• Senior Claims Benefit Specialist

    CVS Health (Tallahassee, FL)
    …+ Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Applies medical necessity guidelines, ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
    CVS Health (08/28/25)
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  • Claims Specialist Sr - Commercial…

    Sedgwick (Tallahassee, FL)
    …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Specialist Sr - Commercial Coverage Specialist **PRIMARY PURPOSE** ... **:** To analyze complex or technically difficult medical malpractice claims ; to provide resolution of highly complex nature and/or severe injury claims ; to… more
    Sedgwick (07/10/25)
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  • Specialist , Configuration Oversight…

    Molina Healthcare (Orlando, FL)
    …communicate written and verbal + Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using claims ... incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims . ( _Use for claims specific positions only_ )… more
    Molina Healthcare (08/16/25)
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  • Senior Claim Benefit Specialist

    CVS Health (Tallahassee, FL)
    …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
    CVS Health (08/01/25)
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  • 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 ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...+ Ability to create routine reports + Prior word processing , spreadsheet and internet software experience including p roficiency… more
    LogixHealth (07/11/25)
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  • Patient Claims Specialist

    Modernizing Medicine (Tampa, FL)
    …for all inbound and outbound patient calls regarding patient balance inquiries, claims processing , insurance updates, and payment collections + Initiate outbound ... Chile, and Germany. ModMed (https://www.modmed.com/company/) is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient… more
    Modernizing Medicine (08/08/25)
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  • Wire Processing Senior Specialist

    Truist (Orlando, FL)
    …guidelines. 2. Independently analyze, research, and support electronic payment cases/ claims /inquiries escalated by internal departments and client service centers to ... resolution. Claims /inquiries related to Regulation E are met in accordance...tools. 9. Support extended hours for same day wire processing for all channels. 10. Under minimal supervision, perform… more
    Truist (07/31/25)
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  • Claims Processor (with Facets) - Healthcare…

    Cognizant (Tallahassee, FL)
    processing is required. **Travel:** None required **About the role:** As Claims Adjudication Specialist , you will be responsible for timely and accurate ... * 1 year of Facets experience. * Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures. * Must… more
    Cognizant (08/26/25)
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  • Workers' Compensation Specialist Senior

    City of Jacksonville (Jacksonville, FL)
    …of workers' compensation laws, rules, and regulations and workers' compensation claims processing practices and procedures with substantial litigation experience ... laws, rules, and regulations. + Knowledge of complex workers' compensation claims processing practices and procedures involving lost time, disability,… more
    City of Jacksonville (07/10/25)
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  • Fnw Program Specialist IV-DACS - (For…

    MyFlorida (Jacksonville, FL)
    …business hours. JOB DUTIES: General: Designs, implements, and coordinates the claims processing financial information management systems for Florida Department ... FNW PROGRAM SPECIALIST IV-DACS - 42004087 (FOR INTERNAL AGENCY EMPLOYEES...of computer processing /management information system development for claims processing . Coordinates with USDA in obtaining… more
    MyFlorida (08/26/25)
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