- Molina Healthcare (FL)
- …to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of ... for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and… more
- Sedgwick (Tallahassee, FL)
- …: To investigate claims internationally of any size or complexity, against insurance or other companies for personal, casualty, or property loss or damages and ... Best Workplaces in Financial Services & Insurance Executive General Adjuster **PRIMARY PURPOSE**...Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Prepares loss… more
- Sedgwick (Jacksonville, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Executive General Adjuster - Southeast Region **PRIMARY PURPOSE** **:** To ... investigate losses or claims internationally on any size National Account (Maintaining a...total combined anticipated revenue of at least $500,000) against insurance or other companies for personal, casualty, or property… more
- Elevance Health (Miami, FL)
- …to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to ... + Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business… more
- Robert Half Management Resources (Jacksonville, FL)
- …medical billing operations, ensuring timely and accurate processing. * Handle medical claims by reviewing, validating, and resolving discrepancies. * ... knowledge of medical billing processes and practices. * Familiarity with medical claims management and resolution. * Excellent analytical skills and… more
- CVS Health (Largo, FL)
- …in-person support across multiple worksites, handling complex benefit and claims inquiries, and providing education during open enrollment and health-related ... and Resolve:** Handle member inquiries and escalations related to benefits, claims , eligibility, and policy interpretation by identifying root causes, coordinating… more
- HCA Healthcare (Jacksonville, FL)
- …from EOBs and works to correct the errors in a timely manner. + Monitors insurance claims by running appropriate reports and contacting insurance companies ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- Humana (Tallahassee, FL)
- …in identification of cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. The Actuary, Analytics/Forecasting ensures data integrity ... community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to… more
- Sedgwick (Orlando, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Leave of Absence Coordinator **Leave of Absence Representative** **Our teams ... and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Establishes FMLA claims ; tracks and codes documentation in accordance with internal workflow… more
- Sedgwick (Orlando, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Care Team Representative **Entry-level, Care Team Representative** Are you looking ... OF THE ROLE:** To provide excellent service displaying empathy to callers regarding claims for multiple lines of business, including but not limited to, expediting… more