & Insurance VP Internal Audit **PRIMARY PURPOSE** **:** Ensures the global plan of coverage for all ... risks are properly planned and assess where and when audit resources are required through close work with business...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
    Sedgwick (09/04/25)
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  • Claims and Call Auditor (Call Center QC)

    CHS (Clearwater, FL)
    **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance ... medical audits, target audits, re-audits, etc and audits for claims which are in excess of payment authority limits...are in excess of payment authority limits in assigned audit queues. + Listen to and view all recorded… more
    CHS (06/14/25)
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  • QA Audit Manager - Operations

    Healthfirst (FL)
    …problem-solving approaches in producing analyzing and interpreting reports on trending audit finding results and summarizing details to Operations leadership to ... address identified areas for improvement. + Serve as point of escalation for audit disputes. + Conduct comprehensive needs analysis to ensure that audit programs… more
    Healthfirst (08/16/25)
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