- Molina Healthcare (St. Petersburg, FL)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (St. Petersburg, FL)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **Responsibilities:** + The Managed Care Financial Analyst Sr . performs financial analyses of patient data for BayCare ... reports for health system management. + Models contracts performance in adjudication systems and Excel during the contract negotiation process. + Serves as Primary… more
- Molina Healthcare (St. Petersburg, FL)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- MetLife (Tampa, FL)
- …and possess in-depth knowledge of plan designs, benefit features and how claims are paid * Strong understanding of industry marketplace and legal developments. ... all levels of the organization * Ability to analyze data to influence and execute on renewal decisions *...computer navigation skills and ability to work in multiple systems simultaneously (Microsoft suite, different company platforms) * Strong… more
- CHS (Clearwater, FL)
- …medical necessity and appropriateness, eligibility and coordination of benefits + Documents fully claims referred to senior staff for review and determination + ... **Overview** **Health Insurance Medical Claims Examiner** **(Initial Training On Site - 90...work independently + Knowledge of medical and dental coding systems + Knowledge of medical terminology **Qualifications** **Qualifications:** +… more
- Bank of America (Tampa, FL)
- …detection algorithms and systems . Perform regular audits and analysis of transaction data to detect new fraud trends. * Guiding team to Develop new fraud ... Fraud Analytics and Innovation Senior Leader - Client Protection Newark, Delaware;Plano, Texas;...data required for performing analysis. * Partner with claims , policy, strategy, and product teams to deliver … more
- MyFlorida (Tampa, FL)
- OPS - SENIOR CLERK - 36999001 Date: May 31, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 847672 Agency: Department of Lottery Working Title: OPS - SENIOR CLERK - 36999001 Pay Plan: Temp Position Number: 36999001 Salary: $17 per… more
- Elevance Health (Tampa, FL)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- The Cigna Group (Tampa, FL)
- …data layers used for reporting, analytics, data exploration, and data processing pipelines/solutions. Develop stable and scalable systems aligned to ... _The job profile for this position is Software Engineering Senior Advisor which is a Band 4 Career Track...claims , membership eligibility, etc. Build automated solutions for data quality checks, Audit Balance and Controls (ABC), and… more
- MyFlorida (Tampa, FL)
- …duties which includes but is not limited to computer software and hardware, data systems and Versa:Regulation. + Investigates food borne illnesses and ... SENIOR SANITATION AND SAFETY SPECIALIST - 79011546 Date:...sanitation problems. Prepares administrative reports and maintains inspection activity data reports on a daily basis. Maintains appropriate continuing… more
- Elevance Health (Tampa, FL)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- Bank of America (Tampa, FL)
- …expand our capabilities, reduce customer friction, and make strategic investment decisions. Data related to customer profiles and online banking login events hold an ... deliver on organizational loss goals. Device and Non Monetary Fraud and Innovation Senior Analyst- This job is responsible for performing complex analyses of online… more
- Wolters Kluwer (Tampa, FL)
- …in some cases, exceeding customer expectations + Creating, tracking, and analyzing data on reviewer performance metrics using customer lens to provide upwards ... recommendation to management, senior leadership, and customers on how to improve customer...prior supervisory experience, preferably in a legal billing or claims environment. + 5+ years' experience in the legal… more
- MyFlorida (Tampa, FL)
- …required. This position will work closely with the Economic Self-Sufficiency Senior Management Analyst Supervisors, Program Administrators and other regional ESS ... needed and/or required competencies for staff. + Effectively provides/analyzes data and provides staff development and improvement information as indicated… more