- MyFlorida (Fort Lauderdale, FL)
- …issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through ... of first payments when potential issues are detected on initial or additional claims . This is accomplished through tracking the assigned claim load and utilizing the… more
- MyFlorida (Orlando, FL)
- …Reemployment Assistance Programs Adjudication Unit. Job duties revolve around providing quality customer service using a variety of methods, reviewing claimant and ... applying laws and policies to determine the eligibility of reemployment assistance claims using the CONNECT system. This includes gathering claimant and employer… more
- Healthfirst (FL)
- …Operational units meet organizational and regulatory standards for proper function, quality , and in support of enhancing Member/Provider service experiences. + ... operational areas. + Contribute to the overall success of the Quality Assurance service organization by identifying opportunities to continuously improve the… more
- AdventHealth (Maitland, FL)
- …financial modeling and risk forecasting. + Identifies and implements improvements in quality control and timeliness of reporting. + Extracts, collects, analyzes, and ... various sources using knowledge of healthcare managed care contracts and administrative claims data. + Employs existing complex models and implements them on new… more
- Sedgwick (Jacksonville, FL)
- …the line of business for new or existing clients ensuring product quality and regulatory standards compliance. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Acts as ... combination of education and experience required to include two (2) years of claims management, managed care or other related experience. **Skills & Knowledge** + In… more
- CVS Health (Miami, FL)
- …in-person support across multiple worksites, handling complex benefit and claims inquiries, and providing education during open enrollment and health-related ... and Resolve:** Handle member inquiries and escalations related to benefits, claims , eligibility, and policy interpretation by identifying root causes, coordinating… more
- Molina Healthcare (Orlando, FL)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... appropriate information has been provided. + Audits loaded provider records for quality and financial accuracy and provides documented feedback. + Assists in… more
- Walgreens (St. Petersburg, FL)
- …billing is completed and accurate prior to claim submission (ie, medical claims billing). + Process reimbursement checks/payment in accordance with policy. + Review ... price modify logs and ensure there are corresponding SDL (submit direct link) claims . + Review, research and resolve all third party chargebacks in a timely manner.… more
- LogixHealth (Dania Beach, FL)
- …Key Responsibilities: + Analyze A/R (Accounts Receivable) reports to follow up on unpaid claims + Assist with trouble shooting with pockets of A/R + Submit required ... documentation to insurance companies as requested + Research claims for information in order to process bills in...clinical, and other data insights that directly improve the quality and efficiency of patient care. At LogixHealth, we're… more
- Prime Therapeutics (Tallahassee, FL)
- …experience in at least one of the specific areas for position (eg, claims , eligibility, product, benefits, implementations or related area) + Must be eligible to ... relations + Implementation experience + Thorough understanding of pharmaceutical claims data and general understanding of medical claims...new ideas and work collaboratively to provide the highest quality of care and service to our members. If… more