55 Results for

Adjudicator Jobs in Florida

Jobs

Claims Adjudicator Miami Jewish Health Systems Inc

Miami, FL

Completes all medical claims adjudication tasks twice monthly including, tracking all claims in system, verifying referrals/authorizations, entering new providers, working expectations generating remittance notices, file transmissions and mailing checks per established department protocol. Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for Accounting.

5 days ago

Implement & Coding Consultant Elevance Health Inc

Tampa, FL

$78,800–$135,929 / year

Minimum Requirements: Requires a BA/BS degree and a minimum of 5 years of related medical policy experience including prior experience leading large, multi-stakeholder regional or enterprise projects; or any combination of education and experience which would provide an equivalent background. Primary duties may include, but are not limited to: Conceptualizes implementation approaches that consider both broad business issues/objectives across regions and detailed considerations of adjudication systems, benefit design, and regulatory environments that vary by region.

11 days ago

Implement & Coding Consultant Elevance Health

Tampa, FL

$78,800–$135,929 / year

11 days ago

Offensive Security Validation Specialist StratAcuity Staffing Partners Inc

Tampa, FL

$70–$85 / hour

In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. The specialist will use hands-on penetration-testing experience to determine whether reported vulnerabilities are valid, identify false positives, assess exploitability, recognize vulnerability chains, and document evidence that supports remediation decisions.

1 day ago

Supervisory IT Specialist (Customer Support) U.S. Department of Veterans Affairs

West Palm Beach, FL

$89,508–$116,362 / year

Customer Service - Works with clients and customers (that is, any individuals who use or receive the services or products that your work unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations; knows about available products and services; is committed to providing quality products and services. Open to current permanent employees (career or career-conditional) of the Department of Veterans Affairs (competitive or excepted), Current permanent Federal employees eligible for transfer, former federal employees eligible for Reinstatement, veterans eligible for consideration under VEOA, Certain Military Spouses, Peace Corps/VISTA, disabled individuals eligible under Schedule A, and those eligible under current Interchange Agreements.

1 day ago

EDUCATION AND TRAINING SPECIALIST - 67071906 APD/ DDDP CHATTAHOOCHEE, FL Government of Florida

Chattahoochee, FL

$1,500–$1,990.13

Research and develop curricula using computer programs such as PowerPoint, Captivate, Articulate or other computer software programs for the improvement and development of our agency staff through New Employee Orientation (NEO) and continuing training. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.

1 day ago

EPIC BEACON CLINICAL APPLICATIONS ANALYST - PHARMACY H. Lee Moffitt Cancer Center & Research Institute Inc

Tampa, FL

$138,424–$211,120 / year

The Clinical Application Analyst (Pharmacy) is responsible for the design, build, optimization, and support of Epic pharmacy and clinical applications across inpatient, ambulatory, and oncology settings. The Clinical Application Analyst Pharmacy is responsible for the design, build, optimization, and support of Epic pharmacy and clinical applications across inpatient, ambulatory, and oncology settings.

21 days ago

Manager, Personnel Background Investigations KPMG International Cooperative

Fort Lauderdale, FL

$127,200–$246,900 / year

Albany, NY; Albuquerque, NM; Anchorage, AK; Ashburn, VA; Atlanta, GA; Austin, TX; Baltimore, MD; Baton Rouge, LA; Bentonville, AR; Birmingham, AL; Boise, ID; Boston, MA; Boulder, CO; Buffalo, NY; Charlotte, NC; Chicago, IL; Cincinnati, OH; Cleveland, OH; Columbus, OH; Dallas, TX; Denver, CO; Des Moines, IA; Detroit, MI; El Segundo, CA; Fort Worth, TX; Ft Lauderdale, FL; Greenville, SC; Harrisburg, PA; Hartford, CT; Honolulu, HI; Houston, TX; Indianapolis, IN; Irvine, CA; Jackson, MS; Jacksonville, FL; Kansas City, MO; Knoxville, TN; Las Vegas, NV; Lincoln, NE; Los Angeles, CA; Louisville, KY; McLean, VA; Melville, NY; Memphis, TN; Miami, FL; Milwaukee, WI; Minneapolis, MN; Montvale, NJ; Morristown, NJ; Nashville, TN; New Orleans, LA; New York, NY; Oklahoma City, OK; Omaha, NE; Orlando, FL; Philadelphia, PA; Phoenix, AZ; Pittsburgh, PA; Portland, OR; Providence, RI; Raleigh, NC; Richmond, VA; Rochester, NY; Sacramento, CA; Salt Lake City, UT; San Antonio, TX; San Diego, CA; San Francisco, CA; San Juan, PR; Santa Clara, CA; Seattle, WA; Shreveport, LA; St Louis, MO; Stamford, CT; Tallahassee, FL; Tampa, FL; Tempe, AZ; Virginia Beach, VA; Washington, DC; Winston-Salem, NC. Responsibilities: Apply comprehensive and specialist knowledge in conducting background investigation case management and adjudication programming to mitigate and minimize risks associated with personnel and third-party talent acquisition or other background related investigations of parties with trusted access to people, information, and assets in alignment to all set forth governmental, client driven, or regulatory obligations.

