- Molina Healthcare (South Florida, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims . Ensures that claims are settled in a timely fashion and in accordance… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... ** Claims Representative I (Health & Dental)** **Location:** Must live within 50 miles of the Mason, OH,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... **Pharmacy Data Claims Analyst & Insights (Business Analyst II)** _Location:...Experience working in a health plan and/or pharmacy benefit manager (PBM) strongly preferred. + Strong proficiency in SQL,… more
- Elevance Health (Miami, FL)
- …Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care management within...be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... one of our Elevance Health PulsePoint locations. **Nurse Case Manager I** Responsible for performing care management within the...such as at hospitals for discharge planning. **Ideal candidate ** MUST ** reside and licensed in the state… more
- Elevance Health (Miami, FL)
- …through education and data. This role is responsible for a local market. **Location:** Candidates must reside and be licensed in the state of Florida. **How you ... The **Behavioral Health Provider Quality Manager ** is responsible for leading Behavioral Health (BH)...be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Miami, FL)
- …This is primarily a remote position but may be required to go in for meetings/training. MUST RESIDE IN THE STATE OF FLORIDA. **Work Hours:** 8am - 5pm, Monday - ... medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied....be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …and connection. This includes remote work and 1-2 days in office per week. Candidates must reside within a 50-mile or 1-hour commute each way of a relevant ... medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied....be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... **Operations Expert** **Location:** Must live within 50 miles of the Mason,...responsible for providing technical direction, guidance and resources to claims , customer service, or membership associates on a day-to-day… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... medical policy, reimbursement, and provider utilization patterns. + Coordinates prompt claims resolution through direct contact with providers, claims , pricing… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... a designated virtual-eligible role and specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... **Grievance/Appeals Analyst Lead** **Candidates must be located within 50 miles of Atlanta,...and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... in office 1 - 2 days per week). Candidates must live within 50 miles of one of Elevance's...Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing… more
- Elevance Health (Hialeah, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... medical directors in interpreting appropriateness of care and accurate claims payment. + May also manage appeals for services...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Hialeah, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... medical directors in interpreting appropriateness of care and accurate claims payment. + May also manage appeals for services...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. **How you will… more
- Elevance Health (Miami, FL)
- …and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant ... of proposal activities and responses with other operating areas such as Claims , Underwriting, Sales, and Specialty companies assuring their actions come together as… more