- Elevance Health (Tampa, FL)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches...dealing with Healthcare Fraud Please be advised that Elevance Health only accepts resumes for compensation from agencies that… more
- MyFlorida (Tallahassee, FL)
- …features a highly competitive set of employee benefits including: * State Group Insurance Coverage Options, including health , life, dental, vision, and other ... Bureau of Fiscal Agent Operations to ensure that the claims processing system has the correct edits and audits...- Two years of experience working with a Medicaid health plan or Pharmacy Benefits Manager (PBM).… more
- Elevance Health (FL)
- ** Manager II Grievance/Appeals** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... unless an accommodation is granted as required by law._ The ** Manager II Grievance/Appeals** responsible for management oversight of grievances and appeals… more
- Community Health Systems (Naples, FL)
- …Offer** + Competitive Compensation + Comprehensive Benefits: Medical, Dental, Vision, Life Insurance + Generous PTO & Extended Illness Bank (EIB) + Career ... inappropriate care. + Serve as the primary liaison with CHS Corporate for insurance and legal program coordination. **Patient Safety & Incident Oversight** + Lead… more
- NTT America, Inc. (Tallahassee, FL)
- … and the corporate insurance group as regards to high value insurance claims , to ensure that documentary information has been collected, secured, and ... developing, monitoring, and enforcing the corporate-wide personnel safety, environmental, health and regulatory management programs. This position has the...preserved so that claims will be resolved in a timely manner as… more
- Elevance Health (Miami, FL)
- …week. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations._ Carelon Payment Integrity is a proud member of the Elevance ... Health family of companies, Carelon Insights, formerly Payment Integrity,...dollar volume of provider. + Analyzes data to select claims to be reviewed, conducts reviews using medical charts,… more
- Elevance Health (Miami, FL)
- …in multiple states. **Preferred Skills, Capabilities, and Experiences:** + Certification as a Case Manager is preferred. + BS in a health or human services ... **Telephonic Nurse Case Manager II** **Location:** This role requires associates to...monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically… more
- Option Care Health (Tallahassee, FL)
- …market data. Pay Range is $16.69-$27.82 **Benefits:** -401k -Dental Insurance -Disability Insurance - Health Insurance -Life Insurance -Paid Time off ... + Supports the ongoing activities needed to ensure clean claims on hold and denial management (follow-up on paperwork...-Vision Insurance _Option Care Health subscribes to a policy of equal employment opportunity,… more
- Sedgwick (Tallahassee, FL)
- …guidelines. + Maintains ongoing communication with the client, Client Service Director, and Claims Examiner until the assigned Field Case Manager arrives onsite. ... apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge...dental, vision, 401k and matching, PTO, disability and life insurance , employee assistance, flexible spending or health … more
- WTW (Tampa, FL)
- …experience in professional services, ideally gained in a benefit consulting/brokerage firm or health underwriting / actuarial function of an insurance company + ... **Description** As a Health and Benefits Associate you will contribute to... and benefit programs. You will support the project manager on select projects, interface with vendors and key… more