- Elevance Health (Tampa, FL)
- …by law._ **Carelon Payment Integrity** is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- The Hartford (Lake Mary, FL)
- Team Leader Claims - CH08AE We're determined to make a...world? What else can we do to destigmatize mental health in the workplace? Can we make our communities ... our team as we help shape the future. The Claims Team Leader will manage and direct claim investigation,...and execution of the investigation, disposition and settlement of claims , in compliance with corporate claim standards and procedures,… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...requirements. + Apply clinical criteria and policies to member/provider claims and coordinate clinical resolutions with MD support. **Performance… more
- MyFlorida (Ocala, FL)
- … Excellent retirement package and optional deferred compensation plan. Health , vision, dental, disability, and other supplemental insurance available at ... needed, interviewing veterans and family members, preparing and submitting claims for benefits to the US Department of Veterans...medical center at the request of the veteran or health care provider within 48 hours of the request.… more
- MyFlorida (Pensacola, FL)
- …Paid Bi-weekly Excellent retirement package and optional deferred compensation plan. Health , vision, dental, disability and other supplemental insurance available at ... needed, interviewing veterans and family members, preparing and submitting claims for benefits to the US Department of Veterans...medical center at the request of the Veteran or health care provider within 48 hours of the request.… more
- Molina Healthcare (FL)
- JOB DESCRIPTION Job Summary Leads and manages team responsible for claims activities including reviewing and resolving member and provider complaints, and ... oversees necessary correspondence in accordance with regulatory requirements. * Ensures claims production standards set by the department are met. * Maintains… more
- Highmark Health (Tallahassee, FL)
- …Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- BrightSpring Health Services (Gainesville, FL)
- …is focused on maintaining local compliance with state, federal, and BrightSpring Health requirements. The HR Specialist should have a full understanding of the ... relations with staff and management + Inform operations of worker's compensation claims process. Assist as needed with claim processing. Keep supervisors and… more
- MyFlorida (Alachua, FL)
- …Bi-weekly Excellent retirement package and optional deferred compensation plan. Health , vision, dental, disability, and other supplemental insurance available at ... needed, interviewing veterans and family members, preparing and submitting claims for benefits to the US Department of Veterans...and obtain information in order to prepare and submit claims for any and all federal and state benefits… more