- Evolent (Tallahassee, FL)
- …to find the most valuable defects. The IQA reports to a associate director or a manager . One or many IQAs may be engaged in any testing effort **What You Will Be ... risks and issues in coordination with the lead / manager for status reporting + Responsible to enforce department...Knowledge of Medicare, Medicaid, Commercial Plans and understanding on claims workflow, members, providers + A minimum of 1… more
- Walgreens (Davie, FL)
- …Co. Pharmacy Code of Conduct. + Performs duties as assigned by Pharmacy Manager , Staff Pharmacist and Store Manager including utilizing pharmacy systems to ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more
- Walgreens (Wellington, FL)
- …Co. Pharmacy Code of Conduct. + Performs duties as assigned by Pharmacy Manager , Staff Pharmacist and Store Manager including utilizing pharmacy systems to ... pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient… more
- USAA (Tampa, FL)
- …P&C Claims Operations and/or Optimization experience. + 2+ years of MCO ( Manager , Claims Operations) experience. + Deep operational knowledge of end-to-end ... claims processes. + Demonstrated knowledge of new and emerging...color, religion, sex, sexual orientation, gender identity, national origin, disability , or status as a protected veteran._ **If you… more
- Elevance Health (Tampa, FL)
- …I** is responsible for accurate and timely maintenance of provider information on claims and provider databases. **How You Will Make an Impact** Primary duties may ... but are not limited to: + Assists in synchronization of data among multiple claims systems and application of business rules as they apply to each database. +… more
- Elevance Health (Tampa, FL)
- …healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, ... and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying and developing enterprise-wide specific… more
- Elevance Health (Miami, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … 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 ... fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately… 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...bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance,… 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 ... fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately… more