Revenue Cycle Specialist III, RCM Team Select Home Care LLCRevenue Cycle Specialist III, RCMMiami, FL$18–$24 / hourThe Revenue Cycle Specialist III is a position that calculates and posts receipts to appropriate accounts, verifies details of transactions; performs billing, posting and collection of claims related to specific payers. Handles critical accounts and projects, coordinating with management, operations, and payers to ensure issues are resolved.
Senior Fraud, Waste and Abuse (FWA) Specialist PacificSource Health PlansSenior Fraud, Waste and Abuse (FWA) SpecialistFL$65,296.83–$111,004.62 / yearThis position leads program administration activities, partners with operational teams and regulatory agencies, and develops processes that strengthen the organization''s ability to detect, prevent, investigate, recover, and report fraud, waste, abuse, and payment integrity concerns. The Senior Fraud, Waste and Abuse (FWA) Specialist serves as the organization's subject matter expert responsible for supporting and advancing PacificSource''s Payment Integrity and FWA programs.
Ability Analyst The Hartford Insurance Group IncAbility AnalystSunrise, FL$46,222–$69,333 / yearFor full-time, occasional, part-time or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Wi-Fi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 10Mbps/75Mbps will be required. The Hartford will make a direct contribution of $125 per month - with a lifetime maximum up to $10,000 - as a supplemental payment towards your student loan in order to help you manage the stress of student debt and help you pay down your student loan faster.
Medical Director Wisconsin Physicians Service Insurance CorpMedical DirectorMiami, FLThe Contractor Medical Director (CMD) is responsible for researching and reviewing clinical evidence in support of developing Local Coverage Determinations (LCDs), conducting medical review (MR) activities, providing clinical program outreach activities, taking party or participant status in Administrative Law Judge (ALJ) appeals hearings, and performing appeals. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams.
NewQuality Assurance Technician Coca-Cola Beverages Florida LLCQuality Assurance TechnicianHollywood, FLWho We Are: Coca-Cola Beverages Florida, LLC (Coke Florida) is a family-owned independent Coca-Cola bottler that is the third largest privately-held and the sixth largest independent Coca-Cola bottler in the United States. This program recognizes outstanding U.S. private companies and the achievements of their management teams in four key areas: strategy, ability to execute, corporate culture, and governance/financial performance.
Liability Adjuster I TWAY Trustway ServicesLiability Adjuster IMiami, FloridaAs a Liability Adjuster I, you'll investigate claims, make informed decisions, negotiate fair outcomes, and guide customers through one of the most important moments they'll have with our company. At AssuranceAmerica, you'll have the opportunity to sharpen your technical expertise, expand your leadership skills, and build a career with a company that believes your growth drives our success.
Investigator, Special Investigative Unit Coding Molina Healthcare IncInvestigator, Special Investigative Unit CodingFLWorking knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.). In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
Director, Health Plan Operations (Must reside in Florida) Molina Healthcare IncDirector, Health Plan Operations (Must reside in Florida)Miami, FLRemoteSupports member stakeholder experience team initiatives including: member static website, member web portal and Customer Relationship Management (CRM); ensures compliance with regulatory requirements and successful communication and implementation with members, employees and other key stakeholders to limit operational impact. Essential Job Duties • Under the direction of senior leadership, organizes, plans, staffs, and coordinates health plan operations for market-specific designated lines of business (Medicaid, Medicare, Marketplace, Childrens Health Insurance Program (CHIP), Medicare-Medicaid Plan (MMP), etc.).
Provider Services Advocate Independent Living Systems LLCProvider Services AdvocateMiami, FLILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Provider Services Advocate plays an essential role in supporting healthcare providers by serving as a liaison between providers and the organization.
Lead Software Engineer Healthcare Payer SME - CapAdmin Platform AliviLead Software Engineer Healthcare Payer SME - CapAdmin PlatformMiami, FLAlivi is seeking a Lead Software Engineer with deep healthcare payer domain expertise to join our CapAdmin platform team, our proprietary claims administration system supporting our TPA (Third-Party Administrator) operations. The ideal candidate is a senior engineer who has lived inside a payer or TPA platform someone who understands not just how to build software, but how claims, eligibility, capitation, COB, UM, and UB04 workflows actually function in a real payer environment.
Lead Software Engineer Healthcare Payer SME — CapAdmin Platform AliviLead Software Engineer Healthcare Payer SME — CapAdmin PlatformMiami, FLAlivi is seeking a Lead Software Engineer with deep healthcare payer domain expertise to join our CapAdmin platform team, our proprietary claims administration system supporting our TPA (Third-Party Administrator) operations. The ideal candidate is a senior engineer who has lived inside a payer or TPA platform someone who understands not just how to build software, but how claims, eligibility, capitation, COB, UM, and UB04 workflows actually function in a real payer environment.
