- Centene Corporation (Tallahassee, FL)
- …and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to ... outcomes. + Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data. + Support execution of large-scale… more
- Elevance Health (Miami, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Centene Corporation (Pembroke Pines, FL)
- …development coding, auditing, data information and gathering insights is highly preferred. Healthcare experience with provider and claims data analysis is ... and outcome measurement. + May include: + Financial, pharmacy, claims , provider, and member data. + IRS, CMS, HHSC,...and generate reports through MS-Excel, MS-Access, and SQL using Business Objects interface and direct links to core databases… more
- CVS Health (Tallahassee, FL)
- …**Required Qualifications** + 3-5 years of data interpretation and analysis experience. + Healthcare background. + Experience with internal claims data and ... for the validation of existing fraud waste and abuse business rules and leads designed to detect aberrant billing...to determine the impact of the scheme on Aetna business . + Keep current with new and emerging fraud,… more
- Molina Healthcare (Jacksonville, FL)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. Provides technical expertise,… more
- CVS Health (Tallahassee, FL)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a...skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,… more
- CVS Health (Tallahassee, FL)
- …**Position Summary** The Senior Manager Analytic Consultant is an experienced customer-facing analyst who supports the Account Team's ability to craft a compelling ... and actionable information. This role is responsible for medical claims and economics reporting and analytics for a book...collaborate with field leaders, making certain to understand their business retention and growth objectives and how the work… more
- Highmark Health (Tallahassee, FL)
- …degree + 10-15 years experience in support of a Marketing function or Data Analyst role or in a business environment with responsibility for application of ... Support Analyst or equivalent training and experience in a business , specialty pharmacy, clinical pharmacy or clinical environment with direct responsibility for… more
- Elevance Health (FL)
- …care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. The **Senior ... Health Economist (** Advanced Analytics Analyst Senior) measures financial performance of core Carelon products leveraging claims , authorization, and membership… more
- ChenMed (Miami, FL)
- …independent judgment **EDUCATION AND EXPERIENCE CRITERIA:** + Bachelor's Degree in healthcare administration, business administration, finance or related field ... maximize cash flow through the creation of effective, scalable business . The incumbent in this role assists with the...role assists with the strategic alignment and oversight of claims assembly and submission processes. In close collaboration with… more