- CVS Health (Tallahassee, FL)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… more
- Molina Healthcare (Orlando, FL)
- …lead for both new and existing features (regression testing). + Vendor Management : Provides single point of contact for various vendors (software and interfaces). ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
- CVS Health (Tallahassee, FL)
- …in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases ... all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… more
- Acosta Group (Jacksonville, FL)
- …stakeholders, third-party administrators, brokers, and insurers to ensure effective claims management , litigation, risk financing, and compliance. ... Cyber, D&O). + This includes the areas of underwriting, claims management and safety/loss prevention ** Claims...and liability claims . Supervise the Sr. Risk Claims Analyst and ensure alignment with best… more
- Highmark Health (Tallahassee, FL)
- …met. Individual contributor roles as needed. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but not limited to: involved in hiring ... termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.Plan, organize, staff, direct and control the… more
- Molina Healthcare (FL)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** +… more
- Molina Healthcare (St. Petersburg, FL)
- …Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of ... healthcare regulations, managed care claims workflows, and provider reimbursement models to shape recommendations...At least 7 years of experience as a Business Analyst or Program Manager in a Managed Care Organization… more
- Zelis (St. Petersburg, FL)
- …that shape who you are. Position Overview At Zelis, the Clinical Dispute Analyst role is responsible for the resolution of facility and provider disputes as ... will be responsible for reviewing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence...client turnaround times are met. + Accountable for daily management of claim dispute volume, adhering to client turnaround… more
- Prime Therapeutics (Tallahassee, FL)
- …systems, particularly those that may be in use in a Pharmacy Benefit Management setting ( Claims Processing, Prior Authorization, Telephony, Membership, etc.). + ... **Additional Qualifications** + A bachelor's degree in business intelligence, management information systems, mathematics, statistics, analytics, computer and information… more
- HUB International (Tallahassee, FL)
- …a liaison between the client and insurance carriers for service, enrollment, claims and administration; constantly maintaining quality and service standards as it ... and claim representatives) and client contacts. + Confidentially assist with all claims matters and bring to resolution with proper documentation and follow up… more