- Molina Healthcare (St. Petersburg, FL)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... years operational managed care experience (call center, appeals or claims environment). + Health claims processing...center, appeals or claims environment). + Health claims processing background, including coordination of benefits,… more
- Molina Healthcare (Miami, FL)
- …Provides leadership and direction to MMS Operational Units management staff (eg, Claims Processing , Provider Services, Provider Enrollment, Finance, Managed Care ... or equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high… more
- CVS Health (Tallahassee, FL)
- …communications, organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Demonstrated ability to handle ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
- Molina Healthcare (Tampa, FL)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- Molina Healthcare (FL)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Create succinct ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +… more
- Sedgwick (Tallahassee, FL)
- …+ Strong utilization practice knowledge + Knowledge of the insurance industry and claims processing + Knowledge of current pharmacy trends and alternative ... conduct a peer review of medications used on specific claims and provides insight for drug interactions, health and...cases. + Consults with pharmacy UR team for difficult claims requiring weaning schedule. + Assesses needs, gives appropriate… more
- Prime Therapeutics (Tallahassee, FL)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare, and/or related field + Must be eligible to ... analysis of Prime's financial pricing programs, including data extraction, storage, manipulation, processing and analysis + Analyze claims data of varying… more
- Molina Healthcare (St. Petersburg, FL)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Sedgwick (Tallahassee, FL)
- …to apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge of field case management + Excellent oral and ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- Sysco (Maitland, FL)
- …major transition projects within the FreshPoint Business Unit, focusing on intercompany claims processing and pricing automation. This role ensures seamless ... post-transition. Duties and Responsibilities **Primary Responsibility** + Manages intercompany claims processes, acting as liaison between business stakeholders and… more