- Sedgwick (Orlando, FL)
- …disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining ... and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations;… more
- Travelers Insurance Company (Tallahassee, FL)
- …evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim life cycle ... does not manage staff. **What Will You Do?** + Directly handle assigned severe claims . + Full damage value for average claim (without regard to coverage or liability… more
- Travelers Insurance Company (Orlando, FL)
- …reserving, negotiating and resolving assigned serious and complex Auto Liability claims . Provides quality claim handling throughout the claim life cycle (customer ... regard to coverage or liability defenses). + Directly handle assigned severe claims . + Provide quality customer service and ensure file quality, timely coverage… more
- Highmark Health (Tallahassee, FL)
- …:** GENERAL OVERVIEW: Applicants Must Be Able to Read and Comprehend Spanish Medical Terminology The Quality analyst is responsible for compiling and analyzing data ... relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- Sedgwick (Orlando, FL)
- …a professional career? Bring your 2+ years' experience in a office setting or medical experience and grow with us! + A stable and consistent work environment in ... physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability plan; to make… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …medicines for those with CNS disorders, we are seeking a skilled and experienced Medical Director of CNS Early Assets, Global Medical Affairs, responsible for ... certain assets within the broader CNS TA portfolio Medical Affairs (both US and Global), with a specialization...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Sedgwick (Tallahassee, FL)
- …time frames, and claims status either by phone, written correspondence and/or claims system. + Reviews medical information to determine if the claimant meets ... live within the United States. **PRIMARY PURPOSE** **:** To process claims and determine accommodation options following written guidelines and procedures pursuant… more
- Elevance Health (Tampa, FL)
- …for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Elevance Health (Tampa, FL)
- …healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health ... be considered. Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to… more
- Sedgwick (Tallahassee, FL)
- …operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor ... individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims within… more