- Acosta Group (Jacksonville, FL)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position..., assesses the reason for the escalation, and provides resolution in priority order as directed by the Supervisor.… more
- Molina Healthcare (Jacksonville, FL)
- …with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution . Interprets and presents in-depth ... **Job Description** **Job Summary** Serves as claims subject matter expert. Assist the business teams...subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages… more
- Molina Healthcare (Jacksonville, FL)
- …understanding of Molina claims life cycle and all processes that affect claims payment + Participates in defect resolution for assigned component + ... review of production support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains understanding of solution… more
- Molina Healthcare (Jacksonville, FL)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of...Benefits and contracts configuration in QNXT + Must have claims processing experience + Knowledge is SQL + Experience… more
- Molina Healthcare (Jacksonville, FL)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... ensuring the highest quality on every project/request. Responsible for error resolution , follow up and performance metrics monitoring. + Provides peer review… more