- Point32Health (FL)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be ... IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Prime Therapeutics (Tallahassee, FL)
- …claims , contracting and pharmacy reimbursement. Works directly with business partners across the enterprise. **Responsibilities** + Executes compliance procedures ... every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry &...as assigned **Education & Experience** + Bachelor's degree in business , healthcare , or related area of study,… more
- Evolent (Tallahassee, FL)
- …analyses into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based ... reason why diversity and inclusion are core to our business . Join Evolent for the mission. Stay for the...bundled payments, etc. is preferred + Working knowledge of healthcare claims ; specifically, differences between institutional vs… more
- The Cigna Group (Sunrise, FL)
- …+ **Bachelor's degree strongly preferred in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered ... the office or visit Providers 3 days per week The **Provider Contracting Lead Analyst ** serves as an integral member of the Provider Contracting Team and reports to… more
- Healthfirst (FL)
- …with supervisor and peers to establish goals, priorities and deliverables of Business / Project Analyst team. Ensurelong-term strategic and short-term tactical ... own optimal performance as well as performance of the Business /Project Analyst team. + Regularly meet with...any area of operations (Member Services, Enrollment & Billing, Claims , Provider Services, etc.). + Experience with database reporting… 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 ... in varied and complex data; and articulates analytic findings, business implications, and recommendations to realize identified opportunities. **ESSENTIAL… 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
- 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)
- …Qualifications** **REQUIRED QUALIFICATIONS:** + At least 7 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) ... coordination, and ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** ** Business Leadership & Operational Ownership**… more