- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Cognizant (Tallahassee, FL)
- …of Facets experience. + Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent ... to multi-task successfully? If so, please apply today! The Claims Processor, you will ensure accurate and timely adjudication...with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or… more
- CHS (Clearwater, FL)
- **Overview** **Health Insurance Medical Claims Examiner** **Monday-Friday Schedule with daytime hours** **Responsibilities** **Summary:** The Medical ... Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines....appropriateness, eligibility and coordination of benefits + Documents fully claims referred to senior staff for review … more
- CHS (Clearwater, FL)
- …strong operational controls relating to claims cost control, including review processes for potential pre-existing conditions, determining medical necessity, ... claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost… more
- Ryder System (Tallahassee, FL)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The ... Senior Claims Representative handles complex and mid-to-high exposure bodily injury...all relevant laws and regulations as well as related medical and legal terminology + Requires strong claim technical… more
- CRC Insurance Services, Inc. (FL)
- …Fluency:** English (Required) **Work Shift:** 1st Shift (United States of America) **Please review the following job description:** A Complex Claims Manager - ... Defect and Environmental is responsible for investigating, evaluating, and resolving insurance claims related to environmental damage, as well as claims … more
- Sedgwick (Tallahassee, FL)
- …properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical claims which include state and ... Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Adjuster I Workers Compensation I CA experience required I Hybrid **PRIMARY… more
- Sedgwick (Tallahassee, FL)
- …properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical claims which include state and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Adjuster- General Liability Are you looking for an opportunity to join a… more
- USAA (Tampa, FL)
- …**Auto Adjuster** you will proactively handle the complete end to end claims process. Taking statements, policy and coverages, determination of liability and ... defined guidelines and framework, responsible to adjust moderately complex auto insurance claims presented by or against our members to include the end-to-end … more
- USAA (Tampa, FL)
- …truly makes us special and impactful. **The Opportunity** As a dedicated Sr Auto Claims Adjuster, you will adjust highly complex auto insurance claims presented ... by or against our members to include the end-to-end claims process and settling claims in compliance with state laws and regulations. Accountable for delivering… more