- Evolent (Tallahassee, FL)
- …fostering trust, expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate ... raw unadjudicated claims data. **Qualifications Required and Preferred:** + Bachelor's degree, preferably with a quantitative major (eg actuarial, statistics, … more
- Healthfirst (FL)
- …problem solving, and analytical skills. + Experience within any area of operations (Member Services, Enrollment & Billing, Claims , Provider Services, etc.). ... peers to establish goals, priorities and deliverables of Business/ Project Analyst team. Ensurelong-term strategic and short-term tactical Operational needs for… more
- Molina Healthcare (Orlando, FL)
- …as necessary to debug/analyze problems. + Fields direct questions from Molina Operations Staff regarding business, technical and operations rules. + Develops ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
- Highmark Health (Tallahassee, FL)
- …(BPIR), Eloquence and Collection of Documents (COD). Oversee day to day department operations . Manage AI Business Analyst staff and AI Coordinators. Responsible ... other analytical responsibilities. The incumbent conducts oversight of Commercial Operations Account installation processes, ensuring accurate and timely processes… more
- Molina Healthcare (FL)
- **Job Description** **Job Summary** The Health Plan Operations , Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- TEKsystems (Jacksonville, FL)
- …denied for the same reason (vertical audit) 2. rebilling - focus on "out the door" claim appeals that are more ready to go - have already been vetted. take this time ... phone to communicate and solve problems - determine why claims are denied - determine where to send appeals...determine where to send appeals - determine whether a claim needs to be escalated High degree of ownership… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …Associates Degree or higher preferred + Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer ... Job Description The Membership Accounting Analyst is responsible for the timely and accurate...government-sponsored health plans. OUR MISSION To improve health plan operations and elevate the customer experience. OUR VISION Empowering… more
- Prime Therapeutics (Tallahassee, FL)
- …years of work experience. + Prior experience as a Business Intelligence Developer/ Analyst or Data Analyst supporting business intelligence, reporting, analytics ... Data Management, Data Stewardship, or Data Governance experience. + Experience with business operations systems, particularly those that may be in use in a Pharmacy… more