- Elevance Health (Tampa, FL)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately… more
- Cognizant (Tallahassee, FL)
- …satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify due process was followed. Determine if the appeal ... or Grievance is legitimate. A strong understanding of Claims , Appeals and Medical Benefits. Referring suspicious or complicated Claims to investigators.… more
- Elevance Health (Miami, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …basic life, accidental death & dismemberment, short-term and long-term disability insurance , tuition reimbursement, student loan assistance, a generous 401(k) match, ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Allegion (Orlando, FL)
- …and approving of branch personnel expense reports + Manage all workman's comp claims and participate in depositions pertaining to claims against the branch ... policies are being followed and manage all vehicle damage claims . + Participate in the weekly Field Manager's Call,...**You'll** **Get from Us:** + Health, dental and vision insurance coverage, helping you "be safe, be healthy". +… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …basic life, accidental death & dismemberment, short-term and long-term disability insurance , tuition reimbursement, student loan assistance, a generous 401(k) match, ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …basic life, accidental death & dismemberment, short-term and long-term disability insurance , tuition reimbursement, student loan assistance, a generous 401(k) match, ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more
- Molina Healthcare (FL)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Elevance Health (Tampa, FL)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related questions… more
- Carnival Cruise Line (Miami, FL)
- …planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to duty. + ... to assess fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk and escalate to the… more