- Trustmark (Tallahassee, FL)
- …the best to our colleagues, clients and communities. Responsible for overseeing a claims processing organization. Ensures claims are processed in a timely manner ... in accordance and compliant with government regulations. Develops claims adjudication policies and procedures that maximize the accuracy of claims payments.… more
- GuideOne Insurance (Tampa, FL)
- …etc.), submits monthly reports detailing unit activity and results to line of business director and senior claims management as requested. + Responsible for ... As the Casualty Claims Manager, you will be responsible for independently...this is a work from home position leading a remote team. Accountabilities: + Provides direction to claim adjusters… more
- GuideOne Insurance (Tampa, FL)
- As a Commercial Casualty Claims Adjuster, you will serve as a real partner to our members by processing claims accurately and efficiently so they can resume ... you. Accountabilities: + This position handles Commercial General Liability, Director 's & Officer Liability, Employment Practices Liability, Commercial Auto… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to...member PHI / HIPAA information + This is a remote position\#LI- Remote **Scheduled Weekly Hours** 40 **Pay… more
- Merck (Tallahassee, FL)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages ... questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific Congress Support, and… more
- Centene Corporation (Tallahassee, FL)
- …perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement ... of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to improve quality… more
- Prime Therapeutics (Tallahassee, FL)
- …It fuels our passion and drives every decision we make. **Job Posting Title** Director Account Management, PACE - Remote **Job Description** + Owns overall ... Management Centers (CMC) and Shared Services, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis… more
- Takeda Pharmaceuticals (Tallahassee, FL)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure...around the world. This position is currently classified as " remote " in accordance with Takeda's Hybrid and Remote… more
- Molina Healthcare (St. Petersburg, FL)
- …and other end users for operational and strategic analysis. **Knowledge/Skills/Abilities** The Director of Reporting & Analytics is a key leader within the ... BI_** + **_Clinic Systems experience - CCA_** + **_Experience with CM, UM, Claims , or Authorizations_** To all current Molina employees: If you are interested in… more
- Molina Healthcare (Tampa, FL)
- …* Proficiency in Microsoft Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, ... MCO, Medicare, Medicaid, Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting… more
- United Therapeutics (Tallahassee, FL)
- …the pharmaceutical and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code, the Sunshine ... Compliance departments related to the Food Drug and Cosmetic Act, the False Claims Act, Anti-Kickback Statute, the Sunshine Act and other healthcare related laws and… more
- Molina Healthcare (FL)
- …* Provides assessments and business rules to Corporate Configuration for COB tables and Claims edits logic in the QNXT system as well as maintenance to the internal ... Payment Integrity Tracking databases. * Ensures CMS and state regulatory requirements are met, for Pre-pay Edits, Overpayment Recovery, COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational… more
- Molina Healthcare (FL)
- …deliver effective customer service for all service needs including benefits, claims , billing inquiries, service requests, suggestions and complaints. Directly and ... through team members resolves both member and provider inquiries and complaints fairly and effectively. Provides direction and coordination to deliver accurate product and service information to members and providers, and identifies opportunities to increase… more
- Western Digital (Tallahassee, FL)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... requirements. + Insure the proper and efficient handling of claims as they relate to workers' compensation insurance requirements....to be performed in California, Colorado, New York or remote jobs that can be performed in California, Colorado… more
- HomeSafe Alliance (Jacksonville, FL)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… more
- Celestica (Orlando, FL)
- …ID: 124191 Region: Americas Country: USA State/Province: New Hampshire City: Remote Employee US **General Overview** **Functional Area:** Supply Chain Management ... (SCM) **Career Stream:** Supply Chain Management (SCM) **Role:** Director 1 (DR1) **Job Title:** Director , Strategic...ensure capacity is installed as needed. + Supports E&O claims , shortage management and follow up escalations with customers… more
- Mass Markets (FL)
- …a trusted partner in the industry. We are seeking an experienced and visionary Director of Strategic Growth and Capture to lead and drive large-scale capture efforts ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service,… more
- Mathematica (Tallahassee, FL)
- …data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and ... and Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from kickoff through… more
- Prime Therapeutics (Tallahassee, FL)
- …and drives every decision we make. **Job Posting Title** Underwriter - Remote **Job Description** The Underwriter is responsible for assisting in the development ... Evaluates the utilization and financial experience of customers and prospects + Performs claims re-pricing analyses of moderately complex external claims data +… more
- Prime Therapeutics (Tallahassee, FL)
- …we make. **Job Posting Title** Senior Business Integration Consultant - Remote **Job Description** The Senior Business Integration Consultant is responsible for ... efforts + Proficiency in one or more of the following areas: claims , eligibility, prior authorization, accumulators, and/or benefits + Previous PBM or healthcare… more