- Robert Half Accountemps (Plantation, FL)
- Description We are offering a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation, Florida. As ... a Medical Claims Analyst, you will be tasked with handling various aspects of the claims process, including auditing, billing, and claim administration,… more
- Sedgwick (Miami, FL)
- …properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical claims which include state and ... work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Adjuster - Liability **PRIMARY PURPOSE:** To analyze mid- and higher-level… more
- Elevance Health (Miami, FL)
- …strongly preferred. + Prior health care fraud audit/investigation experience preferred. + Medical claims review with prior health care fraud audit/investigation ... make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post-payment auditing. +… more
- Elevance Health (Miami, FL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the… more
- Walgreens (Pompano Beach, FL)
- …for billing is completed and accurate prior to claim submission (ie, medical claims billing). + Process reimbursement checks/payment in accordance with ... experience with Walgreens. + Experience in processes related to submitting medical claims , including but not limited to Medicare submission, knowledgeable in EOB… more
- Carnival Cruise Line (Miami, FL)
- …clinical experience required. +2 years of healthcare quality, risk management, and legal/ medical claims experience preferred. + Prior Experience with Electronic ... corrective and preventative plans, and monitors risk plans. + Investigates medical complaints and claims : assists with root cause analysis and assesses need for… more
- Robert Half Office Team (Davie, FL)
- …and Outlook for various tasks * Schedule appointments efficiently and accurately * Process medical claims , including Medicaid claims * Use insurance portals ... with Medicaid claim processing is a plus. * Experience in handling medical claims , ideally within a healthcare setting. TalentMatch(R) Robert Half is the world's… more
- University of Miami (Miami, FL)
- …potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. + Conduct additional investigation ... federal, and state regulations, and PRO activities to ensure hospital and medical staff activities comply with regulations. + Develops and modifies policies to… more
- University of Miami (Miami, FL)
- …in Miami, FL. Medical coders help to complete, review, and process medical claims to help physician practices and hospitals get reimbursed from insurance ... Trauma, and other specialties that are predominantly invasive codes for medical specialties including Ancillary, Non-Surgical and Surgical services. Has a thorough… more
- Sedgwick (Miami, FL)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner - Workers Compensation **PRIMARY PURPOSE** : To analyze complex or ... technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to… more
- Sedgwick (Miami, FL)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Environmental Claims Specialist **Job Description Summary** To analyze complex or technically ... difficult environmental claims ; to provide resolution of highly complex nature and/or...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Molina Healthcare (Miami, FL)
- …and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department ... retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity… more
- Sedgwick (Miami, FL)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Director - Complex Claims **PRIMARY PURPOSE** **:** To be responsible for the day to day ... activities of the complex claims unit, to assess the work done by the...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Sedgwick (Miami, FL)
- …Forbes Best-in-State Employer Entry- Level, Bilingual Spanish, Customer Service and Claims Positions **PRIMARY PURPOSE** **:** To expedite the Customer Service ... claims application process; to ensure correct case assignment; and...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- NextEra Energy (Miami, FL)
- ** Claims Agent I** **Date:** Nov 30, 2024 **Location(s):** Miami, FL, US, 33134 **Company:** NextEra Energy is America's largest electric company, providing clean, ... This position is responsible for handling Bodily Injury and Property Damage Claims asserted against the company. The position involves being "on call" which… more
- Elevance Health (Miami, FL)
- ** Claims Representative I (Health & Dental)** **Location:** Must live within 50 miles of the Mason, OH, Norfolk, VA, Richmond, VA, Grand Prairie, TX, Houston, TX, ... Miami, FL, Tampa, FL Chicago, IL, or Columbu, GA PulsePoints. The ** Claims Representative I** is responsible for successfully completing the required basic training.… more
- Elevance Health (Miami, FL)
- …for fraud and abuse prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Provider Auditor Senior** is responsible for… more
- Elevance Health (Miami, FL)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Crawford & Company (Sunrise, FL)
- …knowledge of disability contracts, policies, and products and continued understanding of medical and vocational issues. Uses disability claims system for timely ... equivalent experience required. + 2 + years of STD/LTD claims adjudication. + Aptitude for learning medical ...STD/LTD claims adjudication. + Aptitude for learning medical terminology and conditions, as well as interpreting procedures… more
- Elevance Health (Miami, FL)
- …Admin (** **Evaluation and Management Coding/Auditing)** ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and ... are not limited to: + Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules, as well as… more