- MyFlorida (Tallahassee, FL)
- …design and implement algorithms to effectively data-mine within various types of claims data utilizing a variety of software applications; compile research, data ... limited to, the following: * Identify suspicious patterns in claims data and other sources by applying your knowledge...collaboration with the team and the Program Integrity Unit Manager , draft investigative work plans and develop case strategies… more
- Elevance Health (Tampa, FL)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Tampa, FL)
- …I** is responsible for accurate and timely maintenance of provider information on claims and provider databases. **How You Will Make an Impact** Primary duties may ... to: + Assists in synchronization of data among multiple claims systems and application of business rules as they...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Tampa, FL)
- …healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, ... and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying and developing enterprise-wide specific… more
- Elevance Health (Miami, FL)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Miami, FL)
- …in order to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health insurance policies, ... health insurance claims handling and provider network contracting. **How will you...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- MyFlorida (Chattahoochee, FL)
- …include: + This position serves as the Hospital Health Care Risk Manager /Safety Officer and is highly responsible professional, managerial and administrative work to ... planning, and coordinating responsibilities to prevent or minimize accidental injury, illness, property damage, or other preventable loss or negligent acts. The Risk… 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.) ... or equivalent and a minimum of 5 years related claims /customer service experience; or any combination of education and...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Miami, FL)
- …analysis; and reporting of statistical results. + Analyze health care data, including claims , clinical data, national survey data, and other large datasets using R ... Experience with health plan administrative databases (pharmacy and medical claims ) and/or other big datasets is preferred. For candidates...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… 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 ... experience. + Facets systems knowledge considered a plus. + Claims and/or Encounters experience preferred. + Experience with Medicaid...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more