- USAA (Tampa, FL)
- …guidelines. + Applies advanced medical expertise by serving as primary resource for Health Claims for the approach to medical risk assessment rules. + ... Reviews and interprets relevant medical literature for application to health claims policies and guidelines. + Collaborates with senior leaders and staff to… more
- CHS (Clearwater, FL)
- **Overview** ** Health Insurance Medical Claims Examiner** **(Initial Training On Site - 90 days - Remote position after training in FL)** **Must live within ... **Summary:** The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.… more
- Elevance Health (Miami, FL)
- …The ** Claims Representative III** is responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. ... **Job Title:** Claims Representative III **Schedule:** Monday-Friday 7am-3:30pm EST **Virtual**...50,000 members, HealthSun is one of the fastest growing health plans in South Florida. As a local plan,… more
- Highmark Health (Tallahassee, FL)
- … + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years ... activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS ( Health Now… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health … more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health … more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health … more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... focus on collaborative business relationships, value based care, population health , or disease or care management. Medical ...population health , or disease or care management. Medical Directors support Humana values, and Humana's Bold Goal… more
- Ascension Health (Orange Park, FL)
- **Details** + **Department:** Medical Claims Cardiology + **Schedule:** Days + **Hospital:** Ascension St. Vincent's Medical Group + **Location:** Orange ... bills for reimbursement to individual and third party payers in an out-patient or medical office environment. + Prepare insurance claims for submission to third… more
- Humana (Tallahassee, FL)
- …us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health … more