- 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)
- …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 ... ** Claims Representative I (Health & Dental)** **Location:** Must live within 50 miles of the Mason, OH,...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 ... ** Claims Representative I (Health and Dental)** **Location:** Remote,...help from co-workers, specialists and managers on non-basic issues. Must pass the appropriate pre-employment test battery. **How you… 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 ... **Pharmacy Data Claims Analyst & Insights (Business Analyst II)** _Location:...Experience working in a health plan and/or pharmacy benefit manager (PBM) strongly preferred. + Strong proficiency in SQL,… 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 ... one of our Elevance Health PulsePoint locations. **Nurse Case Manager I** Responsible for performing care management within the...such as at hospitals for discharge planning. **Ideal candidate ** MUST ** reside and licensed in the state… more
- Elevance Health (Miami, FL)
- …Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the...be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …and connection. This includes remote work and 1-2 days in office per week. Candidates must reside within a 50-mile or 1-hour commute each way of a relevant ... Elevance Health location. The **Nurse Case Manager Sr.** is responsible for care management within the...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 ... with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities… 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 ... to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Miami, FL)
- …Based Care** **Location:** This position will work a hybrid model (remote and office). Must reside within 50 miles/1 hour commute of our Miami or Tampa, ... + Prior experience with provider network contracting, provider networks, claims , finance, and operations. + Experience with Medicaid, Medicare,...be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …- Cost of Care** **Location:** This position will work a hybrid model (remote and office). Must reside within 50 miles/1 hour commute of our Miami or Tampa, FL ... + Prior experience with provider network contracting, provider networks, claims , finance, and operations. + Experience with Medicaid, Medicare,...be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour… more
- Elevance Health (Miami, FL)
- …This is primarily a remote position but may be required to go in for meetings/training. MUST RESIDE IN THE STATE OF FLORIDA. Monday-Friday 8 am - 5 pm EST ... medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied....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 ... **Operations Expert** **Location:** Must live within 50 miles of the Mason,...responsible for providing technical direction, guidance and resources to claims , customer service, or membership associates on a day-to-day… 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 ... 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 ... + 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 ... (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 ... **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