- Graybar (Fort Pierce, FL)
- …policies + Handle customer complaints promptly and effectively, and report potential claims + Keep management informed of local competition and market conditions + ... Reimbursement** and **Career Development Programs** . + And **More Perks** that support your well-being and career growth. Benefit eligibility may vary across… more
- CVS Health (Tallahassee, FL)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... Care Management, PCP and other key players to discuss service needs and support safe transitions. - Follows members identified as inpatient in hospitals (whether… more
- Pearl Interactive Network (Tallahassee, FL)
- …The **Customer Service Representative** is responsible for providing exceptional support to members and potential members during the open enrollment ... + Navigate pre-scripted responses, read them verbatim to provide basic and claims -specific information, and ensure callers receive accurate details. + Perform other… more
- Evolent (Tallahassee, FL)
- …engineers in designing, building, integrating and maintaining data pipelines to support healthcare data integration and operations. This role involves managing data ... as HIPAA, as well as healthcare systems and domains (FHIR/HL7, EMR/EHR, Claims , Members, Providers, Payors, etc.). + Experience with designing and implementing… more
- WESCO (Groveland, FL)
- …As the Senior Warehouse Admin you will provide operational and administrative support at the facility level. This includes counting stock, processing and running ... + Maintain return authorization and credit memo forms + File and research freight claims when appropriate + Assist with building maintenance and security + Run and… more
- Baker Construction (Fort Myers, FL)
- …scoping documents, terms and conditions, delivery, etc. as applicable to support the procurement process + Generates requests for proposal(s), solicits and ... to identify and determine impact of potential contract changes, disputes, and claims + Leads LEAN/SQP committee and identifies improvement opportunities + Ensures… more
- Deloitte (Tallahassee, FL)
- …pharmacies and patients. + Prepare self-insured financial projections and support health plan management, including financial reporting, premium rate setting, ... by reviewing services, contracts, performance guarantees, and renewals. + Analyze claims utilization data and assess health plan performance against strategy. +… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …as well as knowledge of the interconnection between Utilization Management, claims , and regulatory requirements to respond to complex and/or escalated inquiries. ... with business partners such as providers, facilities, and vendors to support program effectiveness. + Uses Utilization Management system platform with proficiency.… more
- Humana (Tallahassee, FL)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- Marriott (Fort Lauderdale, FL)
- …* Works with the unemployment services provider to respond to unemployment claims . * Attends unemployment hearings and ensures property is properly represented. * ... to Standard and Local Operating Procedures (SOPs and LSOPs) and support the Peer Review Process. **Managing Human** **Resources Communication** * Communicates… more