- Molina Healthcare (St. Petersburg, FL)
- …identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and ... **Job Description** **Job Summary** The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. … more
- Molina Healthcare (Tampa, FL)
- JOB DESCRIPTION Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory ... standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations… more
- WelbeHealth (Tallahassee, FL)
- …Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate ... corrections + Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change… more
- WTW (Miami, FL)
- **Description** We are seeking a highly motivated individual to join our Company as a Claims Analyst based in Miami. The candidate will have multiple claims ... + Maintain strong professional relationships with key parties to facilitate efficient claims resolution. **Compliance & Quality Assurance** + Ensure adherence to… more
- Highmark Health (Tallahassee, FL)
- …medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information ... reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards.… more
- Healthfirst (FL)
- …York, NY.** **Duties & Responsibilities** : + Conducts independent assessments of current claims edits to ensure comprehensive and defensible claims editing is ... opportunity with respect to new edits, modifications to existing edits, and recommended claims policy changes. + Leads implementation efforts with respect to new or… more
- Highmark Health (Tallahassee, FL)
- …is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various ... including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims , and Medical Policy. The person in this position must fully… more
- MetLife (Tampa, FL)
- …Help Us Build a Confident Future (Key Responsibilities): The PFML Senior Operations Quality Analyst is responsible for: * Evaluating and improving business and ... core business challenges within MetLife. This role will conduct quality reviews of disability claims , collecting and...role will conduct quality reviews of disability claims , collecting and analyzing quality opportunities, and… more
- MetLife (Tampa, FL)
- Job Title Short Term Disability (STD) Senior Quality Analyst Job Location Virtual within a Commutable Distance of Aurora IL, Bloomfield, CT, Cary NC, Oriskany ... Build a Confident Future (Key Responsibilities): The STD Senior Quality Analyst is responsible for: * Virtual...State Plans, PFML, and concurrent Absence Management Solutions (AMS) claims to ensure we meet or exceed customer expectations.… more
- Elevance Health (Miami, FL)
- **Business Information Analyst II - HEDIS Quality Analytics** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering ... analytics to improve the delivery of care. The **Business Information Analyst II** will be responsible for analyzing, reporting and developing recommendations… more