- Molina Healthcare (Jacksonville, FL)
- …Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management, and other business partners to… more
- Elevance Health (Tampa, FL)
- **Clinical Documentation and Claims Integrity Director ** **Location:** Alternate locations may be considered. This position will work a hybrid model ( remote ... home-care and community based services. The **Clinical Document Improvement Director ** is responsible for leading encounter processing, diagnostic documentation and… more
- Molina Healthcare (Tampa, FL)
- …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners… more
- Molina Healthcare (Tampa, FL)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions. + Monitors and enforces compliance with… more
- Molina Healthcare (Miami, FL)
- …5 years of experience in Medicare, DSNP and CSNP population, Enrollment, A&G, Claims , Compliance, or other Operations experience To all current Molina employees: If ... you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 -… more
- Molina Healthcare (Tampa, FL)
- …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
- Wounded Warrior Project (Jacksonville, FL)
- …started, we're ready for you. The Wounded Warrior Project (WWP) National Service Director leads and develops a team of benefits professionals who support warriors, ... (VBA) and Veterans Health Administration (VHA). The National Service Director sets priorities, upholds standards, and enforces accountability to ensure… more
- Humana (Tallahassee, FL)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Norstella (Tallahassee, FL)
- Sr. Director , RWD Analytics and Innovation (Healthcare & Life Sciences) Company: Norstella Location: Remote , United States Date Posted: Jul 30, 2025 Employment ... India. **Job Description :** We are seeking a dynamic and visionary Senior Director of RWD (Real-World Data) Analytics and Innovation to lead real-world data special… more
- Humana (Tallahassee, FL)
- …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the appropriateness of services… more
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