- Point32Health (FL)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... service or member services representative in health care or insurance + Preferred: 2 years' Appeals and...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… 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 ... analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or...Minimum of 3 years experience working in grievances and appeals , claims , or customer service; or any… more
- Molina Healthcare (Orlando, FL)
- …to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical ... in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific… more
- Elevance Health (Miami, FL)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... implications for system edits. + Coordinates research and responds to system inquiries and appeals . + Conducts research of claims systems and system edits to… more
- Affordable Care (New Pt Richey, FL)
- …Strong verbal and written communication skills. + Knowledge of dental/ medical insurance processes, including verification, claims , appeals , and denial ... scheduling, patient check-in/out, discussing treatment and financial arrangements, and managing insurance billing to ensure timely, accurate claims and maximum… more
- CHS (Clearwater, FL)
- **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party ... insurance marketing organizations, and employers. One core service, claims administration, is where submissions for payment/reimbursement/sharing from medical… more
- Humana (Tallahassee, FL)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... caring community and help us put health first** The Medical Director actively uses their medical background,...of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of… more
- MetLife (Tampa, FL)
- …meeting all key performance indicators * Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and ... fast-paced environment and in accordance with state and department of insurance regulations. * Develop actions plans and identify return to work potential * Provides… more
- Akumin (FL)
- …not limited to:** + Initiate follow-up with insurance companies for payments of pending claims . + Appeals denied claims with insurance carriers. + ... Job Description The ** Medical Collector** contacts payers for status of payment... as needed, including correction of missing/inaccurate data, and appeals of denied claims with appropriate documentation… more
- CenterWell (Tallahassee, FL)
- …help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims . The Medical Director, Primary Care ... an in-depth evaluation of variable factors. The Medical Director relies on medical background and reviews health claims . The Medical Director work… more