- MetLife (Tampa, FL)
- …analyze and render appropriate claim decisions on STD, PML and state claims . Clarify functional capacity through independent problem-solving measures and discretion ... to work, discuss terms of the certificate, and the basis for payment /non- payment . . Communicate with a variety of constituents (for example, claimants, doctors,… more
- Sedgwick (Tallahassee, FL)
- …best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing ... and inclusion. **PRIMARY PURPOSE** **:** To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims … more
- Elevance Health (Tampa, FL)
- …or quality assurance environment preferred. + Broad knowledge of medical claims billing/ payment systems provider billing guidelines, payer reimbursement ... an accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance...auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all… more
- CDM Smith (Orlando, FL)
- …**Business Unit:** FSU **Job Description:** CDM Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical ... in evaluating and analyzing financial data related to disaster-related claims , including property damage, business interruption, and other loss categories. The … more
- MyFlorida (Tallahassee, FL)
- …issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through ... Potential issues that must be resolved prior to the payment of benefits include but are not limited to:...when potential issues are detected on initial or additional claims . This is accomplished through tracking the assigned claim… more
- MyFlorida (Fort Lauderdale, FL)
- …issues and the chargeability of employer accounts for benefit payments on claims . This may be accomplished telephonically, through written correspondence, or through ... Potential issues that must be resolved prior to the payment of benefits include but are not limited to:...when potential issues are detected on initial or additional claims . This is accomplished through tracking the assigned claim… more
- MyFlorida (Orlando, FL)
- …This is an OPS Employment Security Representative II- Employment Review Specialist position in the Department of Commerce's Reemployment Assistance Programs ... and policies to determine the eligibility of reemployment assistance claims using the CONNECT system. This includes gathering claimant...Potential issues that must be resolved prior to the payment of benefits include but are not limited to:… more
- Banner Health (FL)
- …for improvement of clinical documentation and accurate MS-DRG, Ambulatory Payment Classification (APC) or ICD-10 assignments on health records. Provides ... Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment Classification (APC) or utilized operational systems. Provides explanatory and… more
- Elevance Health (Tampa, FL)
- …preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer ... and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims … more
- Cummins Inc. (Orlando, FL)
- …GPP Database Link (https://cummins365.sharepoint.com/sites/CS38534/) **Job Summary:** Technical specialist and primary customer support contact to diagnose ... etc Completes required documentation, such as service worksheets, timesheets, warranty claims , quality documents via handwritten forms or business system input… more