• Fraud and Waste Investigator

    Humana (Tallahassee, FL)
    …or Healthcare ( Medical Chart Review/Insurance Billing) or Internal/External Audit or Regulatory/Compliance OR Claims Investigations or Criminal ... ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and… more
    Humana (06/06/25)
    - Related Jobs
  • Coordinator Quality Assurance

    Kanaan Communications, LLC (Palatka, FL)
    …+ Paid Time Off, Parental Leave, and Holidays + Insurance (including medical , prescription drug, dental, vision, disability, life insurance) + 401(k) w/ Company ... partners to identify potential opportunities for damage prevention through the field audit process. + Identify at-risk Field Technicians who need additional training… more
    Kanaan Communications, LLC (06/03/25)
    - Related Jobs
  • Senior Manager, Fleet & Sample Operations

    Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
    …with Sales and Marketing on sample allocation and planning. + Support audit readiness and compliance reviews. **Operational Efficiency & Field Partnership** + ... with states and local laws. **Company benefits** : Comprehensive medical , dental, vision, prescription drug coverage, company provided basic...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
    Otsuka America Pharmaceutical Inc. (05/16/25)
    - Related Jobs
  • Certified Pharmacy Technician, Specialty/Home…

    Walmart (Orlando, FL)
    …rotating merchandise and supplies from distribution centers and suppliers; handling claims and returns; completing, maintaining, and securing paperwork, forms, and ... process Medicare orders to ensure compliance; and interpreting and documenting Medicare audit documents. + Ensures fulfillment of pharmacy prescriptions in a Home… more
    Walmart (04/30/25)
    - Related Jobs
  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Orlando, FL)
    …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and...+ Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager… more
    Molina Healthcare (05/16/25)
    - Related Jobs
  • Director, Grievance and Appeals

    Humana (Tallahassee, FL)
    …operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes ... efficiencies + Collaborates with upstream business partners such as Claims , Clinical Guidance, and the Provider Network to identify...starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +… more
    Humana (05/30/25)
    - Related Jobs
  • Pharmacy Quality Assurance Specialist

    Elevance Health (Tampa, FL)
    …the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How ... in a timely manner to ensure prompt resolution. + Tracks and trends audit results, providing feedback effectively and professionally to management. + Identifies and… more
    Elevance Health (06/04/25)
    - Related Jobs
  • Auditor-Coding

    Ascension Health (Jacksonville, FL)
    **Details** + **Department:** Ascension Medical Group + **Schedule:** Full-Time, Days Mon. - Fri. 8AM-5PM + **Hospital:** Ascension St. Vincent's + **Location:** ... the time of the offer._ **Responsibilities** Perform periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of supporting… more
    Ascension Health (03/31/25)
    - Related Jobs
  • Paralegal

    University of Florida (Duval County, FL)
    …type: Staff Full-Time Location: Duval Categories: Veteran's Preference Eligible, Legal/ Audit Services/Compliance Department: 27030000 - HA-SELF INSURANCE TRUST FUND ... developing, and updating various databanks, including but not limited to various claims tracking logs containing detailed documentation of a wide variety of content… more
    University of Florida (06/07/25)
    - Related Jobs
  • Accounts Payable Associate Sr

    Sedgwick (Orlando, FL)
    …& Insurance Accounts Payable Associate Sr **PRIMARY PURPOSE OF THE ROLE:** To audit invoices presented for payment and input into data into the accounts payable ... promotional growth opportunities + A diverse and comprehensive benefits offering including medical , dental vision, 401K, PTO and more The statements contained in… more
    Sedgwick (05/31/25)
    - Related Jobs