- Target (Hialeah, FL)
- …management of onsite (or other) medical representative in collaboration with onsite HR, Sedgwick and the HQ Claims team. Lead and manage all regulatory ... members and their dependents comprehensive health benefits and programs, which may include medical , vision, dental, life insurance and more, to help you and your… more
- Elevance Health (Miami, FL)
- **Account Service Manager ** **Location: Must be within 50 miles of any location listed; position has both office/remote expectations.** AmeriBen is a proud member of ... Health family of companies. We are a third-party administrator (TPA) of medical benefits, also providing medical management, human resource consulting and… more
- Elevance Health (Miami, FL)
- **Account Service Manager - Pharmacy Account Management** **Location:** This position will work a hybrid model (remote and office). The ideal candidate must live ... to worksite and other locations as necessary. The **Account Service Manager ** is responsible for providing advanced customer service representation and strategic… more
- Elevance Health (Miami, FL)
- **CarelonRx Account Manager II** **Location:** This position will work a hybrid model (remote and office). The ideal candidate must live within 50 miles of one of ... Health PulsePoint locations listed on the requisition. The **CarelonRx Account Manager II** is responsible for retention and operational excellence that… more
- Carnival Cruise Line (Miami, FL)
- …refurbishment projects for the New Builds & Refurbishments department. The Project Manager is responsible for the planning, development and execution of large-scale ... shipyards and dry docks as well as in service. The project manager will supervise and monitor contractors / service vendors (including engineers, designers)… more
- Elevance Health (Hialeah, FL)
- **Nurse Medical Management II** **Location: multiple states: Texas, Florida,** or **Maryland.** The ideal candidate will live within 50 miles of one of our ... **Hours: Monday - Friday, Includes weekends and Holidays.** The **Nurse Medical Management II** is responsible to collaborate with healthcare providers and… more
- Elevance Health (Miami, FL)
- **Nurse Medical Management I** **location: multiple states: Texas, Florida an Maryland** or The ideal candidate will live within 50 miles of one of our designated ... locations. **Hours: Monday - Friday, Includes weekends and Holidays.** The **Nurse Medical Management I** is responsible to collaborate with healthcare providers and… more
- Elevance Health (Miami, FL)
- …+ Investigates potential fraud and over-utilization by performing the most complex medical reviews via prepayment claims review and post payment auditing. ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **RN Hospital Audit/Appeal Lead** is responsible for… more
- Elevance Health (Miami, FL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Miami, FL)
- …Health office**_ The **Provider Reimburse Admin** ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... Will Make an Impact:** + Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules, as well as… more
- Elevance Health (Miami, FL)
- …for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare related ... + 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)
- …Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator II** is responsible for the identification, ... to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim...bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits,… more
- Elevance Health (Miami, FL)
- …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 ... times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring...increments or decrements. + Communicates with sales, administration and claims to assess the rating and administrative impact or… more
- Elevance Health (Miami, FL)
- …Monday - Friday. **2 Holidays** per year and **occasional** weekends. The **Nurse Medical Management Sr** serves as **team lead** for nursing staff who collaborate ... promote effective use of resources for the most complex or elevated medical issues. Ensures medically appropriate, high quality, cost effective care through… more
- Elevance Health (Miami, FL)
- …negotiation process. Can work with multiple provider types, eg physician, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and ... to identify strategies to control costs. + Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable… more
- Elevance Health (Miami, FL)
- …the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. **How ... knowledge of insurance, call center, quality and pharmacy industry and medical terminology, and in-depth knowledge of relevant systems and proven understanding… more
- Elevance Health (Miami, FL)
- …as a trusted advisor and educator on healthcare-related inquiries, such as claims questions, helping find a doctor, and explaining benefits. **Available Shifts:** ... and incentive bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits, 401(k) +match,… more
- Elevance Health (Miami, FL)
- …procedures. + Develops and analyzes business performance reports (eg for claims data, provider data, utilization data) and provides notations of performance ... and incentive bonus programs (unless covered by a collective bargaining agreement), medical , dental, vision, short and long term disability benefits, 401(k) +match,… more