- Lincoln Financial (Tallahassee, FL)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll… more
- Sedgwick (Tallahassee, FL)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- 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
- Elevance Health (Tampa, FL)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- NHS Management, LLC (Tallahassee, FL)
- …risk management policies to include reviews of significant events/unusual occurrences and a review of the medical record. We offer the following benefits for ... way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will...that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer… more
- CVS Health (Tallahassee, FL)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... Qualifications** + Candidate must have an active and unrestricted Compact Licensed Practical Nurse (LPN) License in state of residence + 3+ years of Licensed… more
- Elevance Health (Miami, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Molina Healthcare (Miami, FL)
- …including hospital acute care/ medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** + ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...scope of a Payment Integrity Clinician. This includes assessing medical documentation, itemized bills, and claims data… more
- Sedgwick (Tallahassee, FL)
- …cases accordingly. + Interviews practitioners involved in medical malpractice claims . + Participates in follow-up review and investigation as directed ... Professional Liability **PRIMARY PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure.… more
- Travelers Insurance Company (Orlando, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more