• Pharmacy Claims Auditor CPhT

    Conduent (Orlando, FL)
    … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
    Conduent (04/22/25)
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  • Claims Team Lead - Liability Bodily Injury

    Sedgwick (Tampa, 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 - Liability Bodily Injury **PRIMARY PURPOSE** : To supervise the… more
    Sedgwick (05/20/25)
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  • Quality Analyst

    Highmark Health (Tallahassee, FL)
    …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
    Highmark Health (05/24/25)
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  • Workforce Absence Team Lead

    Sedgwick (Tallahassee, FL)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
    Sedgwick (05/20/25)
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  • DRG Coding Auditor Principal

    Elevance Health (Miami, FL)
    …Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an...you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding… more
    Elevance Health (06/05/25)
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  • External Audit Facilitator

    Elevance Health (Tampa, FL)
    **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
    Elevance Health (05/23/25)
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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 (05/09/25)
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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 (05/10/25)
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  • Manager, Claims Operations & Research

    Molina Healthcare (Miami, FL)
    **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more
    Molina Healthcare (06/07/25)
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  • Professional Lines Claims Manager

    NextEra Energy (North Palm Beach, FL)
    **Professional Lines Claims Manager** **Date:** May 30, 2025 **Location(s):** North Palm Beach, FL, US, 33408 **Company:** NextEra Energy At PALMS Insurance, a ... Specific Description** The ideal candidate for the Professional Lines Claims Manager position will be able to handle and...post binding claim audits as needed and communicate the audit results to appropriate internal and external stakeholders. *… more
    NextEra Energy (05/31/25)
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