• Medical Claims Adjudication - remote

    Cognizant (Tallahassee, FL)
    …duties as assigned by management. **Qualifications:** + A minimum of 2 years' claims processing experience is required. + Knowledge of physician practice and ... for payments, utilization review/quality assurance procedures. + Excellent problem-solving skill in healthcare claims adjudication. + Ability to work at a… more
    Cognizant (08/01/25)
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  • Claims and Call Auditor (Call Center QC)

    CHS (Clearwater, FL)
    …guidelines, and reporting requirements; Federal and state regulations; and timeliness of claims processing . + Utilize Excel, prepares tracking and trending ... up-to-date working knowledge on regulatory requirements associated with billing and claims processing , as well as HIPAA guidelines/established Encryption… more
    CHS (06/14/25)
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  • Claims Specialist, Audit & Contracting

    LogixHealth (Dania, FL)
    Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
    LogixHealth (07/11/25)
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  • Senior Analyst Pricing - Remote

    Prime Therapeutics (Tallahassee, FL)
    …analysis to include 3 years of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare , and/or related field + Previous experience ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
    Prime Therapeutics (08/13/25)
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  • Pricing Analyst Sr - Strong SQL/GCP - Remote

    Prime Therapeutics (Tallahassee, FL)
    …analysis to include 3 years of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare , and/or related field. + Previous experience ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
    Prime Therapeutics (08/01/25)
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  • Patient Claims Specialist

    Modernizing Medicine (Tampa, FL)
    …for all inbound and outbound patient calls regarding patient balance inquiries, claims processing , insurance updates, and payment collections + Initiate outbound ... in our mission to make a positive impact on healthcare . Join Us! + South Florida Business Journal, Best...related experience required + Basic understanding of medical billing claims submission process and working with insurance carriers required… more
    Modernizing Medicine (08/08/25)
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  • Customer Solutions and Claims Specialist

    Nestle (Palm Beach Gardens, FL)
    …and nutrition for patients and consumers. **POSITION OVERVIEW:** The Customer Solutions and Claims Specialist serves as the primary point of contact for the customer ... Identify and resolve demand capture failures to ensure timely processing . + Monitor and address account specific issues upon...rewards package, which includes a 401k with company match, healthcare coverage and a broad range of other benefits.… more
    Nestle (07/22/25)
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  • Claims Configuration, Product Owner

    Healthfirst (FL)
    …contract reimbursement terms, code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants ... and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital… more
    Healthfirst (07/18/25)
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  • Medicaid State Technology Lead

    Humana (Tallahassee, FL)
    …payor operations, technology, communications, and processes + Solid understanding of healthcare operations, particularly around claims processing , ... make an impact** **Required Qualifications** + Bachelor's degree in healthcare administration, public health, information systems, business, policy administration or… more
    Humana (08/19/25)
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  • Lead Analyst, Configuration Oversight - Payment…

    Molina Healthcare (St. Petersburg, FL)
    …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen.… more
    Molina Healthcare (07/24/25)
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