- Molina Healthcare (St. Petersburg, FL)
- …you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners ... Mastery * Track record coordinating cross-functional action plans with Enrollment, Claims , Pharmacy, Network, and Member Services * Hands-on experience maintaining… more
- Molina Healthcare (Orlando, FL)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... care experience + Experience in one or more of the following: Claims , Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.… more
- Molina Healthcare (Miami, FL)
- …leadership and direction to MMS Operational Units management staff (eg, Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care Provider ... equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high volume… more
- MyFlorida (Tallahassee, FL)
- …Number: 40099084 Salary: $20.70 Posting Closing Date: 10/31/2025 Total Compensation Estimator Tool (https://compcalculator.myflorida.com/) JOB TYPE: FULL TIME / OPS ... issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through… more
- MyFlorida (Fort Lauderdale, FL)
- …40099086 Salary: $20.70 Posting Closing Date: 09/28/2025 Total Compensation Estimator Tool (https://compcalculator.myflorida.com/) JOB TYPE: FULL TIME/OPS POSITION ... issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through… more
- Sedgwick (Orlando, FL)
- …and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Establishes FMLA claims ; tracks and codes documentation in accordance with internal workflow ... processes. + Analyzes FMLA and other paid leave claims to determine eligibility, certification, payment calculations, payments and/or adjustments in compliance with… more
- Sedgwick (Orlando, FL)
- …OF THE ROLE:** To provide excellent service displaying empathy to callers regarding claims for multiple lines of business, including but not limited to, expediting ... the claims process, and providing detailed claim notes on all...required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions… more
- Elevance Health (Tampa, FL)
- …in order to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health insurance policies, ... health insurance claims handling and provider network contracting. **How will you...in good faith believes is the range of possible compensation for this role at the time of this… more
- Elevance Health (Tampa, FL)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses...in good faith believes is the range of possible compensation for this role at the time of this… more
- MyFlorida (Tallahassee, FL)
- …$59,000 - $62,000 Posting Closing Date: 09/02/2025 Total Compensation Estimator Tool (https://compcalculator.myflorida.com/) Health Insurance Fraud Analyst II ... design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data… more