- Molina Healthcare (St. Petersburg, FL)
- …supervised learning and rule-based logic to detect potentially incorrectly paid claims . + Contribute to improve data quality, perform data audits, identify ... discrepancies and resolve issues. + Support the identification of opportunities for operational improvement or growth based on analytical findings. + Areas of exposure may include: + Economics/Finance + Data Analysis / Science + Fraud, Waste, and Abuse… more
- CVS Health (Tallahassee, FL)
- …to complex issues, regarding policies and procedures, contract language, service, claims or compensation issues, and provider education needs. + Optimizes ... interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. + Meets with key Providers at regular intervals to ensure service levels meet expectations. + Collaborates with internal… more
- Molina Healthcare (Tampa, FL)
- …affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable ... financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care… more
- Akumin (Tampa, FL)
- Job Description **The Medical Biller** is responsible for submitting medical claims to government and private payers. Ensures that service date, CPT code, necessary ... equipment utilized has been entered correctly into the billing system. Distributes claims into electronic and paper billing queues and transmits patient statements… more
- The Hartford (Lake Mary, FL)
- Consultant Claims - CH08CE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here ... position within the ENVIRONMENTAL unit of The Hartford's Complex Claims Unit (CCU), responsible for the management of various...Additional information: This role can have a Hybrid or Remote work arrangement. Candidates who live near one of… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Claims Risk Management Professional is responsible for ensuring payment quality of claims ... with TRICARE policy requirements. This role involves reviewing pre-payment, high dollar claims to assess payment accuracy and identify potential claim payment risks.… more
- Sedgwick (Miami, FL)
- …& Insurance General Liability Adjuster Join a team where your expertise drives impact-our remote GL Adjuster role puts you at the center of resolving complex ... claims with flexibility and autonomy. **PRIMARY PURPOSE:** To analyze...**PRIMARY PURPOSE:** To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication… more
- Sedgwick (Orlando, FL)
- …flexibility-and connection.** **This role follows a hybrid work model, blending remote flexibility with in-office collaboration. To make that possible, candidates ... **_caring counts-and so do you._** **We're not just a global leader in claims management; we're a team driven by empathy, expertise, and impact. Right now,… more
- MyFlorida (Fort Lauderdale, FL)
- …determining managed care compliance with the SMMC contract as it relates to claims processing. Examples of work include: Analyzes programmatic reports of claims ... identified in the managed care plan provider reimbursement and claims processes. Conducts program training to Medicaid managed care...position may require travel. This position is not a remote or teleworking position. Benefits of Working for the… more
- The Hartford (Lake Mary, FL)
- Consultant Claims - CH08CE We're determined to make a...INFORMATION : This role can have a Hybrid or Remote work arrangement. Candidates who live near one of ... Consultant is a claim handling role within the Complex Claims Unit (CCU). CCU Construction is a highly specialized...do not live near an office will have a remote work arrangement, with the expectation of coming into… more