- Elevance Health (Tampa, FL)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- CHS (Clearwater, FL)
- … claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...Examiner queues waiting to be adjudicated, and in either audit or needing approval status. * Developing and implementing… more
- CHS (Clearwater, FL)
- … and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer ... Duties and Responsibilities:** + In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for claims … more
- Conduent (Orlando, FL)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Molina Healthcare (Miami, FL)
- …and improvements. + Provides oversight of research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit ... **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage… more
- NextEra Energy (North Palm Beach, FL)
- **Professional Lines Claims Manager** **Date:** May 30, 2025 **Location(s):** North Palm Beach, FL, US, 33408 **Company:** NextEra Energy At PALMS Insurance, a ... Specific Description** The ideal candidate for the Professional Lines Claims Manager position will be able to handle and...post binding claim audits as needed and communicate the audit results to appropriate internal and external stakeholders. *… more
- CVS Health (Tallahassee, FL)
- …a Regional Pharmacy Onsite Auditor, you will be an essential part to the Pharmacy Audit Department at CVS/Caremark. In this role, you will be based from your home ... and travel onsite to conduct claims audits at pharmacies throughout multiple states by reviewing...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- CRC Insurance Services, Inc. (FL)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- CRC Insurance Services, Inc. (FL)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- Elevance Health (Miami, FL)
- …Indices), complex clinical guidelines and maintaining objectivity in the performance of medical audit activities. + Draws on extremely advanced ICD-10 coding ... including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit...environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines,… more
Recent Jobs
-
Social Worker II - Weekend/Evening Availability
- Arkansas Children's (Springdale, AR)