- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and ... Standard Operating Procedures (SOPs). * Responds to provider correspondence related to claims recovery requests and provider remittances where recovery … more
- Carrington (Jacksonville, FL)
- **Come join our amazing team and work remote from home!** The Sr Claims & Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred ... identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as… more
- Sedgwick (Orlando, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr. Claims Specialist , Veterinary Claims | Professional Liability | Remote ... **PRIMARY PURPOSE** **:** To analyze complex or technically difficult veterinary claims ; to provide resolution of highly complex nature and/or severe injury … more
- Travelers Insurance Company (Tallahassee, FL)
- …efficiently manage both allocated and unallocated loss adjustment expenses + Evaluate all claims for recovery potential; directly handle recovery efforts ... negotiate and resolve the company's most severe and/or complex claims , in multiple jurisdictions, in accordance with Best Practices....and/or engage and direct Company resources for recovery efforts. + Responsible for prompt and proper disposition… more
- HCA Healthcare (Ocala, FL)
- …Do you have the career opportunities as a Clinical Denial Coding Review Specialist you want with your current employer? We have an exciting opportunity for ... of colleagues. Do you want to work as a Clinical Denial Coding Review Specialist where your passion for creating positive patient interactions is valued? If you are… more
- CDM Smith (West Palm Beach, FL)
- …40509BR **Business Unit:** FSU **Job Description:** The Disaster Program Delivery Specialist : * Collects, coordinates and/or reviews applicant data to determine ... gather information from applicants, and understands each applicants' projects and recovery priorities. * Supports the communication process with the applicant about… more
- Cardinal Health (Doral, FL)
- …paper and online. + Oversees appeals and denials management to maximize revenue recovery and minimize financial leakage, ensuring all claims are accurately ... or appropriate. + Acts as a subject matter expert in claims processing. + Processes claims : investigates insurance claims ; properly resolves by follow-up &… more
- Truist (Orlando, FL)
- …guidelines. 2. Independently analyze, research, and support electronic payment cases/ claims /inquiries escalated by internal departments and client service centers to ... resolution. Claims /inquiries related to Regulation E are met in accordance...to travel to offsite backup facility for testing and recovery operations. 3. Must be able to work independently,… more
- Molina Healthcare (Tampa, FL)
- …for oversight, production, and resolution of health plan payment integrity (PI) recovery concepts. Executes and monitors health plan scoreable action items (SAIs) to ... (CMS) and state regulatory requirements are met for pre-pay edits and overpayment recovery . Manages inventory and works in collaboration with PI team to ensure SAI… more
- Elevance Health (Lake Mary, FL)
- …at least one of the following: AA/AS or minimum of 15 years of experience in claims auditing, quality assurance, or recovery auditing. + Requires at least one of ... Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case… more