- Molina Healthcare (Doral, FL)
- …requests for appeal into information system and prepares documentation for further review . + Research issues utilizing systems and other available resources. + ... to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists with interdepartmental issues… more
- GAP Solutions Inc (Tallahassee, FL)
- **Position Objective:** As a Junior Human Resource Specialist , apply HR skills in support of managers, program staff and customers on the full range of HR topics ... Assisting with drafting SOP's. + Processing personal liability insurance reimbursement claims . + Initiating tentative selection notifications, notice of results or… more
- MetLife (Tampa, FL)
- …PR office Once a month in office for meetings Key Responsibilities: . Handle, review , and administer Family & Medical Leave Act standalone/ADA (as well as other ... leave) claims and adhere to federal and state regulatory and/or...Bachelor's degree . Knowledge of system applications and Disability claims knowledge/working knowledge of FMLA/Disability/Leave procedures preferred Equal Employment… more
- Truist (Orlando, FL)
- …English (Required) **Work Shift:** 1st shift (United States of America) **Please review the following job description:** Under minimal supervision of the Operations ... guidelines. 2. Independently analyze, research, and support electronic payment cases/ claims /inquiries escalated by internal departments and client service centers to… more
- Intermountain Health (Tallahassee, FL)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital....reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and… more
- Deloitte (Miami, FL)
- …pricing studies + Implement competitive vendor search and selection initiatives + Review of health plan renewals including assisting in rate negotiation, and ... medical and pharmacy + Prepare financial projections and rate development + Review health plan performance, including reviewing policy year settlements and premium… more
- NBC Universal (Miami, FL)
- …and actions closed in a timely manner. . Assists in the review /breakdown of production plans to identify potential EHS issues, eg, hazardous conditions ... laws and regulations. As necessary, assist Human Resources with Workers Compensation claims by individuals. . Assist operations with preparation and coordination of… more
- Kemper (Lake Mary, FL)
- …to our stakeholders that delivers on our promises._ **Position Summary:** Our Claims Litigation Specialist will investigate, evaluate and handle to conclusion ... all assigned litigated claims . The Litigation Specialist will have advanced...FL, and Henderson, NV **Position Responsibilities:** + Ability to review loss facts, including legal pleadings and new suits… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …Remote Position Type Full Time Job Category Pharmaceutical Description PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE Polaris Pharmacy Services is an industry ... Authorization Technicians to join the Polaris team. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected… more
- Elevance Health (Tampa, FL)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... issues of coding and DRG assignment accuracy. Specializes in review of DRG coding via medical record and attending...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines… more