- Elevance Health (Tampa, FL)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible for… more
- Intermountain Health (Tallahassee, FL)
- …and applicable regulations. **Skills** + Pharmacy + Pharmacy Benefits Management (PBM) + Medical Prescriptions + Pharmacy Claims + Customer Service + Problem ... Resolution + Phone Calls (Inbound/Outbound) + Oral Communication + Written Communication + Group Problem Solving + Medicare Part D + Medicaid + Mentorship/Coaching + Decision Making + Microsoft Excel **Minimum Qualifications:** + Pharm D. degree or Masters… more
- Humana (Tallahassee, FL)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- MyFlorida (Tallahassee, FL)
- …* Experience in auditing, data analysis, or fraud detection. * Knowledge of claims processing and medical terminology. * Experience in creating, supporting, or ... design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data… more
- The Cigna Group (Tampa, FL)
- …channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, ... Cigna's competitive position. + Creates and manages initiatives that improve total medical cost and quality. + Drives change with external provider partners by… more
- The Cigna Group (Sunrise, FL)
- …channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, ... and maintain Cigna's competitive position. + Supports initiatives that improve total medical cost and quality. + Drives change with external provider partners by… more
- Sedgwick (Orlando, FL)
- …Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets ... PURPOSE** **:** To manage claim caseload of basic to highly complex claims within granted authority level including related financial implications, along with… more
- Elevance Health (Miami, FL)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... into effective and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management CPT codes.… more
- CVS Health (Tallahassee, FL)
- …for complaints and appeals received by the organization. This includes denied claims , coverage issues, medical necessity, service quality, or other concerns ... Excel, PowerPoint, Outlook). **Preferred Qualifications** + Prior experience working with claims . + Prior experience in health insurance. + Prior experience in… more
- Travelers Insurance Company (Tampa, FL)
- …bills, mail and wage statements. Prints and prepares claim documents for legal and medical reviews. Reports and assigns claims , and transitions closed files to ... professionals in multiple departments to assist with the timely resolution of claims , which may include: Properly documents claim files, including notes and diaries,… more