• Appeals and Grievances Clinical Specialist - RN,…

    Healthfirst (FL)
    …+ Experience in clinical practice with experience in appeals & grievances, claims processing , utilization review or utilization management/case management. + ... This position is 100% Remote . We are hiring for the following schedules...of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension… more
    Healthfirst (08/27/25)
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  • IBM i (AS400) Infrastructure Specialist

    Cognizant (Tallahassee, FL)
    …team is responsible for 24x7x365 monitoring of all IBM i LPARS, along with processing all backups. This role will also involve monitoring the IBM i RxClaim health, ... monitoring of: Claim adjudication jobs, ASP alerts, CPU alerts, Claims queue monitoring, Storage monitoring, Connect Direct subsystem. +...flexible shift environment (24 x 7) This is a remote opportunity within the US. Candidate must be currently… more
    Cognizant (08/28/25)
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  • Generative AI Architect

    TEKsystems (Gainesville, FL)
    …with reusable components they are building * Set of business cases are in claims processing , care space, internally from an enterprise perspective they have a ... for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
    TEKsystems (08/28/25)
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  • Financial Underwriting Representative

    Humana (Tallahassee, FL)
    …in assisting the underwriting team by providing essential support in the evaluation and processing of renewal and new business work on a group level basis. This ... coverage + Experience in negotiation + Experience working with healthcare or claims related data **Additional Information** **Work At Home / Internet Information:**… more
    Humana (08/27/25)
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  • Coding Supervisor - CPC

    Trinity Health (Fort Lauderdale, FL)
    …and HCPCS level II coding guidelines, along with CCI edits and Medicare claims processing manual contents in a multi-facility, integrated health care delivery ... capitated payments.** **Ability to work remotely from home following Trinity remote work guidelines** **Ability to teach/instruct/train coders on processes and… more
    Trinity Health (08/20/25)
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  • Medicaid State Technology Lead

    Humana (Tallahassee, FL)
    …and processes + Solid understanding of healthcare operations, particularly around claims processing , enrollment, provider data management and clinical ... to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be… more
    Humana (08/19/25)
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