- Zelis (St. Petersburg, FL)
- …focused on supervising a team of Clinician's performing clinical reviews of facility claims , including UB's, Itemized Bills and medical records, to verify ... and operational support to the Manager, Clinical Chart Review, Sr . Level Clinicians and Operations Analysts as directed by...output and queues for timely and proper management of claims . + Ensure client turnaround times and specific processing… more
- Sedgwick (Miami, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr IT Security Advisor **PRIMARY PURPOSE OF THE ROLE:** To manage the implementation ... progress, including retesting and closure validation. + Experience maintaining audit trails and documentation for compliance and governance. + Familiarity… more
- L3Harris (Palm Bay, FL)
- …land, sea and cyber domains in the interest of national security. Job Title: Sr . Associate Procurement Job Code: 29906 Job Location: Palm Bay, FL Job Schedule: 9/80: ... 80 hours worked - and have every other Friday off Job Description: A Senior Associate, plans and implements activities related to the procurement of raw materials,… 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**...as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with… more
- Cardinal Health (Tallahassee, FL)
- …with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, ... medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles… more
- CVS Health (Tallahassee, FL)
- …R, Alteryx, Trifacta, Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including ... to join our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team....a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more
- Stryker (Miami, FL)
- The Senior Manager, Compliance Investigations (Americas) is an integral part of the strategic expansion of Stryker's compliance and ethics function. The position ... evidence, conducting interviews, drafting memos, preparing concise reports for senior leadership and key stakeholders. + **Strategic Case Management:** Apply… more
- Elevance Health (Tampa, FL)
- …- 5:30pm (4 days) 11:30am - 8pm (1 day) EST** The **Nurse Case Manager Senior ** is responsible for care management within the scope of licensure for members with ... management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- RTX Corporation (Largo, FL)
- …that create a safer, more secure world. We have an exciting opportunity for a ** Senior Manager, Supply Chain (SC) Legal Advisor** , who will report to the Associate ... standard provisions. + Review and advise SC on performance issues such as claims and insolvency. + Assist the organization in writing business processes, policies… more
- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... in response to approved change requests; retain old and new report design for audit trail purposes. + Analyze data sets and trends for anomalies, outliers, trend… more