- Elevance Health (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
- Cummins Inc. (Riviera Beach, FL)
- …Completing required documentation, such as work completed documents, time sheets, warranty claims , quality documents via handwritten forms or business system ... Completes required documentation, such as work completed documents, time sheets, warranty claims , quality documents via handwritten forms or business system… more
- Molina Healthcare (St. Petersburg, 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
- AdventHealth (Altamonte Springs, FL)
- …the Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient ... in support of medical management programs, promoting the delivery of high quality , patient focused and cost-effective medical care. **The value you will bring… more
- Cummins Inc. (Orlando, FL)
- …lists, etc Completes required documentation, such as service worksheets, timesheets, warranty claims , quality documents via handwritten forms or business system ... guidelines, using required tools within standard repair time to ensure a quality repair; disassembles and assembles engines or power generators following guidelines,… more
- Cummins Inc. (Tampa, FL)
- …Completing required documentation, such as work completed documents, time sheets, warranty claims , quality documents via handwritten forms or business system ... guidelines, using required tools within standard repair time to ensure a quality repair; disassembles and assembles engines or power generators following guidelines,… more
- 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
- Highmark Health (Tallahassee, FL)
- …and/or performing quality control review and final adjudication of paper/electronic claims . Determines whether to return, deny or pay claims following ... claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit… more
- Molina Healthcare (Miami, FL)
- …Description** **Job Summary** Responsible for work load assignment to the provider Claims adjudicators and senior provider claims adjudicators. Train and coach ... new employees. Provide clear and concise results on the provider claims model across all states. Monitors and controls workflow. Provides support to leadership… more
- Zurich NA (Maitland, FL)
- WC Senior Claims Specialist 126746 At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing ... your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct… more