- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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