- Molina Healthcare (Jacksonville, FL)
- …of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation to the...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… more
- CVS Health (Plantation, FL)
- …- Familiarity with medical terminology. - Hands on experience in end-to-end medical claims processing. - Knowledge of the ACAS system. **Education** **-** ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- Humana (Tallahassee, FL)
- …skills to make an impact** **Required Qualifications** **5+ years of medical claims processing/auditing or encounter data management experience** **Demonstrated ... team leadership experience** **Demonstrated experience in managing projects effectively** ** Medical claims experience** **Additional Information** **_This position… more
- UNUM (Tallahassee, FL)
- …Physical Medicine and Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across ... Unum US product lines. The incumbent provides high quality, timely, and efficient medical consultative services to the Benefits Center. The Medical Consultant… more
- University of Miami (Miami, FL)
- …potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. + Conduct additional investigation ... reportable events and prepare submission for approval by Associate Medical Risk management Officer and the Chief Medical...and physicians in sensitive situations involving actual or potential claims . + Analyze and trend data as captured through… more
- Molina Healthcare (Tampa, FL)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program… more
- Sedgwick (Tallahassee, 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
- MyFlorida (Bunnell, FL)
- …or dental clerical experience. Knowledge of determining financial eligibility. Knowledge of processing medical or dental claims . Knowledge of working medical ... involve processing Medicaid HMO's, Medicare and third party/commercial insurance claims . Responsible for reviewing insurance web portals for eligibility,… more
- Humana (Tallahassee, FL)
- …to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing ... and researching medical claims + Proficient in Microsoft Office (Word, Excel, Access, PowerPoint) + Working knowledge of SQL + Familiarity with EDI X12 formats… more
- CHS (Clearwater, FL)
- …**Education and/or Experience:** + High school graduate or equivalent. + Knowledge of medical terminology, billing, claims and the health insurance industry is ... **Overview** ** ** ** Medical Insurance Call Center Representative | Member and...Time employees can enjoy: * Health Coverage: Two flexible medical plans. * Dental & Vision: Comprehensive coverage by… more