4 days ago

Fire Protection Specialist U.S. Department of the Interior

Homestead, FL

$61,722–$80,243 / year

Merit Promotion Eligibility Documentation such as: Federal employees must submit a copy of their latest SF-50 "Notification of Personnel Action" that reflects career or career-conditional tenure, such as the initial hire, promotion, or reassignment, showing position title, series, grade and tenure (please do not submit an Award SF-50 unless it provides the necessary information) and, if different, an SF-50 showing highest permanent grade ever held. PCS INFORMATION: Yes, entitlements for payment of basic moving expenses, as required and to the extent allowed by the Federal Travel Regulation (FTR) 302-3.101, are authorized for eligible applicants changing duty station when the change meets the distance tests as provided in FTR 302-1.1 and 302-2.6.

4 days ago

Program Management Specialist U.S. Department of Agriculture

Miami, FL

$65,735–$85,460 / year

Employees of the following USDA agencies who apply for this position, whose current permanent grade is equal to the grade of the advertised position, and whose selection would result in a relocation outside the commuting area of their current duty station may not currently be considered for selection to this position: Agricultural Research Service; Economic Research Service; National Institute of Food and Agriculture, National Agricultural Statistics Service; United States Forest Service; Food and Nutrition Administration; Foreign Agricultural Service; Rural Development and component organizations; the Farm Production and Conservation (FPAC) mission area, to include the FPAC Business Center, the Natural Resources Conservation Service, the Risk Management Agency, and Farm Service Agency and Farm Service Agency County employees; Office of the General Counsel; and Office of the Assistant Secretary for Civil Rights. A present or former member of the Foreign Service may be considered for this opportunity if s/he: previously appointed under the Foreign Service Act of 1946, as amended, the Foreign Service Act of 1980, or legislation that supplements or replaces the latter Act; served in the Foreign Service under an unlimited, career-type appointment and, immediately before separation from that appointment, completed one year of continuous service under one or more non-temporary appointments in the Foreign Service, which may include the service that made him/her eligible for the career-type appointment; and.

5 days ago

Supervisory IT Specialist U.S. Department of Veterans Affairs

Miami, FL

$125,776–$163,514 / year

SELECTIVE PLACEMENT FACTOR: In addition to the minimum qualifications described above, you must meet the following requirement(s) to be considered qualified for the position: Within the past five (5) years, the applicant has served as the program lead or senior technical authority for a mission-critical, high-availability enterprise system deployed in a cloud environment, built on an enterprise application stack that includes a Java-based application, a relational database, and one of more data replication, synchronization, or messaging mechanisms, with direct ownership of system sustainment data integration or synchronization with a partner organization, and leadership of the technical and/or vendor teams supporting IT. Customer Service - Works with clients and customers (that is, any individuals who use or receive the services or products that your work unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations; knows about available products and services; is committed to providing quality products and services.

5 days ago

Legal Administrative Specialist (Contact Representation) U.S. Department of Veterans Affairs

Saint Petersburg, FL

$67,970–$88,356 / year

Customer Service: Works with clients and customers (that is, any individuals who use or receive the services or products that your work unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations; knows about available products and services; is committed to providing quality products and services. MINIMUM QUALIFICATION REQUIREMENT: You may qualify based on your experience and/or education as described below: GS-10 Grade Level: Specialized Experience: Specialized experience is defined as (1) experience that has demonstrated the capability of being a self-reliant decision-maker and possessing the ability to work independently when providing customer service benefits counseling and claims processing.

