- CVS Health (Tallahassee, FL)
- …attention to detail **Preferred Qualifications** Healthcare/Pharmacy Experience Knowledge of medical /pharmacy claims Salesforce Experience **Education** HS or ... and external partners. Responsibilities include reviewing insurance benefits (both medical and pharmacy), claim history review, maintaining complete, timely, and… more
- Deloitte (Miami, FL)
- …and business terms) with PBMS + Experience performing analytical analysis of medical & pharmacy claims , including understanding financial impact of network ... emerging trends and cost drivers + Work directly with medical and PBM vendors to analyze the program offering...in rate negotiation, and analyzing financial terms for both medical and pharmacy + Prepare financial projections and rate… more
- TEKsystems (Daytona Beach, FL)
- …United States Responsibilities: + Loss Drafts Associates will assist customers with claims on their homeowner's insurance. + The specialist manages the loss claim ... the benefits available for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement… more
- Command Investigations (Jacksonville, FL)
- …hire. Visit our website and find out why at www.GoCommand.com . The Claims Investigator should demonstrate proficiency in the following areas: + AOE/COE, Auto, or ... include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: + Medical , dental and vision insurance + 401K + Extensive performance bonus program… more
- Command Investigations (FL)
- …Visit our website and find out why at www.GoCommand.com . The Claims /Surveillance Investigator should demonstrate proficiency in the following areas: + AOE/COE, ... to advanced, experienced, Investigators pay in the industry + 401(k) + Health Insurance: Medical , Dental, Vision + Paid time off + Paid Travel Time + Paid Daily… more
- Elevance Health (Tampa, FL)
- …for fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Provider Auditor II i** s responsible for… more
- Elevance Health (Tampa, FL)
- …for fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Provider Auditor II** is responsible for… more
- Sedgwick (Orlando, FL)
- …time frames, and claims status either by phone, written correspondence and/or claims system. * Reviews medical information to determine if the claimant meets ... 12650 Ingenuity Dr Orlando FL 32826 **PRIMARY PURPOSE:** To process claims and determine accommodation options following written guidelines and procedures pursuant… more
- Sedgwick (Jacksonville, FL)
- …and analyzing the responses. + Requests physician certification and/or extensions from medical offices and enters into claims system. + Documents telephone ... or payment information to clients and claimants. + Enters claims data into claims management system upon...conversations pertinent to the claims process in claims notes. + Logs… more
- AdventHealth (Maitland, FL)
- …language as it relates to reimbursement methodologies Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ... relates to reimbursement methodologies + Applies detailed understanding of medical coding systems affecting the adjudication of claims... medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG… more