- Humana (Tallahassee, FL)
- …PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare ... policies and internal controls, and communicating issues and recommendations to management . Coordinates implementation and compliance with corrective action… more
- Sedgwick (Tallahassee, FL)
- …the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating ... Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach,… more
- Carnival Cruise Line (Miami, FL)
- …team to assess fitness for duty per International Maritime Health standards. + **Crew Medical Claims Management ** + Escalate high- risk crew cases to risk ... management . + Conduct quality assurance and patient satisfaction audits to ensure compliance and continuous improvement. + **Team Management ** + Coach and… more
- AdventHealth (Maitland, FL)
- …Manages Quality and Risk and understands and applies quality assurance and risk management procedures in all areas of work performed Identifies and solves ... Risk and understands and applies quality assurance and risk management procedures in all areas of...provider types Managed Care, Patient Financial services, health insurance claims processing, contract management , or medical economics… more
- Carnival Cruise Line (Miami, FL)
- …fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management ** + Review crew cases of high risk and escalate to the ... attention of risk management and the case management (MD), clinical.... + Conduct audits and quality checks to ensure compliance and continuous improvement. + **Team Management **… more
- Sedgwick (Orlando, FL)
- …or college preferred. **Experience** Three (3) years of benefits or disability case/ claims management experience or equivalent combination of education and ... (SSDI), and other disability offsets. + Medically manages disability claims ensuring compliance with duration control guidelines...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Sedgwick (Orlando, FL)
- …on state regulations. **Experience** Three (3) years of benefits or disability case/ claims management experience or equivalent combination of education and ... regarding return to work. + Medically manages complex disability claims ensuring compliance with duration control guidelines...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Sedgwick (Orlando, FL)
- …on state regulations. **Experience** Three (3) years of benefits or disability case/ claims management experience or equivalent combination of education and ... regarding return to work. + Medically manages complex disability claims ensuring compliance with duration control guidelines...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Sedgwick (Orlando, FL)
- …combination of education and experience required. One (1) year of benefits or claims management experience preferred. **Skills & Knowledge** * Excellent oral and ... on the ADA, state, and/or client requirements. Processes ADA claims ensuring compliance with duration control guidelines,...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Molina Healthcare (St. Petersburg, FL)
- **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with ... forecast funding needs, and evaluate ROI on the covered benefits and its management + Oversees vendor performance, compliance , and satisfaction, with a focus… more