• Director , Appeals & Grievances (Medicare…

    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
    Molina Healthcare (07/18/25)
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  • Director , Initial Claims

    Humana (Tallahassee, FL)
    …a part of our caring community and help us put health first** The Director , Initial Claims supports providers, members, and collection services in the processing ... adjudicating claims , along with researching and resolving claims inquiries. The Director , Initial Claims...will be up to once a quarter.** Work at Home/ Remote Requirements **Work-At-Home Requirements** + To ensure Home or… more
    Humana (08/09/25)
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  • Director Business Process Ownership…

    USAA (Tampa, FL)
    …a dedicated Director Business Process Ownership - Advanced Capabilities - Claims Optimization. This role is remote eligible, however, individuals residing ... efficient and effective processes. **What sets you apart:** + Demonstrated P&C claims technical acumen + Demonstrated knowledge of new and emerging industry… more
    USAA (08/09/25)
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  • Sr. Claims Specialist - Complex…

    Zurich NA (Tallahassee, FL)
    … Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-MD1 #LI- DIRECTOR #LI- REMOTE EOE Disability / Veterans ... Sr. Claims Specialist - Complex Construction 126105 Zurich North...North America is seeking a skilled and experienced Senior Claims Specialist to join our Complex Liability Claims more
    Zurich NA (08/08/25)
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  • Director , Operational Oversight…

    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 (07/13/25)
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  • Director , Enrollment (Duals)…

    Molina Healthcare (Orlando, 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 (08/08/25)
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  • Director , Operational Oversight - Medicare…

    Molina Healthcare (Jacksonville, 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 (07/19/25)
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  • Director , Applications (AI/Azure…

    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
    Molina Healthcare (06/29/25)
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  • National Service Director

    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
    Wounded Warrior Project (06/14/25)
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  • Medical Director - Florida

    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
    Humana (07/29/25)
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