- Sedgwick (Miami, FL)
- …place to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Associate - Workers Compensation (REMOTE - MUST RESIDE IN FL) ... **PRIMARY PURPOSE** : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within… more
- Molina Healthcare (Miami, FL)
- …remediation plans and fixes, overall progress, and status of impacted claims **JOB QUALIFICATIONS** **Required Education** Associate 's Degree or equivalent ... **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit… more
- Kemper (Miami, FL)
- …to the public. + Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or ... The SIU Investigator will conduct field and desk investigations of insurance claims referred to and accepted for investigation by the Special Investigative Unit.… more
- Humana (Miramar, FL)
- …a part of our caring community and help us put health first** The Claims Research & Resolution Representative 3 manages claims operations, assisting in ... processing of corrected claims . The Claims Research & Resolution Representative 3 performs advanced administrative / operational / customer support duties that… more
- Humana (Miramar, FL)
- …a part of our caring community and help us put health first** The Claims Processing Representative reviews and adjudicates complex or specialty claims , submitted ... or electronically while performing basic administrative/clerical/operational/customer support/computational tasks. The Claims Processing Representative determines whether to return, deny, or… more
- Molina Healthcare (Miami, FL)
- **Job Description** Job Summary Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are ... appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints,… more
- DLA Piper (Miami, FL)
- …see what we can achieve. Together. **Summary** DLA Piper's Atlanta office seeks an associate with 2-3 years of construction law experience to join its Real Estate ... agreements in various industry sectors; advising clients with respect to management of claims and disputes concerning change orders, extra work claims , delay,… more
- Walgreens (Pembroke Pines, FL)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- ChenMed (Miami, FL)
- …We're rapidly expanding and we need great people to join our team. The Associate Director of Pharmacy & Dispensing is responsible for the operation of the ... also responsible for execution and implementing policies and procedures. The Associate Director, Pharmacy communicates effectively with providers and staff, makes… more
- Walmart (Miramar, FL)
- …Floor in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and ... digital tools to drive sales, improve the shopping experience, and elevate associate engagement; utilizing hand held technology to make immediate business decisions… more
- Walmart (Miramar, FL)
- …area in accordance with Company policies and procedures by properly handling claims and returns; zoning the area; receiving and stocking merchandise; setting up, ... cleaning, and organizing product displays; removing damaged goods; signing and pricing merchandise appropriately; completing required audits, paperwork, logs, and other required documentation; and securing fragile and high-shrink merchandise. Provides Member… more
- Sysco (Pompano Beach, FL)
- …delivery impacts. + Communicate daily with Director of Transportation, Claims Coordinator, and Transportation Supervisors, Transportation Leads, and Transportation ... company policies (ie attendance, Code of Business Conduct and Ethics, Associate Handbook, etc.). + Accept additional responsibilities or special projects as… more
- Molina Healthcare (Miami, FL)
- …in determining medical necessity for medications along with assisting with pharmacy claims . **Highly qualified candidates for this role will have the following ... Education** : High School Diploma or GED equivalent **Preferred Education** : Associate degree **Required Experience** : 2 years' experience as a Pharmacy Technician… more
- Molina Healthcare (Miami, FL)
- …organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to derive proper courses ... and conversion of new and existing health plans. + Completes analysis on retroactive claims reports + Pre and post validation of complex retro reports. + Submit RFCs… more
- System One (Coral Gables, FL)
- …contract documents for QA/QC . + Leads in evaluating change requests, claims , and cost proposals from contractor, coordinates responses with the project manager, ... Assists with logs and tracks all issues, proposed changes, change orders, and claims . + Manages the administration of project documentation, records, and reporting… more
- Molina Healthcare (Miami, FL)
- …to, and the appropriate approvals and escalations are achieved. Coordinates with both the Associate Vice President of Fraud, Waste and Abuse (FWA) and Associate ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid,… more
- University of Miami (Miami, FL)
- …and other regulatory agency reportable events and prepare submission for approval by Associate Medical Risk management Officer and the Chief Medical Risk Officer. + ... potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. + Conduct additional investigation and assist… more
- Walgreens (Hallandale Beach, FL)
- …and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), ... for non-returnable ABC overstock. Verifies posting of all pharmacy/ prescription claims . + Completes execution of all pricing activities including price changes,… more
- ADP (Miami, FL)
- …delivery of document requests during audits and ensuring all employer tax and claims fiduciary, compliance and operational requirements are met. Like what you see? ... unemployment and other employer tax costs. + Manage tax compliance and unemployment claims expenses and product budget. + Lead team that establishes and enforces SUI… more
- Molina Healthcare (Miami, FL)
- …Education** : High School Diploma or GED equivalent **Preferred Education** : Associate degree **Required Experience** : 2 years' experience as a Pharmacy Technician ... Pharmacy Technician, Pharm Tech, Tech, National Certification, State License, Certification, Claims , Pharmacy Claims , Pharmacy, PBM, National Certified Pharmacy… more