- Centene Corporation (Tallahassee, FL)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... fresh perspective on workplace flexibility. **Position Purpose:** The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handles more… more
- BayCare Health System (Clearwater, FL)
- …+ Conduct thorough investigations by gathering relevant information, documentation, and medical records. + Triage, plan, and execute intake of Appeals and ... + Knowledge of health plan operations, benefit coverage, and claims processing. Familiarity with regulatory requirements governing grievance and appeal… more
- Elevance Health (Tampa, FL)
- **Financial Operations Recovery Process Specialist ** **Location:** _Virtual:_ This role enables associate to work virtually full-time, with the exception of required ... Capabilities, and Experiences:** + Previous experience in high-volume operations ( claims , customer service, enrollment and billing) strongly preferred. Please be… more
- Command Investigations (Lake Mary, FL)
- …business located in Lake Mary has an immediate need for a full-time Data Entry Specialist . In this role, you will be responsible for case referral intake from our ... written and verbal communication skills + Basic understanding of claims vocabulary + Investigative mindset (questioning the out of...High School diploma Benefits Include: + Full-time employment + Medical , dental and vision insurance + 401K + PTO… more
- Molina Healthcare (Jacksonville, FL)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical … more
- Insight Global (Coleman, FL)
- …representation, program coordination, medical coding or billing, appointment scheduling, medical claims processing, or administrative support within a ... Job Description * Coordinate and schedule off-site medical referrals * Enter referral data into patient...with client contracts and HIPAA * Manage and document medical records for off-site referrals * Facilitate weekly Utilization… more
- Mass Markets (FL)
- …sometimes even cars! + Health Benefits: Full-time employees are eligible for comprehensive medical , dental, and vision coverage after 60 days of employment, and all ... employees have access to MEC medical plans after just 30 days. Benefit options vary by location. + Retirement Savings: Secure your future with retirement savings… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …as staff meetings, Talent Management System (TMS) training and comply with specialist continuing medical education (CME) requirements timely. Other duties may ... Summary North Florida/ South Georgia VA Healthcare System's Medical Specialty Care Service is seeking an experienced...claimed by the applicant. [If the applicant does not claim an ECFMG certificate, facility officials must still confirm… more
- Allied Universal (Jacksonville, FL)
- … with red flags that suggest fraudulent behavior In relation to an Insurance claim . The SIU Specialist must use their extensive knowledge of Insurance policies ... Company Overview: Advance Your Career in Insurance Claims with Allied Universal(R) Compliance and Investigation Services....Fraud Claim Law Associate (FCLA) + Fraud Claim Law Specialist (FCLS) + Certified Protection… more
- Sedgwick (Orlando, FL)
- …to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to ... Inbound call center experience preferred. **Skills & Knowledge** + Knowledge of medical terminology + Understanding of claims management + Excellent oral… more