Pharmacy Claims Auditor CPhT Conduent IncPharmacy Claims Auditor CPhTMiami, FLIn this role, you can expect the following working conditions: Hybrid work: Will be working from home 25% of the month and will be working in the field doing audits at different pharmacy locations 75% of the month. Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them.
NewClaims Team Lead, Auto Sedgwick Claims Management Services, Inc.Claims Team Lead, AutoFLPRIMARY PURPOSE OF THE ROLE: To supervise the operation of multiple teams of examiners and staff for liability claims for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Skills & knowledge: thorough knowledge of claims management processes and procedures for multiple product lines, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products, leadership/management skills, analytical and interpretive skills, ability to work in a team environment, and the ability to meet or exceed Performance Competencies.
NewGovernment Claims Admin 2, Remote, Business Office, FT, 08A-4:30P Baptist Health South Florida IncGovernment Claims Admin 2, Remote, Business Office, FT, 08A-4:30PMiami, FL$20.62–$26.19 / hourBaptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. Our approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including: Career growth and development opportunities, with clear pathways and ongoing support.
Epic Claims Analyst III StratAcuity Staffing Partners IncEpic Claims Analyst IIIFlorida, FLRemote$100,000–$120,000 / yearIn 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 ideal candidate will have deep expertise in Epic Claims workflows, healthcare billing operations, and reimbursement processes, along with Epic certification in either Hospital Claims or Professional Claims.
EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealthEPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full TimeFLEpic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.
Examiner, Claims Location: FL Molina Healthcare IncExaminer, Claims Location: FLFLProvides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.
Senior Examiner, Claims Molina Healthcare IncSenior Examiner, ClaimsFLProvides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. At least 2 years of experience in claims, and/or customer service experience in a clerical role - preferably in a managed care setting, or equivalent combination of relevant education and experience.
Claims Team Lead - Workers Compensation | Jurisdiction: Southeast States | Licensing: FL or Home State Required - Remote Sedgwick Claims Management Services, Inc.Claims Team Lead - Workers Compensation | Jurisdiction: Southeast States | Licensing: FL or Home State Required - RemoteFLRemote$67,000–$85,000 / yearPRIMARY PURPOSE OF THE ROLE To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Mental: 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.
NewSenior Provider Experience Program Manager - Healthcare Claims CVS Health CorpSenior Provider Experience Program Manager - Healthcare ClaimsFL$106,605–$284,280 / yearWhat you will do: Lead enterprise delivery of multiple, highly complex business process and technology initiatives aligned to the Provider Experience / Provider NPS program, supporting all lines of business. Drive Agile delivery of Provider Experience / Provider NPS initiatives, supporting business process and technology improvements across multiple lines of business.
Claims Examiner - Leave Administration Pitney Bowes IncClaims Examiner - Leave AdministrationFL$32–$36 / hourThis includes investgating initial claims, leave revalidation, facilitating return-to-work efforts, coordinate employee payroll and time tracking while on leave, and working with work site managers and/or human resources personnel for workplace accommodations according to restrictions implemented by employees' treating physicians. Candidates need to demonstrate investigative and analytical skills, advanced written and verbal skills, a proven record in return-to-work programs, and understanding the social security disability insurance program.
AVP - General Liability Claims Manager - Remote CRC Insurance Services, LLCAVP - General Liability Claims Manager - RemoteFLRemotePlease review the following job description: The AVP - GL Claims Manager, reporting directly to SVP - Claims, is a full-time remote role responsible for managing and overseeing General Liability claims activities across assigned programs. Day-to-day responsibilities include supervising claims handling workflows, reviewing complex and high-severity claims, providing guidance on coverage, liability, and damages evaluation, and ensuring consistent application of claims best practices.
Lost Time Claims Specialist II (FL & GA University of Pittsburgh Medical CenterLost Time Claims Specialist II (FL & GAFLPrevious experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation and compensability decisions. The Lost Time Claims Specialist 2 will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company.
Revenue Cycle & Claims Operations Lead Porter CaresRevenue Cycle & Claims Operations LeadPompano Beach, FloridaDriven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. Partner directly with Athena's professional services / support team to build and maintain custom rules that suppress inappropriate low-dollar (“penny claim”) edits and prevent unwanted allowable-amount or co-insurance recalculation on contracts where the full billed amount is the contracted rate.
Analyst, Claims Research Molina Healthcare IncAnalyst, Claims ResearchFLProvides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
Third Party Claims Specialist Broward HealthThird Party Claims SpecialistFort Lauderdale, FLWe're working together to build strong communities inside and outside. Company sees the whole person and looks to support your well-being.
Claims Manager Harmony PlusClaims ManagerDoral, FloridaPosition Objective: The Credit and Collection Manager - Claims has the responsibility of leading and coordinating activities related to credit management, collections and claims administration. His main objective is to ensure efficiency in the recovery of outstanding accounts and the effective resolution of claims, thus contributing to cash flow and customer satisfaction.
Sub-Servicing Hazard Claim Specialist Lakeview Loan ServicingSub-Servicing Hazard Claim SpecialistCoral Gables, FloridaRemoteFull timeThe Sub-Servicing Hazard Claim Specialist will provide monthly Quality Assurance results to the sub-servicers and subservicing oversight teams to ensure performance and accountability. This individual will perform exception reviews and end-to-end administration of hazard claims, including identification of damaged properties, claim filing, and ensuring hazard claims are settled promptly and fairly.
Corporate Claim Litigation Attorney Lead Consultant (Remote) Allstate Insurance CompanyCorporate Claim Litigation Attorney Lead Consultant (Remote)FLRemote$90,700–$153,925 / yearThe ideal candidate will have at least 3 years of relevant and substantive experience in a law firm or in-house legal department related to insurance defense work, and some experience managing or litigating bad faith or extra-contractual allegations. Claim Litigation Counsel will be expected to provide guidance to the Claims Organization regarding insurance claims of heightened exposure, complex extra-contractual matters, bad faith, and other major claim-related litigation.
Corporate Claim Litigation Attorney Expert (Remote) Allstate Insurance CompanyCorporate Claim Litigation Attorney Expert (Remote)FLRemote$130,000–$180,000 / yearClaim Litigation Counsel will be expected to provide advice and counsel to the Claims Organization regarding insurance claims of heightened exposure, complex extra-contractual matters, bad faith, and other major claim-related litigation. The ideal candidate will have at least 7 years of relevant substantive experience in a law firm or in-house legal department related to insurance defense work, and some experience managing or litigating bad faith or extra-contractual allegations.
Senior Claim Benefit Specialist - Remote CVS Health CorpSenior Claim Benefit Specialist - RemoteFLRemote$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication.