• Claims Examiner - Managed…

    Cedars-Sinai (CA)
    …people throughout Los Angeles and beyond. **Req ID** : 11588 **Working Title** : Claims Examiner - Managed Care **Department** : MNS Managed Care ... **Job Description** The Claims Examiner is responsible for accurately...is a leader in providing high-quality healthcare encompassing primary care , specialized medicine and research. Since 1902, Cedars-Sinai has… more
    Cedars-Sinai (09/11/25)
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  • Claims Examiner III

    Dignity Health (Bakersfield, CA)
    **Job Summary and Responsibilities** The Claims Examiner III is an advanced-level role responsible for the detailed and accurate processing, review, and ... claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most...pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to… more
    Dignity Health (09/25/25)
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  • Ops Medical/Health Care Program Analyst

    MyFlorida (Tallahassee, FL)
    …does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive ... the Bureau's responsibility: Operations, Data Detection, Investigations, Overpayment Recovery, and Managed Care oversight. MPI operates with dynamic and… more
    MyFlorida (11/20/25)
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  • Medical Health Care Program Analyst

    MyFlorida (Tallahassee, FL)
    …the Bureau's responsibility: Operations, Data Detection, Investigations, Overpayment Recovery, and Managed Care oversight. MPI operates with dynamic and ... 68064693 - MEDICAL HEALTH CARE PROGRAM ANALYST Date: Nov 19, 2025 The...engage in other prevention activities, including pre-payment reviews, paid claims reversals, site visits, identifying and processing sanctions of… more
    MyFlorida (11/20/25)
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  • Analyst, Compliance Auditing, Monitoring…

    Option Care Health (Bannockburn, IL)
    …compliance programs. + Direct experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines. + Proficiency with audit software ... no limit to the growth of your career.** Option Care Health, Inc. is the largest independent home and...large datasets, such as related to healthcare operations, billing, claims , and patient information to support Compliance activities and… more
    Option Care Health (10/19/25)
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  • Lead Investigator, Special Investigative…

    Molina Healthcare (Cincinnati, OH)
    …lieu of education experience) + At least five (5) years' experience working in a Managed Care Organization or health insurance company + Minimum of two (2) ... investigative and law enforcement procedures with emphasis on fraud investigations + Knowledge of Managed Care and the Medicaid and Medicare programs as well as… more
    Molina Healthcare (11/21/25)
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  • Operations Support Services Coordinator

    Sedgwick (Knoxville, TN)
    …reports, claim adjustments, provider requests and operational expense check requests. + Queues claims for Managed Care ; transfers payment allocations; and ... Coordinator **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple...logins and the applicable security access for the company's claims management systems by determining the validity for incoming… more
    Sedgwick (11/01/25)
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  • Investigator, Special Investigative Unit - FLORIDA

    Molina Healthcare (Savannah, GA)
    …investigative and law enforcement procedures with emphasis on fraud investigations. + Knowledge of Managed Care and the Medicaid and Medicare programs as well as ... ASSOCIATION** : + Health Care Anti-Fraud Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all… more
    Molina Healthcare (10/18/25)
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