- Elevance Health (Miami, FL)
- …necessary, to determine root cause and appropriate resolution. + Must work with Claims Operations to remediate impacted claims . **Minimum Requirements:** + ... or GED and a minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Evolent (Tallahassee, FL)
- …analyses into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based ... RVUs, bundled payments, etc. is preferred + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing… more
- MyFlorida (Tallahassee, FL)
- …design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data ... limited to, the following: * Identify suspicious patterns in claims data and other sources by applying your knowledge...criminal actions. * Build queries in support of PIU operations and the maintenance of data integrity for PIU… more
- Publix (Lakeland, FL)
- …in the business and directly influence how we manage risk across our retail operations in eight states. This is a corporate counsel role, ideal for someone who ... wide range of liability matters including premises, fleet, pharmacy, and product claims . + Develop and refine internal litigation processes and policies for… more
- Carnival Cruise Line (Miami, FL)
- …role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management. The Manager leads a team of specialists to ensure ... reviewing care plans, coordinating with internal stakeholders, supporting disability claims , and facilitating return-to-work planning. The Manager also escalates… more
- ChenMed (Miami, FL)
- …and prioritize opportunities, and spot trends + Extensive knowledge of healthcare /medical economics data such as hospital/physician /ASC claims , utilization ... the primary medical cost analytics consultant to our Finance, Clinical, Operations , and Specialty Care leadership and will make data-driven strategy recommendations… more
- Evolent (Tallahassee, FL)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... Bachelor's degree, preferably with a quantitative major (eg actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health… more
- Zelis (St. Petersburg, FL)
- …of the Expert Claims Review (ECR) department is responsible for daily operations and team management of the DRG product. The Manager, DRG Validation will be ... So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more… more
- Carnival Cruise Line (Miami, FL)
- …role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management. The Manager leads a team of associates and ... planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to duty. +… more
- Evolent (Tallahassee, FL)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more