- CVS Health (Tallahassee, FL)
- …abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and ... during interactions with internal and external partners. + Provide Trial Testimony in support of Criminal or Civil proceedings. + Gives presentations to internal and… more
- Molina Healthcare (Miami, FL)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external… more
- Molina Healthcare (Orlando, FL)
- …and test analytics, enforcing test quality standards, and providing whole project support and oversight. In addition to integration with other projects. Responsible ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
- Molina Healthcare (FL)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** +… more
- Molina Healthcare (St. Petersburg, FL)
- …thought partner to health plan leadership and provide well-reasoned recommendations that support short- and long-term business goals. + Partners with Network to ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Zelis (St. Petersburg, FL)
- …that shape who you are. Position Overview At Zelis, the Clinical Dispute Analyst role is responsible for the resolution of facility and provider disputes as ... will be responsible for reviewing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence...matter expert for content and bill reviews and provide support where needed for inquiries and research requests. +… more
- HCA Healthcare (Pensacola, FL)
- …Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. ... banking partnerships + Education assistance (tuition, student loan, certification support , dependent scholarships) + Colleague recognition program + Time Away… more
- Highmark Health (Tallahassee, FL)
- …to work closely with the section's Accountant, Accounting Coordinators, Associate Analyst , providing, guidance, feedback, training, motivation, and support . This ... of Quote to ID card status to customers, including Groups, Sales and Support teams within the company. Responsible for resource planning, budget compilation and… more
- Prime Therapeutics (Tallahassee, FL)
- …that may drive the creation of new data assets or information exchange in support of business needs. + Creates and/or guides the creation of database tables, ... years of work experience. + Prior experience as a Business Intelligence Developer/ Analyst or Data Analyst supporting business intelligence, reporting, analytics… more
- Air National Guard Units (Tyndall AFB, FL)
- …to qualify for this position, you must provide transcripts or other documentation to support your Educational claims . To receive credit for Education, you must ... and optimum use of resources. Sets policy, directs and monitors support and related programs including planning and programming, funds distribution and… more