- Sedgwick (Miami, FL)
- …place to work. Great 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 unit, and develop and improve the individuals within the… more
- Molina Healthcare (St. Petersburg, FL)
- …including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure ... knowledge/skills/abilities:** * Establishes and maintains benefits, provider contracts, fee schedules, claims edits, and other system settings in the claim payment… more
- Humana (Tallahassee, FL)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Acosta Group (Jacksonville, FL)
- **DESCRIPTION** The Sr. Casualty Risk Analyst will assist the Director of Risk Management in the implementation of the corporation's property and casualty risk ... management programs with an emphasis on Workers' Compensation claims . In addition to providing technical claim support and...Inside + Work with others **Mental/reasoning:** + Reading - Complex + Math - Complex + Analysis/Comprehension… 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...+ Proven experience with Microsoft Office. Formulate and prepare complex reports, spreadsheets and budgets using Excel and Access… more
- Humana (Tallahassee, FL)
- …of our dynamic Wisconsin leadership team in this position as the Director , Consumer Service Operations. This position works with insurance companies, providers, ... members, and collection services in the settlement of claims through Call Center operations. Comprised of a team of claims associates researching & resolving the… more
- Humana (Tallahassee, FL)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records,… more
- Humana (Tallahassee, FL)
- …relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and… more
- Humana (Tallahassee, FL)
- …part of our caring community and help us put health first** The Director , Medicaid Trend Mitigation Strategy provides data-based strategic direction to identify and ... planning support for business segments or the company at large. The Director , Medicaid Trend Mitigation Strategy requires an in-depth understanding of how… more
- ADP (Maitland, FL)
- **ADP is hiring a Sr Director , Tax - Audit & Finance** + _Are you a Sr Tax Director , skilled in providing strategic financial guidance to leadership?_ + _Are you ... this may be the role for you. As Sr. Director , Tax - Audit & Finance, you will lead...requests during audits and ensuring all employer tax and claims fiduciary, compliance and operational requirements are met. Like… more
- Turner & Townsend (Orlando, FL)
- …client's vision. **Job Description** **Turner & Townsend Heery** is seeking a **Project Director ** to join our team in Orlando, Florida on a multi-year, sports ... related program. The Project Director will have sports related experience; knowledge of design,...the framework for construction quality control. + Review the claims resolutions recommendations. + Ensures Owner's Representative staffing levels… more
- Celestica (Orlando, FL)
- …Supply Chain Management (SCM) **Career Stream:** Supply Chain Management (SCM) **Role:** Director 1 (DR1) **Job Title:** Director , Strategic Supply Chain ... dynamic market environment. **Detailed Description** We are currently seeking a ** Director , Strategic Supply Chain Management (Capital Equipment)** to join our team… more
- Humana (Tallahassee, FL)
- …The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Danaher Corporation (Deland, FL)
- …Business System (https://www.danaher.com/how-we-work/danaher-business-system) which makes everything possible. Director Global Quality and Regulatory Compliance JOB ... Beverage applications. + Responsible for ensuring product meets all product claims specifications and regulatory requirements throughout the product lifecycle. +… more
- CVS Health (Tallahassee, FL)
- …health care more personal, convenient and affordable. **Position Summary** The Lead Director , Practice Transformation plays a key role by leading transformation of ... population data, risk stratification + Experience working with clinical and claims data **Preferred Qualifications** + Ability to manage multiple stakeholders,… 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 ... leadership experience with the ability to manage cross-functional teams and complex pursuits. + Strong analytical, organizational, and decision-making skills. +… more
- Molina Healthcare (Tampa, FL)
- …years leadership/supervisory experience required * Progressive management experience to manage complex work systems and workflows required * Knowledge of pre-edit ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid,… more
- Healthfirst (FL)
- …various operations + Oversee quality assessments to ensure that customer service, claims processing, and other critical functions meet defined quality benchmarks + ... and guidelines that impact Contact Center Operations, Enrollment and Billing and Claims operations for Medicaid, Medicare, and Commercial lines of business (ie… 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 ... databases._** + Proven success managing initiatives with multiple stakeholders and complex workflows. To all current Molina employees: If you are interested… more
- Prime Therapeutics (Tallahassee, FL)
- …or enhanced financial pricing strategies. This position will also lead highly complex financial pricing analyses, and provide consultation and analytic insight to ... 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