- Molina Healthcare (Tampa, 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 (Tampa, 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
- Elevance Health (Tampa, FL)
- …** is responsible for providing support, configuration, design, testing and implementation for claims systems . Ensures accurate adjudication of claims , by ... **Pre-Pay Editing Analyst Sr ** **Location:** This role requires associates to be...and the vendor to ensure quality and timeliness of systems /project deliverables. + Configures new designs/updates in the system.… more
- Molina Healthcare (Tampa, FL)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- USAA (Tampa, FL)
- …what truly makes us special and impactful. **The Opportunity** As a dedicated Senior Auto Appraiser, within defined guidelines and framework, you are responsible for ... the investigation, negotiation, evaluation and appraisal of vehicle damage claims for both repairable and total loss vehicles to ensure estimate accuracy in… more
- Sedgwick (Tampa, FL)
- …+ Assists with ad hoc analysis and communicates results and recommendations to senior management. + Maintains various systems and updates as appropriate; may ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr . FP&A Analyst/ Hybrid **PRIMARY PURPOSE** **:** To partner with and support the… more
- Medtronic (Tampa, FL)
- …for these individuals. We are hiring a passionate, fast-paced, and strategic ** Sr . Group Market Development Manager** to manage the healthcare professional (HCP) ... and provides strategic support to reimbursement, clinical, and sales teams. The Sr . Group Market Development Manager will focus on increasing healthcare professional… 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 (Tampa, FL)
- …more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, ... **Job Description** **Job Summary** Sr . Analyst, Network Strategy, Pricing & Analytics guides...(including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future… more
- Molina Healthcare (Tampa, FL)
- … systems to support executive decision-making + Mine and manage information from large data sources + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...reports, and improvement opportunities based on analyses + Provide data driven analytics to Clinical COE, Finance, Claims… more
- Molina Healthcare (Tampa, FL)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Molina Healthcare (Tampa, 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
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and lab data regarding network ... + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + BI tools To all current Molina employees: If you… 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
- 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
- Bank of America (Tampa, FL)
- Fraud Analytics and Innovation Senior Analyst Newark, Delaware;Tampa, Florida; Jacksonville, Florida; Charlotte, North Carolina; Phoenix, Arizona **Job ... customer experience. Key responsibilities include utilizing a variety of systems , such as Excel, SAS, SQL, Tableau, and other...such as Excel, SAS, SQL, Tableau, and other relational data bases, to provide analytical support on strategies, ensure… more
- Walgreens (Lutz, FL)
- …with Company policies and procedures. + Responsible for operating pharmacy systems to obtain patient and drug information and process prescriptions. Assists ... and coaches pharmacy technicians in the operation of pharmacy systems and cashiers in the operation of the pharmacy...those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a… more
- Sedgwick (Tampa, FL)
- …and productivity; to provide strategic planning; to assure security and integrity of data systems ; and to manage vendors and evaluate third party and ... to support efficient technology for internal and customer use; serves as a senior management liaison with other departments within and beyond the Systems … 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