- Citigroup (Jacksonville, FL)
- The Fraud Ops Sr Analyst is a senior level positions responsible for contributing to the development of fraud management policies, processes and procedures to ... of advanced statistical models + Proven experience in the Investigation and Fraud claims process + Experience in trend analysis and alerts in early fraud detection… more
- Cardinal Health (Tallahassee, FL)
- …data from multiple sources (eg, Salesforce, Trella Insights, Definitive Healthcare, claims feeds, internal CRM/ERP) to deliver clear, actionable insights that ... Ensure HIPAA/privacy safeguards and appropriate minimum necessary use of PHI/ claims . + Define and operationalize Reach (# of targeted...benefits and programs to support health and well-being. + Medical , dental and vision coverage + Paid time off… more
- CVS Health (Tallahassee, FL)
- …insights and present findings to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in SQL & Python coding ... We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a...investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate… more
- Highmark Health (Tallahassee, FL)
- …data. This position routinely utilizes data including, but not limited to: medical /surgical physician and institutional claims and encounters, clinical data, ... robust analytical and financial analysis capability for Highmark's pharmacy and medical benefit specialty drug management programs. Furthermore, the incumbent will… more
- Sedgwick (Jacksonville, FL)
- …best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing ... years of related experience to include one (1) year as an Account Coordinator, analyst , associate or three (3) years adjuster experience. **TAKING CARE OF YOU** +… more
- Public Consulting Group (Tallahassee, FL)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... + Provides leadership, management, and direction to the Quality Assurance Analyst team. + Leads and manages department providing oversight on operations,… more
- ChenMed (Miami, FL)
- …in this role assists with the strategic alignment and oversight of claims assembly and submission processes. In close collaboration with Billing, Coding, IT, ... serves as a subject matter expert on risk-adjustment and medical economics to aid in the development of revenue...minimum of five (5) years of direct hands-on process analyst experience in a relevant technical process role; including… more