• Disability Clinical Specialist

    Sedgwick (Orlando, FL)
    …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
    Sedgwick (10/10/25)
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  • AdventHealth West Florida Division Women's…

    AdventHealth (Tampa, FL)
    AdventHealth West Florida Division Women's Services Institute is seeking a Medical Director. The director's medical specialty can be OB/Gyn, Maternal Fetal ... all Ob/Gyn practices in West Florida. + In collaboration with AdventHealth Medical Group (AHMG) leadership, addresses clinical, behavior or operational concerns with… more
    AdventHealth (11/05/25)
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  • Marine Investigator

    Sedgwick (Tallahassee, FL)
    …as it relates to policy language and advises client of the outcome. + Handles medical claims (under P&I coverage) from beginning to end requesting medical ... Insurance Marine Investigator **PRIMARY PURPOSE** **:** To perform detailed admiralty claims investigation and analysis through examination of the loss, collection… more
    Sedgwick (11/25/25)
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  • Bill Review Analyst | Professional Liability…

    Sedgwick (Jacksonville, FL)
    …PURPOSE** : The Bill Review Analyst plays a critical role in supporting the medical malpractice claims team by ensuring legal invoice accuracy, compliance, and ... **ESSENTIAL FUNCTIONS AND RESPONSIBILITIES** + Reviews legal invoices associated with medical malpractice claims to verify accuracy, reasonableness, and… more
    Sedgwick (11/18/25)
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  • VP, Medical Economics

    Molina Healthcare (FL)
    …executive level strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data ... initiatives and strategy. **Essential Job Duties** * Regularly unpacks detailed medical cost information to identify significant trends development and underlying… more
    Molina Healthcare (11/21/25)
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  • Medical Director, Medicare Grievances

    Humana (Tallahassee, FL)
    …and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
    Humana (11/19/25)
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  • Code Edit Disputes Medical Coder

    Humana (Tallahassee, FL)
    …Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The ... Medical Coding Coordinator performs advanced administrative, operational, and customer...apply intermediate mathematical skills. **Where you Come In** The Medical Coding Coordinator extracts clinical information from a variety… more
    Humana (11/14/25)
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  • Negotiator Analyst (Level I)

    CVS Health (Tallahassee, FL)
    …**Position Summary** The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves ... metrics **Required Qualifications** + 3-5 years of experience in a medical claim background with demonstrated ability and strong understanding of benchmarking… more
    CVS Health (11/27/25)
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  • Coding and Reimbursement Specialist

    Elevance Health (Miami, FL)
    …Code (CPC or CCS-P) required. **Preferred Skills, Capabilities, and Experiences:** + Claims processing experience preferred. + Knowledge of medical terminology ... and Reimbursement Specialist** is responsible for reviewing, auditing, and coding medical records for the purpose of reimbursement, training, education and… more
    Elevance Health (11/19/25)
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  • Medical Trend Analytics Manager 1

    Baylor Scott & White Health (Tallahassee, FL)
    …(Commercial, DTE, Medicare, and Medicaid). Candidate will oversee extracting and analyzing medical and pharmacy claims data, translating output into business ... **JOB SUMMARY** 100% remote position** The Medical Trend Analytics Manager 1 is responsible for...with excellent healthcare business acumen and communication skills. The Medical Trend Analytics Manager 1 manages a team that… more
    Baylor Scott & White Health (11/26/25)
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