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.
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.
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.
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.
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.
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.
NewDirector, Pharmacy Amtrust Financial Services IncDirector, PharmacyBoca Raton, FL$130,000–$155,000 / yearAbility to prepare and effectively communicate presentations, interpret/develop reports, metrics and improvement plans, and to interact collaboratively and work effectively with a multi-functional team and throughout the organization; foster an environment of shared responsibility and accountability. This role will achieve outcomes by focusing on analytics, clinical operations, and development of new programs to support organizational vision, and cost savings.
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.
Property 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.
Regional Sales Manager Auto Insurance - South Florida United Auto InsuranceRegional Sales Manager Auto Insurance - South FloridaMiami, FLSCOPE: As a Regional Sales Manager, you will be responsible for generating revenue and meeting sales targets by establishing and maintaining relationships with existing agencies while also seeking out and acquiring new business opportunities. SKILLS & EXPERIENCE: 3 years of proven experience in field sales or a related role with a successful track record of meeting or exceeding sales targets.
Inpatient DRG Reviewer Zelis Healthcare, Inc.Inpatient DRG ReviewerFL$79,000–$99,750 / yearWhere the regrouped 'new DRG' differs from what was originally claimed by the provider, write a customer facing 'rationale' or 'findings' statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Billing Financial Analyst, CBO Jackson Health SystemBilling Financial Analyst, CBOMiami, FLCBO Billing Financial Analyst performs various interviewing, fact collection and financial evaluation tasks in connection with credit and collection in a large and diversified hospital serving both non-indigent and indigent patients qualifying for various types of specialized assistance programs. Reviews claims for accuracy, performs required edits, and submits claims and rebills to payors daily in paper and/or electronic format to ensure accurate and timely filing of claims and prompt payment.
Insurance Risk Manager Origis EnergyInsurance Risk ManagerMiami, FLManage the reporting, processing and adjustment of claims to include tracking, negotiating and resolution at the project and corporate levels including, but not limited to, All-Risk Property and Business Interruption, General and Umbrella/Excess Liability, Workers' Compensation and Employer's Liability, Automobile Liability, Directors & Officers, Cyber, Crime, etc. Origis Energy puts customers first to deploy a wide range of sustainable solutions for grid power generation, performance optimization, and long-term operation of solar and energy storage plants across the U.S. Founded in 2008, Origis Energy is headquartered in Miami, FL.
Senior DME Operations & Revenue Integrity Specialist ValgorithmSenior DME Operations & Revenue Integrity SpecialistFort Lauderdale, FLThe Senior DME Operations & Revenue Integrity Specialist owns front-end documentation compliance, insurance verification, and revenue readiness for Medicare and commercial claims. We are building a highly controlled, audit-ready Medicare DME operation and are seeking our first senior operations hire.
Billing Representative II (A/R) - Boynton Beach, Florida NYU Langone Medical CenterBilling Representative II (A/R) - Boynton Beach, FloridaBoynton Beach, FLUtilize CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned workqueue(s) using payer websites, billing system information and training within expected timeframe. In this role, the successful candidate performs advanced billing and financial clearance functions including claims management, complex denial resolution, insurance authorizations, precertifications, and patient cost estimates.
Director Business Development Crawford & CoDirector Business DevelopmentFLRemoteRole Overview: Under direction from SVP-Business Development, National Sales Director, or Business Unit Head, generates leads, conducts sales calls, prepares proposals and makes formal presentations to potential national account clients in the insured and self-insured casualty insurance or corporate market; leads may be generated through client direct marketing or through agent/broker of insurance carrier distribution network. We're seeking a Director, Business Development with solid experience within the casualty insurance industry and a strong track record in prospect identification, strategic selling, and relationship management to expand our national client base and strengthen long-term partnerships.
Sr. Insurance Verification Representative - Full Time Bascom Palmer Eye Institute - Doral FL University of MiamiSr. Insurance Verification Representative - Full Time Bascom Palmer Eye Institute - Doral FLDoral, 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. Insurance Verification Representative verifies insurance eligibility and authorization for all contracted and non-contracted insurance carriers and takes appropriate steps to facilitate reimbursement to department for services rendered.
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.
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).