- CVS Health (Tallahassee, FL)
- …to work EST time zone hours.** **Position Summary** We are hiring a Senior Analyst to support the Complaint, Grievances and Appeals (CG&A) team. This position will ... and have experience troubleshooting data cleaning workflows. + Experience working in claims or appeals analytics. + Ability to communicate and translate technical… more
- Healthfirst (FL)
- …peers to establish goals, priorities and deliverables of Business/ Project Analyst team. Ensurelong-term strategic and short-term tactical Operational needs for ... ensure their own optimal performance as well as performance of the Business/Project Analyst team. + Regularly meet with supervisor, peers, and stakeholders to drive… more
- CVS Health (Tallahassee, FL)
- …+ Healthcare Insurance and PBM knowledge including Prior Authorizations, Claims , Rebates, Network contracting, Sales, Call Center Ops and Pharmacy Ops + ... day. **Position Summary** CVS Health is looking for an experienced Business Analyst , QA and Technical SME with focus on balancing high-impact business management… more
- CVS Health (Tallahassee, FL)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- Highmark Health (Tallahassee, FL)
- …and/or create analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality of ... to identify, develop and/or monitor actionable opportunities for improving health and healthcare outcomes and clinical quality and costs of care, efficiently and… more
- CVS Health (Tallahassee, FL)
- …setup, essential for online viewing and processing, related to customer service, claims , enrollment, billing, and reporting, in support of internal and external ... level benefits to align with industry coding (ICD 10, place of service, healthcare reform, etc.), similar to entry-level IT programming. + Solicits and assesses… more
- CVS Health (Tallahassee, FL)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- Molina Healthcare (FL)
- …trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- HCA Healthcare (Pensacola, FL)
- **Description** **Introduction** Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with purpose and ... on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny… more
- Molina Healthcare (FL)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + Reviews regulatory… more