- Humana (Tallahassee, FL)
- …community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to ... data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work with… more
- USAA (Tampa, FL)
- …assistance is not available for this position. **These positions will support Claims Litigations.** **What you'll do:** + Develop and implement strategic customer ... to collect and analyze data. **What sets you apart:** + P&C Litigation Claims Operations and/or Optimization experience. + 2+ years Manager, Claims Operations… more
- Sedgwick (Orlando, FL)
- …combination of education and experience required to include two (2) years of claims management, managed care or other related experience. **Skills & Knowledge** + In ... depth knowledge of claims management, managed care and/or absence management processes and...required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions… 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)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with… more
- Prime Therapeutics (Tallahassee, FL)
- …is responsible for the synthesis of data findings in support of clinical claims and programs. **Responsibilities** + Synthesizes a wide variety of data and outputs ... in producing reports, scorecards, or other data using Pharmacy and/or Medical claims data to support projects and initiatives throughout the Integrated Care &… more
- Elevance Health (Miami, FL)
- …the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How ... audits. + Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment &… more
- Prime Therapeutics (Tallahassee, FL)
- …with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness & ... accuracy of Prime's financial pricing programs against adjudicated claims to identify trends and draw insights to provide pricing recommendations + Apply… more
- Zurich NA (Maitland, FL)
- …School Diploma or Equivalent and 10 or more years of experience in the Claims or Underwriting Support area OR + Zurich Certified Insurance Apprentice including an ... and 8 or more years of experience in the Claims or Underwriting Support area OR AVP, Underwriting Director...and experience. We follow local laws to ensure fair compensation . You may also be eligible for bonuses and… more