6 days ago

Supervisory Contract Specialist (Branch Chief) U.S. Department of Veterans Affairs

Eglin AFB, FL

$125,776–$188,573 / year

Experience with substantial coordinating and integration of a number of major work assignments, projects, or program segments of professional, scientific, technical, or administrative work including but not limited to: coordinating activities among various contracts and negotiations where timing is important, determining projects or program segments to be initiated, dropped or curtailed; restructuring or reformulating goals or objectives based on new information, changes in priorities, changes in directives or legislation that impacts VHA contracting. Waiver: When filling a specific vacant position, the senior procurement executive of the selecting agency, at his or her discretion, may waive any or all of the requirements of Paragraphs A and B above if the senior procurement executive certifies that the applicant possesses significant potential for advancement to levels of greater responsibility and authority, based on demonstrated analytical and decision making capabilities, job performance, and qualifying experience.

6 days ago

Front-End Web Developer TriWest Healthcare Alliance

Tampa, FL

Remote

Full time

Technical Skills: Knowledge of and/or experience with Adobe Creative Suite (Photoshop, Illustrator, and Acrobat) as well as Microsoft Office; Extensive knowledge of hand-coding HTML, CSS, JavaScript (including jQuery), NET (C#); Extensive knowledge of developing and testing Section 508 compliance, Knowledge of web design editing software including Microsoft Visual Studio and Adobe Dreamweaver; Proficient in PC operating systems. Consults with Communications and IT staff on architecture issues as required; consults with client departments on project issues and offers training to departments as needed to help ensure TriWest's policy on 508 compliance is enforced.

13 days ago

Information Technology Specialist US Department of State

Oakland Park, FL

$113,356–$147,365 / year

U.S. Department of State career or career conditional status employees in the competitive service; employees who are on temporary or other non-status appointments who have reinstatement or non-competitive eligibility for a competitive service appointment (e.g., career Foreign Service employees, employees on an excepted service appointment at the USUN who have previous career status, etc.); and CTAP. You will be assessed on the following job-related competencies (knowledge, skills, abilities, and other characteristics): Non-Supervisory: Oral Communication, Writing, Interpersonal Skills, Problem Solving, Teamwork, Technology Orientation, Customer Service, Attention to Detail and Self-Management.

14 days ago

Wild Horse & Burro Coordinator U.S. Department of the Interior

Jupiter, FL

$40,736–$80,243 / year

Superior Academic Achievement (SAA): Successfully completed a bachelor''s degree in a directly related field AND meet one of the following: (1) Class Standing: rank in the upper 3rd of the graduating class in the college, university, or major subdivision, based on the completed courses; OR (2) Grade-Point Average (GPA): earn a GPA of (a) 3.0 or higher out of a possible 4.0 ("B" or better) based on 4 years of education, or based on courses completed during the final 2 years of the curriculum -or- (b) 3.5 or higher out of a possible 4.0 ("B" or better) based on the average of the required courses completed in the major field, or the required courses completed during the final two years. Land Management Workforce Flexibility Act (LMWFA): you must submit ALL Appointment AND Termination SF-50s for EACH appointment verifying the Position Occupied code 1-Competitive Service (block 34); AND Documentation of satisfactory performance for each period of temporary employment claimed, such as, performance evaluations, memorandum of record, whereas the supervisor(s) documented an acceptable performance level for a specified rating/employment period.

14 days ago

Medical Claims Examiner Alivi TPA of Florida, LLC

Miami, FL

Full time

Highly complex medical claim reviewAdvance claim adjudicationAdvance claim history analysisReview medical record documentation to determine coding coverageComplex appeals and reconsiderationsEscalated claim resolutionComplex provider and payer issuesComplex duplicate claim investigationsPayer Audit-related claim reviewsComplex void and replace processingAdvance reprocessing resolutionResearch of system and adjudication issuesReview of recurring claim-processing problemsIdentify opportunities for process improvementAssist with system and workflow validationProvide subject-matter expertise to Levels 1 and 2Provide guidance and mentoring to Claims team membersAssist with training and knowledge transferSupport development and refinement of claims proceduresServe as a senior escalation and subject -matter resource for complex claim issues

15 days ago

Temporary Manager, Personnel Background Investigator KPMG International Cooperative

