- 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
- Cushman & Wakefield (Clearwater, FL)
- **Job Title** Sr . Facilities Manager **Job Description Summary** This position has managerial oversight of multiple facilities, an entire campus, or a portfolio of ... Facilities Manager and/or Assistant Facilities Manager reporting into it. The Senior Facilities Manager has the overall responsibility for overseeing the… 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
- 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
- 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
- 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
- Kemper (Tampa, FL)
- …to achieve growth & profit objectives may include training on products, systems , service, and underwriting, book transfers, development of existing accounts, new ... + Operates as the point of contact for operations, systems and policy training for account products as well...Utilizes agency segmentation, reports and technology to manage account data and performance. + Documents all completed activities with… more
- Medtronic (Tampa, FL)
- …Clinical Expert + Translates complex technical messaging, dispels competitive claims , resolves complex technical issues, and maintains customer relationships through ... role with last three consecutive years in a CRM Sr TFE role and have obtained IBHRE certification. -OR-...our walls. **Insight-driven care** . Fresh viewpoints. Cutting-edge AI, data , and automation. You're shaping the future of healthcare… 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
- 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
- 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)
- …related activities. Reviews and makes recommendations on construction related claims . Provides technical assistance and related coordination activities to utility ... customer complaints related to assigned projects under construction. Reviews contract claims for time/monies and submits recommendations to the Resident Engineer… more