- RWE Clean Energy (Tampa, FL)
- …a team setting + Oversee Residential Business Workmanship warranty and production claims . + Negotiate with subcontractors or EPCs as appropriate **Job Requirements ... gigawatts of operating wind, solar and battery projects, focusing on providing high- quality jobs. RWE invests in local and rural communities while strengthening… more
- Molina Healthcare (Jacksonville, FL)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... Records calls accurately in call tracking system. + Maintains specific quality and quantity standards. **JOB QUALIFICATIONS** **Required Education** High School… more
- Centene Corporation (Tallahassee, FL)
- …business needs. + **Design and maintain** attribution models based on claims data, member selection, contractual arrangements, and regulatory requirements. + ... strategic initiatives** related to value-based care, risk adjustment, and quality improvement by ensuring attribution integrity. + Provide directional oversight… more
- Humana (Tallahassee, FL)
- …either the state agency or payer perspective + Detailed understanding of healthcare claims Travel: While this is a remote position, occasional travel to Humana's ... need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel,… more
- Mass Markets (Tampa, FL)
- …transactions. + Collaborate with customer service team members to enhance service quality . + Complete end-of-day deposits and balancing reports. + Adhere to ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service,… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …medical necessity criteria. + Clearly and succinctly presents cases to ensure quality care while advocating for appropriate utilization of health system resources ... as well as knowledge of the interconnection between Utilization Management, claims , and regulatory requirements to respond to complex and/or escalated inquiries.… more
- NextEra Energy (Juno Beach, FL)
- …hearings, and appeals across multiple jurisdictions + Oversee inverse condemnation claims and property damage disputes + Manage appeals and complex valuation ... projects of varying (basic to moderate) complexity and deliver timely and quality legal services to clients with close supervision. **Job Duties & Responsibilities**… more
- USAA (Tampa, FL)
- …and/or process engineering/optimization. + Experience in successfully applying quality management, process improvement, and problem-solving tools and methodologies. ... OFAC, NACHA, PCI). + Familiar with core insurance systems (eg, Guidewire) and claims workflows. + Proven ability to influence decision making through data supported… more
- Humana (Tallahassee, FL)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel,… more
- University of Miami (Miami, FL)
- …for improvement, and cost and savings involved. + Participates in continuing quality improvement activities. + Adheres to University and unit-level policies and ... a pivotal role in ensuring revenue integrity through: trend reporting and claims analysis, development of payor scorecards, Charge Description Master (CDM) reviews,… more