Fort Lauderdale, FL

$127,200–$246,900 / year

Albany, NY; Albuquerque, NM; Anchorage, AK; Ashburn, VA; Atlanta, GA; Austin, TX; Baltimore, MD; Baton Rouge, LA; Bentonville, AR; Birmingham, AL; Boise, ID; Boston, MA; Boulder, CO; Buffalo, NY; Charlotte, NC; Chicago, IL; Cincinnati, OH; Cleveland, OH; Columbus, OH; Dallas, TX; Denver, CO; Des Moines, IA; Detroit, MI; El Segundo, CA; Fort Worth, TX; Ft Lauderdale, FL; Greenville, SC; Harrisburg, PA; Hartford, CT; Honolulu, HI; Houston, TX; Indianapolis, IN; Irvine, CA; Jackson, MS; Jacksonville, FL; Kansas City, MO; Knoxville, TN; Las Vegas, NV; Lincoln, NE; Los Angeles, CA; Louisville, KY; McLean, VA; Melville, NY; Memphis, TN; Miami, FL; Milwaukee, WI; Minneapolis, MN; Montvale, NJ; Morristown, NJ; Nashville, TN; New Orleans, LA; New York, NY; Oklahoma City, OK; Omaha, NE; Orlando, FL; Philadelphia, PA; Phoenix, AZ; Pittsburgh, PA; Portland, OR; Providence, RI; Raleigh, NC; Richmond, VA; Rochester, NY; Sacramento, CA; Salt Lake City, UT; San Antonio, TX; San Diego, CA; San Francisco, CA; San Juan, PR; Santa Clara, CA; Seattle, WA; Shreveport, LA; St Louis, MO; Stamford, CT; Tallahassee, FL; Tampa, FL; Tempe, AZ; Virginia Beach, VA; Washington, DC; Winston-Salem, NC. Exceptional verbal/written communication, collaboration, presentation, and negotiation skills to lead case management and adjudication in an environment driven by customer service, high quality, and teamwork; capable of building strong professional relationships with ability to influence all levels across the organization; able to set and execute strategic initiatives for team; creative thinker with ability to identify innovative business solutions; ability to develop strategic organization and resource plans, defining next generation business and leadership needs.

15 days ago

Lead ID Card Specialist (Personnel Assistant III), NAVY ICA; Orlando, FL Magellan Health Services, Inc.

Orlando, FL

Full time

Provides professional military personnel support services to the U.S. Navy's Identification Card Administration (ICA) program at Navy installations designated as Defense Enrollment Eligibility Reporting System (DEERS) and Real-time Automated Personnel Identification System (RAPIDS) sites. Issues and strictly controls Armed Forces identification and privilege cards for all eligible personnel, (i.e., active duty military, retired military, 100% Disabled American Veteran (DAV) and respective dependents and verified contractors.

15 days ago

Program Support Specialist U.S. Department of the Interior

Homestead, FL

$95,326–$123,927 / year

Land Management Workforce Flexibility Act (LMWFA): If you are applying under LMWFA, you must submit ALL Appointment AND Termination SF-50s for EACH appointment verifying the Position Occupied code 1-Competitive Service (block 34); AND Documentation of satisfactory performance for each period of temporary employment claimed, such as, performance evaluations, memorandum of record, whereas the supervisor(s) documented an acceptable performance level for a specified rating/employment period. If you are a veteran within 120 days of discharge, you must submit signed documentation from the Armed Forces certifying: 1) your expected release/retirement from active duty, 2) under honorable conditions, 3) your pay grade/rank/rate at time of discharge, 4) dates of active-duty service, 5) any campaign or expeditionary medals received, & 6) dated within 120 days of your separation.

17 days ago

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Adjudicator Jobs in Florida

Claims Adjudicator Miami Jewish Health Systems Inc

Implement & Coding Consultant Elevance Health Inc

Implement & Coding Consultant Elevance Health

Offensive Security Validation Specialist StratAcuity Staffing Partners Inc

Supervisory IT Specialist (Customer Support) U.S. Department of Veterans Affairs

EDUCATION AND TRAINING SPECIALIST - 67071906 APD/ DDDP CHATTAHOOCHEE, FL Government of Florida

EPIC BEACON CLINICAL APPLICATIONS ANALYST - PHARMACY H. Lee Moffitt Cancer Center & Research Institute Inc

Manager, Personnel Background Investigations KPMG International Cooperative

Fire Protection Specialist U.S. Department of the Interior

Program Management Specialist U.S. Department of Agriculture

Supervisory IT Specialist U.S. Department of Veterans Affairs

Legal Administrative Specialist (Contact Representation) U.S. Department of Veterans Affairs

Supervisory Contract Specialist (Branch Chief) U.S. Department of Veterans Affairs

Front-End Web Developer TriWest Healthcare Alliance

Information Technology Specialist US Department of State

Wild Horse & Burro Coordinator U.S. Department of the Interior

Medical Claims Examiner Alivi TPA of Florida, LLC

Temporary Manager, Personnel Background Investigator KPMG International Cooperative

Lead ID Card Specialist (Personnel Assistant III), NAVY ICA; Orlando, FL Magellan Health Services, Inc.

Program Support Specialist U.S. Department of the Interior

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