- Molina Healthcare (St. Petersburg, FL)
- …Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment ... to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program… more
- Suddath (Jacksonville, FL)
- …**General position summary:** This position involves assisting and monitoring the claims resolution process, ensuring fair and accurate settlements based on carrier ... integrity. Additionally, you will keep business units informed of updated Risk Management Department information and provide necessary resources. **Essential Duties… more
- Molina Healthcare (Orlando, FL)
- …codes are reported accurately to maintain compliance and to minimize risk and denials. **KNOWLEDGE/SKILLS/ABILITIES** + Performs on-going chart reviews and abstracts ... + Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk … more
- The Hartford (Lake Mary, FL)
- …in the RMS process - meeting with insured's, making presentations, working with claims and underwriting, etc. + Work with Risk Engineering Manager on ... Sr Consultant Risk Engineering - KR08DE We're determined to make...applying them to meaningful work at The Hartford.As a Risk Engineering Consultant at The Hartford, your primary role… more
- Molina Healthcare (St. Petersburg, FL)
- …**Job Summary** This Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk ... skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data.… more
- Travelers Insurance Company (Tampa, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... negotiating and resolving assigned Construction Defect and Latent Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Travelers Insurance Company (Tampa, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... negotiating and resolving assigned Construction Defect and latent Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Molina Healthcare (St. Petersburg, FL)
- …**Job Summary** The Junior Analyst will play a supporting role on the RADV ( Risk Adjustment Data Validation) team, assisting in the execution of CMS and internal ... confirm required data elements. + Collaborate with internal teams-including IT, Risk Adjustment operations, and clinical teams-to ensure accurate and consistent data… more
- L3Harris (Melbourne, FL)
- … risk assessment and oversight of personal injury, property damage and WC claims ; + Coordinate with Risk Management and other stakeholders to maximize ... compliance, and favorably resolve disputes. + Work closely with Risk Management, Workers' Compensation and outside counsel to ensure...recovery of legal fees, costs and judgments for covered claims . + As needed, lead or support internal and… more
- Travelers Insurance Company (Orlando, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more