Medicare Sales Associate (seasonal-temporary) Wisconsin Physicians Service Insurance CorpMedicare Sales Associate (seasonal-temporary)Miami, FLRemoteWe are open to remote work (from home) in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams.
Supplemental Sales Agent - Miami, FL WorksiteSupplemental Sales Agent - Miami, FLMiami, FloridaThe Wise Benefits product suite captures the supplemental benefit offerings of Horace Mann's Worksite Division. Being part of our organization means you can empower educators and others who serve the community to receive better benefits and financial stability.
New["Freight Agent - Miami International Airport (MIACG1)","Freight Agent - Miami International Airport (MIACG1)"] PrimeFlight Aviation Services["Freight Agent - Miami International Airport (MIACG1)","Freight Agent - Miami International Airport (MIACG1)"]MiamiACTIVITY/WORKING CONDITIONS MAY INCLUDE:**+ Ability to lift up to 70 pounds+ Prolonged standing and walking in an indoor/outdoor environment as applicable+ May need to reach with arms and grasp with hands+ May need to push, pull+ May need to crawl and crouch, at times, in confined tight spaces+ May need to bend, stretch, squat, kneel+ May need to climb and work at elevated heights+ Exposure to moderate and at times high noise levels+ Exposure to Biohazards and/or Chemicals+ Exposure to outdoor elements+ Be able to hear and respond to the spoken voice and to audible alarms+ Tasks may involve repetitive motions of the arms, wrists, hands and/or fingers+ Specific vision abilities required for this job include: Close vision (clear vision at 20 inches or less); distance vision (clear vision at 20 feet or more); peripheral vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point); depth perception (three-dimensional vision, ability to judge distances and spatial relationships); ability to adjust focus (ability to adjust the eye to bring an object into sharp focus) The pay rate listed on this post is what the company reasonably expects to pay for this position. Communicate effectively in English (reading, writing, speaking)+ Warehouse or inventory management experience is a plus + Ability to access and interpret information in print and electronically, including the use of electronic devices including IPads/Tablets, Computers, and Mobile Devices+ Effectively communicate with colleagues and clients, both in-person and through electronic means+ Pass a background check and drug screen+ Eligibility to acquire needed credentials and clearances (FAA, RAIC, TSA, Port Authority, U.S. Customs and U.S. Postal- as applicable).+
Multi-Line Representative - State Farm Agent Team Member Yaavar Rahman - State Farm AgentMulti-Line Representative - State Farm Agent Team MemberFort Lauderdale, FLFull timeBefore that, I worked in banking at Wells Fargo, which helped shape my approach to customer service, financial conversations, and relationship building. We’re looking for team members who are hungry, self-motivated, and excited about earning strong income while growing their careers.
Sr Analyst Commercial Logistics Freight Bunge Global SASr Analyst Commercial Logistics FreightCoral Gables, FLReporting to the Director - Freight Trading, the Sr Analyst Commercial Logistics Freight is responsible for all aspects related with the transportation of raw materials including but not limited to agricultural commodities in ocean going vessels chartered under different contract modalities i.e. Time Charter or Voyage Charter. Responsibilities range from the vessel's initial instructions, cargo stow-plan calculations, optimal routing, fuel consumption and replenishment planning to vessel's hire and freight payments, disputes and claims resolution as well as monitor all related port restrictions, delays, and regulations involved in the vessel's service.
Multi-Line Representative - State Farm Agent Team Member Ileana Cabrera-Rodriguez - State Farm AgentMulti-Line Representative - State Farm Agent Team MemberCoral Gables, FLFull timeWe’re looking for someone who is hungry, self-driven, and accountable - someone with strong integrity, good judgment, and a desire to grow as part of a high-performing team. Whether we’re helping someone navigate a claim or personalize a plan, we believe in doing meaningful work that makes a difference.
Service Warranty Administrator - Nissan Pembroke Pines AutoNation IncService Warranty Administrator - Nissan Pembroke PinesPembroke Pines, FLWith a network of dealerships nationwide strengthened by a recognized brand, we offer a wide variety of new and used vehicles, customer financing, parts, and provide expert maintenance and repair services. AutoNation is one of the largest automotive retailers in the United States, offering innovative products, exceptional services, and comprehensive solutions, empowering our customers to make the best decisions for their needs.
Medical Review Nurse (RN) - UM/Appeals experience Molina Healthcare IncMedical Review Nurse (RN) - UM/Appeals experienceFlorida, FLREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Payment Processing Specialist - 994374 Nova Southeastern UniversityPayment Processing Specialist - 994374Fort Lauderdale-Davie, FLSkills: Active Listening - Proficient skills in giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. Major (if required: Required Experience: High School Diploma and five (5) years of medical accounts receivable, medical payment posting process including manual and electronic, or insurance payment remittance process experience.