- Elevance Health (Miami, FL)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- MyFlorida (Tallahassee, FL)
- …design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data ... limited to, the following: * Identify suspicious patterns in claims data and other sources by applying your knowledge...collaboration with the team and the Program Integrity Unit Manager , draft investigative work plans and develop case strategies… more
- Sysco (Auburndale, FL)
- …workplace hazards. Escalating resistance/challenges to leadership and direct line manager to facilitate problem solving. **Duties and Responsibilities:** + Execute ... on injury trends, KPIs, and risk assessments. + Support the workers' compensation claims process by completing OSHA determinations, identifying gaps in claims … more
- Zurich NA (Tallahassee, FL)
- …AVP, Underwriting Officer or VP Senior Underwriting officer level. The hiring manager will determine the appropriate level based upon the selected applicant's ... and 10 or more years of experience in the claims or underwriting support areaOR + Zurich approved Apprenticeship...and 8 or more years of experience in the Claims or Underwriting Support area. + Knowledge of Microsoft… more
- Prime Therapeutics (Tallahassee, FL)
- …Functional Business Consultant The Functional Business Consultant serves as a project manager **,** business system or business process subject matter expert with a ... experience in at least one of the specific areas for position (eg, claims , eligibility, product, benefits, implementations or related area) + Must be eligible to… more
- Zurich NA (Tallahassee, FL)
- …AVP, Underwriting Officer or VP Senior Underwriting officer level. The hiring manager will determine the appropriate level based upon the selected applicant's ... and 10 or more years of experience in the claims or underwriting support areaOR + Zurich approved Apprenticeship...and 8 or more years of experience in the Claims or Underwriting Support area. + Knowledge of Microsoft… more
- Walgreens (Davie, FL)
- …Co. Pharmacy Code of Conduct. + Performs duties as assigned by Pharmacy Manager , Staff Pharmacist and Store Manager including utilizing pharmacy systems to ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more
- Evolent (Tallahassee, FL)
- …to find the most valuable defects. The IQA reports to a associate director or a manager . One or many IQAs may be engaged in any testing effort **What You Will Be ... risks and issues in coordination with the lead / manager for status reporting + Responsible to enforce department...Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1… more
- Walgreens (Quincy, FL)
- …Walgreen Co. Pharmacy Code of Conduct. Performs duties as assigned by Pharmacy Manager , Staff Pharmacist and Store Manager including utilizing pharmacy systems ... the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and… more
- MyFlorida (Jacksonville, FL)
- …Florida. Your Specific Responsibilities: Under the direct supervision of the Program Manager , this is a highly visible and skilled position involving exercise of ... DOH clinical locations. + Provides requested support to team members (program manager , peers, interns, volunteers). + Assists with inventory and ordering office… more