- Orlando Utilities Commission (Orlando, FL)
- **OUC - The** **_Reliable_** **One** **,** is presently seeking a ** Claims Analyst ** to join the Office of General Counsel division. At OUC, we don't just work - ... Florida statutes to review and analyze property and liability claims for OUC. In this role, you will investigate,...In this role, you will investigate, negotiate, and settle claims in a professional, equitable, and consistent manner. You… more
- Percepta (Melbourne, FL)
- …meets Ford and Lincoln Protect policy guidelines. o If all policy guidelines are met, the Claims Analyst is responsible for paying the claim to the dealer. o If ... the satisfaction of being part of a unique culture. The claims payment analyst is responsible for the overall handling (reviewing, approving, and denying)… more
- Acosta Group (Jacksonville, FL)
- …to best practices and account instructions. + Maintain a diary system and complete a claims analyst summary form timely and consistently. + Attend business unit ... **DESCRIPTION** The Sr. Casualty Risk Analyst will assist the Director of Risk Management...risk management programs with an emphasis on Workers' Compensation claims . In addition to providing technical claim support and… more
- Healthfirst (FL)
- …a simple and easy to understand manner to other staff. As the SME, the Claims Configuration Analyst will need to effectively communicate with all levels of the ... + Assist in the on-going evaluation of configuration for new and existing claims business rules including member benefits, claims editing, reference data and… more
- Publix (Lakeland, FL)
- **31050BR** **Position Title:** Pharmacy Quality Related Event Analyst , Customer Claims - Risk Mgmt **Department:** Risk Management **Location:** Lakeland, FL ... as a level one event into the Risk Master claims system. Primary duties include: + retrieving all reported...if an event should be escalated to a Customer Claims Unit (CCU) adjuster, + data entry of all… more
- Healthfirst (FL)
- …the development and configuration of new business, member benefits and products, claims editing, reference data and their enhancements including claims ... enhancements. + Follow the annual product development processes to manage major claims configuration projects, including claims business rule set up outlier… more
- Acosta Group (Tampa, FL)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position...change to provide continuous improvements. **RESPONSIBILITIES** + Process escalated claims , assesses the reason for the escalation, and provides… more
- Acosta Group (Tampa, FL)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position...change to provide continuous improvements. **RESPONSIBILITIES** + Processes escalated claims , assesses the reason for the escalation, and provides… more
- Acosta Group (Tampa, FL)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position...change to provide continuous improvements. **RESPONSIBILITIES** + Processes escalated claims , assesses the reason for the escalation, and provides… more
- Healthfirst (FL)
- **Duties & Responsibilities** : + Conducts routine assessments of current claims edits and ensures comprehensive and defensible editing across all Healthfirst ... edits. + Monitors and reports on performance of current claims editing packages + Supports claims editing...of current claims editing packages + Supports claims editing escalated provider disputes/appeals and provides guidance across… more
- Molina Healthcare (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
- Molina Healthcare (FL)
- **JOB DESCRIPTION** **Job Summary** The Senior Business Analyst is responsible for supporting the claims processing teams by supplying regular, timely, and ... team member, this role leads efforts to ensure the claims teams and other departments have access to quality... teams and other departments have access to quality claims data through processes which are efficient, accurate, and… more
- Molina Healthcare (Jacksonville, FL)
- …**Job Summary** Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and ... interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and… more
- Molina Healthcare (Orlando, FL)
- …**KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit ... configuration, and other claim reimbursement drivers + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Reviews, researches, analyzes and evaluates all… more
- Sumitomo Pharma (Tallahassee, FL)
- …and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into ... dynamic, highly motivated, and experienced individual for the position of ** Analyst , Medicaid Rebates.** This individual contributor role is responsible for… more
- Prime Therapeutics (Tallahassee, FL)
- …complex work efforts + Desire and ability to educate and advance the business systems analyst practice within the Claims IT team and across the organization + ... passion and drives every decision we make. **Job Posting Title** IT Business Systems Analyst Sr **Job Description** The Business Systems Analyst (BSA) Senior IT… more
- Elevance Health (Tampa, FL)
- **Clinical Content Analyst ** **Location:** This position will work a hybrid model (remote and in office one day per week). Ideal candidates will live within 50 miles ... MO, Wallingford, CT, Grand Prairie, TX or Louisville, KY. The **Clinical Content Analyst ** will be responsible for driving the development and execution of the… more
- AdventHealth (Maitland, FL)
- …(Altamonte Springs,FL)** **The role you'll contribute:** A Senior Medical Economics analyst is responsible for analyzing and evaluating financial and economic data ... analyze fee schedules, and determine contract compliance. The Senior Medical Economics analyst must have attention to detail and competencies in decision support and… more
- AdventHealth (Altamonte Springs, FL)
- …identifying and sharing insights that improve operational, clinical, and financial performance. The Analyst will use healthcare data ( claims , labs, MMR data, EHR ... **Senior Medicare Data & Finance Analyst ** **Location:** Virtual **All the benefits and perks...role will include leveraging data from electronic health records, claims , and payer reports by means of SQL queries,… more
- Prime Therapeutics (Tallahassee, FL)
- …passion and drives every decision we make. **Job Posting Title** Senior Pricing Analyst **Job Description** The Senior Pricing Analyst participates in the ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more