- 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)
- **Staff VP Claims Operations (Original Claims )** **Location:** Successful candidate must reside within 50 miles of an Elevance office, and able to work a ... for the strategic and operational business needs of original claims , or first-time claims , for the Government...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 ... **CarelonRx Account Manager II** **Location:** This position will work a...a hybrid model (remote and office). The ideal candidate must live within 50 miles of one of our… 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 ... Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes...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 ... 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 ... office)._ _Alternate locations may be considered._ _The Ideal candidate must live within 50 miles of one of our...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… 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 ... + 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 ... 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 (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 ... (remote and in office 1-2 days per week). Candidates must live within 50 miles one of our Pulse...will make an impact:** * Focuses efforts on lowering claims costs, improving the quality of care, and increasing… 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 ... **LOCATION** **: This is a remote position; however, you must be within 50 miles of an eligible Elevance...medical directors in interpreting appropriateness of care and accurate claims payment. + May also manage appeals for services… 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 ... **Utilization Management Representative II** **Location:** Must live within 50 miles of a Florida...impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides… 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 ... and services, provider experience, digital communications, utilization management, and claims /payment integrity. + Experience in vendor selection, product and… more