- CVS Health (Tallahassee, FL)
- …Trifacta, Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health ... to join our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team....You will work with a collaborative, close-knit team on pharmacy and member specific claims data including,… more
- Elevance Health (Tampa, FL)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Hybrid 1:** This role requires associates to...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Tampa, FL)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Elevance Health (Miami, FL)
- …or related experience is preferred. + Experience with health plan administrative databases ( pharmacy and medical claims ) and/or other big datasets is preferred. ... **Researcher Senior ** **Location:** This role requires associates to be...of statistical results. + Analyze health care data, including claims , clinical data, national survey data, and other large… more
- CVS Health (Tallahassee, FL)
- …each and every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/ Pharmacy /Broker Investigative Team ... abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and… more
- CVS Health (Tallahassee, FL)
- …enterprise operations teams using a variety of platforms. We service medical, pharmacy , sales, product and call center support models across the CVS enterprise. ... in project execution. **Required Qualifications** + 5 or more years of related professional experience + 3 or more years of working directly with SQL database… more
- Publix (Lakeland, FL)
- …company. + Oversee a wide range of liability matters including premises, fleet, pharmacy , and product claims . + Develop and refine internal litigation processes ... a collaborative legal team that values innovation, accountability, and professional growth. **What You'll Do:** + Manage the defense...and policies for attorney-represented and litigated claims . + Provide strategic legal counsel to … more
- CenterWell (Tallahassee, FL)
- …Associate Director will lead the Revenue Cycle Management team for the CenterWell Senior Primary Care Organization. This individual will manage a small internal team ... systems. + Maintain Standard Operations Procedures for RCM functions: claims management, accounts receivable follow-up, internal collections, collection agencies,… more
- Humana (Tallahassee, FL)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, ... or data requires an in-depth evaluation of variable factors. As the Senior Clinical Compliance Professional , you will develop and/or evaluate compliance… more
- Prime Therapeutics (Tallahassee, FL)
- …internal stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with ... Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance Analyst assists in the implementation of Prime's compliance programs,… more