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.).
Bristol West Customer Service Associate: Kansas City, KS • Caledonia, MI • OKC, OK • FL Farmers Group, Inc.Bristol West Customer Service Associate: Kansas City, KS • Caledonia, MI • OKC, OK • FLFlorida, FLRemote$18.23–$20.66 / hourHowever, applicants must reside within 50 miles of one of the following office locations to be eligible for future promotional opportunities: 5665 North Kraft Lake Drive, Caledonia, MI 49316. This role, whether performed virtually or in an office setting, operates in an open office working environment which will include normal and customary distractions, noise, and interruptions.
DME Intake - Patient, Insurance, And Documentation Specialist ValgorithmDME Intake - Patient, Insurance, And Documentation SpecialistFort Lauderdale, FLIndependently manage assigned intake, documentation, and verification workflows • Support denial prevention by ensuring clean, compliant front-end documentation • Coordinate closely with billing on root causes tied to documentation or eligibility • Maintain accurate tracking and timely follow-up on outstanding items. • Submit and track claims under supervision to understand downstream impacts • Review common denial and adjustment reasons tied to intake and documentation gaps • Achieve 90% claim accuracy on supported workflows.
(USA) Liquor Cashier Walmart Inc(USA) Liquor CashierMIRAMAR, FL$18–$26 / hourRespect the Individual: Embraces differences in people cultures ideas and experiences creates a workplace where associates feel seen supported and connected through a culture of belonging creates opportunities for all associates to thrive and perform helps to attract the best talent. Operates hardware such as cash registers or related equipment processes member purchases and assists in payments returns refunds and exchanges using appropriate procedures for different membership and payment types.
Account Representative - State Farm Agent Team Member Eva Hernandez - State Farm AgentAccount Representative - State Farm Agent Team MemberTamarac, FLFull timeAs an Insurance Sales & Customer Service Representative , you'll play a key role in delivering outstanding customer service while identifying opportunities to help customers protect what matters most. If you're driven to provide outstanding customer service, excited by sales opportunities, and ready to grow with a successful agency, this is the opportunity for you.
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.
Grievance/Appeals Representative I Elevance HealthGrievance/Appeals Representative IMiami, FloridaResponds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Commercial HVAC Technician Rockstar RecruitingCommercial HVAC TechnicianMiami, FloridaWe’re looking for a dedicated, highly skilled technician to join a dynamic and growing team focused on delivering exceptional commercial HVAC service. Work on Split Systems, Rooftop Units, Packaged Units, DOAS, VAVs/PIUs, Chillers, Boilers, Exhaust Fans, and more.
Pharmacy Tech - Per Diem - UHealth SoLé Mia University of MiamiPharmacy Tech - Per Diem - UHealth SoLé MiaNorth Miami, FLUHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process.
Research Pharmacy Tech, Per Diem University of MiamiResearch Pharmacy Tech, Per DiemMiami, FLUHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process.
["REVENUE CYCLE SPECIALIST","REVENUE CYCLE SPECIALIST"] COMMUNITY HEALTH OF SOUTH DADE["REVENUE CYCLE SPECIALIST","REVENUE CYCLE SPECIALIST"]MiamiWork the monthly and cumulative missing encounter report by validating open encounters are truly missing and working with the clinicians to ensure that they complete documentation and close encounter. Supports manager/supervisor in identification of potential loss revenue related to trends in charge entry, billing, coding, or contracting practices that are related to charge capture.
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.
Patient Care Coordinator Sedgwick Claims Management Services, Inc.Patient Care CoordinatorTelecommuter, FLPRIMARY PURPOSE: To provide excellent service to callers regarding claims for multiple lines of business; to expedite the claims application process and provide detailed claim notes on all calls; to resolve issues with one call/one person response; and to direct calls to appropriate escalation path as needed. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
NewTow and Storage Negotiation Specialist Sedgwick Claims Management Services, Inc.Tow and Storage Negotiation SpecialistFLMental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
NewService Center Representative. Sedgwick Claims Management Services, Inc.Service Center Representative.FLMental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. PRIMARY PURPOSE: To expedite the claims application process; to ensure correct case assignment; and to act as a customer liaison in assisting the customer with the correct contact person to resolve problems and/or questions.
Major Loss Examiner Amtrust Financial Services IncMajor Loss ExaminerBoca Raton, FLThe successful candidate will evaluate coverage issues and risk transfer opportunities as well as ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, and proper negotiation strategy is employed. Ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed.
Chiropractor Dane Street, LLCChiropractorMiami, FLDane Street is a national leader in Independent Medical Examinations (IMEs) and peer review services, trusted by insurance carriers and organizations across the country for objective, high-quality medical evaluations. Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal.
Bilingual Customer Engagement Specialist Avesis LLCBilingual Customer Engagement SpecialistFLRemote$16.68–$27.81 / hourAt Avsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
NewProperty Manager Avenue5 Residential IncProperty ManagerOpa-locka, FLRespond to resident complaints and issues and serve as liaison to residents and the corporate office regarding the administration of common area maintenance and the enforcement of landlord rules and regulations. Create a climate in which associates want to do their best by leading and communicating a shared vision with associates and providing coaching and development.