• ADA Senior Quality Claims Analyst

    MetLife (Tampa, FL)
    …Responsibilities: * Conducts quality reviews of Americans with Disabilities Act (ADA) claims . * Identifies trends, root causes, and quality gaps from the ... timely and meaningful feedback to associates and management regarding performance and quality standards. * Partners with team to develop criteria and standards in… more
    MetLife (06/13/25)
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  • Claims Processor - Remote

    Cognizant (Tallahassee, FL)
    …coverage guidelines and regulations. * Experience in the analysis and processing of claims , utilization review/ quality assurance procedures. * Must be able to ... - 4:30pm ET **Experience:** A minimum of 1 years claims processing is required. **Travel:** None required **About the...is required. **Travel:** None required **About the role:** As Claims Processor, you will be responsible for timely and… more
    Cognizant (08/01/25)
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  • Senior Technical Specialist, Construction Defect

    Travelers Insurance Company (Orlando, FL)
    …reserving, negotiating and resolving assigned Construction Defect and latent Property Damage claims . Provides quality claim handling throughout the claim life ... partners. **What Will You Do?** + Directly handles assigned severity claims . + Provides quality customer service and ensures quality and timely coverage… more
    Travelers Insurance Company (07/30/25)
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  • Technical Specialist, General Liability

    Travelers Insurance Company (Orlando, FL)
    …and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle ... manage staff. **What Will You Do?** + Directly handles assigned severe claims . + Provides quality customer service and ensures file quality and timely… more
    Travelers Insurance Company (05/24/25)
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  • DRG Coding Auditor

    Elevance Health (Tampa, FL)
    …CODING AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all ... of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance, or recovery auditing. + Requires at least one of the following… more
    Elevance Health (07/22/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Tampa, FL)
    …applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum ... and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims … more
    Elevance Health (08/01/25)
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  • Risk Management Professional

    Humana (Tallahassee, FL)
    …The Claims Risk Management Professional is responsible for ensuring payment quality of claims in accordance with TRICARE policy requirements. This role ... involves reviewing pre-payment, high dollar claims to assess payment accuracy and identify potential claim payment risks. The Claims Risk Management Professional… more
    Humana (07/30/25)
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  • Director, Operational Oversight (Medicare/Duals)…

    Molina Healthcare (Tampa, FL)
    …and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer ... grievances, and member communications. * Exposure to downstream domains: Enrollment, Claims , Pharmacy/PDE, Network, Stars quality metrics. * Proven record… more
    Molina Healthcare (07/13/25)
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  • Clinical Reviewer, Nurse - 9am -6pm PST

    Evolent (Tallahassee, FL)
    …necessary/required. + Participates in continuing education initiatives. + Collaborates with Claims , Quality Management and Provider Relations Departments as ... with the health care delivery team to maintain high quality and cost effective care delivery. **What You'll Be...to the Medical Director. + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential… more
    Evolent (08/01/25)
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  • Claims Manager

    CHS (Clearwater, FL)
    …for Claims Department strategy, planning, staffing projection, budgeting and quality assurance and improvement. * Responsibility for final hiring decisions on ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...service level agreements. You'll manage relationships with vendors, spearhead quality improvements, and foster a culture of transparency and… more
    CHS (05/09/25)
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