- 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 ... Qualifications** + Medical utilization management experience + Working with health insurance organizations, hospitals and other healthcare providers, patient… more
- Elevance Health (Tampa, FL)
- …expertise, as well as single point of service support (eg, calls and claims ) to key client contacts (HR, Benefit Administrators, client key decision makers, etc.) ... the best service possible. + Answers client inquiries regarding health plan or service issues. + Responds to customer...or equivalent and a minimum of 5 years related claims /customer service experience; or any combination of education and… more
- Elevance Health (Tampa, FL)
- …requirements. + Develop and analyze business performance reports (eg, for claims data, provider data, utilization data) and provides notations of performance ... Microsoft Excel experience. + Facets systems knowledge considered a plus. + Claims and/or Encounters experience preferred. + Experience with Medicaid data preferred.… more
- AdventHealth (Maitland, FL)
- …as it relates to reimbursement methodologies + Applies significant understanding of medical coding systems affecting the adjudication of claims to include ... Benefits from Day One Career Development Whole Person Wellbeing Resources Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about… more
- Humana (Tallahassee, FL)
- …us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate ... + Medical utilization management experience, + working with health insurance organizations, hospitals and other healthcare providers, patient… more
- Sedgwick (Miami, FL)
- …and relatively complex National Account. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies, claims , and other records to determine ... insurance coverage. + Administers and reconciles complex catastrophic claims for property. + Interviews, telephones, or corresponds with claimant(s) and witnesses… more
- Centene Corporation (Tallahassee, FL)
- …per year Centene offers a comprehensive benefits package including: competitive pay, health insurance , 401K and stock purchase plans, tuition reimbursement, paid ... 28 million members as a clinical professional on our Medical Management/ Health Services team. Centene is a...of recommendations to providers that would improve utilization and health care quality. + Reviews claims involving… more
- Devereux Advanced Behavioral Health (Orlando, FL)
- …per year) + **Retirement** - 403(b) through TIAA + **Quality Low-Cost Benefits** ( medical , dental, vision), pet insurance , plus student loan debt assistance and ... department in various duties, such as account management, communications with insurance providers, collections, cash posting, contract analysis, and billing. +… more
- Sedgwick (Tallahassee, FL)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- HCA Healthcare (Niceville, FL)
- …log. **EDUCATION REQUIRED AND/OR PREFERRED:** . 4 year Bachelors Degree in nursing, medical technology, clinical laboratory science, public health or other ... active participation in facility clinical improvement activities Previous employee health , medical office, and/or infection control experience preferred… more
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