170 claims jobs found in Miami, FL

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve  your life’s best work.(sm) This position is responsible for processing pending medical claim. MCR Coordinators are responsible for handling claim projects as needed. MCR Coordinators are responsible for making sure claims information is accurate. MCR Coordinators will be expected to maintain production and quality standards. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization Prepares cases for Medical Directors, UM Nurses and Case Managers to conduct clinical review Provide expertise or general claims support by reviewing, researching, investigating, negotiating,...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.SM It’s that time, isn’t it? You’re ready for the next step forward and an opportunity to build on your skills. And it just so happens that there’s never been a better time to get on the team at UnitedHealth Group. We’ve built one of the world’s most effective and respected claims processing teams. And that’s where you come in. We’ll look to you to maintain our reputation for service, accuracy and providing a positive...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Analyzes coverage and settles moderately complex claims in one or more of Gallagher Bassett's specialty claims areas. Generally, incumbent does not work on workers compensation claims. Essential Duties & Responsibilities: Able to manage the full-life cycle of all assigned claims files. Analyzes coverage and determines defense obligations. Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans. Creates reservation of rights and coverage denial letters....

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Analyzes coverage and settles moderately complex claims in one or more of Gallagher Bassett's specialty claims areas. Generally, incumbent does not work on workers compensation claims. Essential Duties & Responsibilities: Able to manage the full-life cycle of all assigned claims files. Analyzes coverage and determines defense obligations. Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans. Creates reservation of rights and coverage denial letters....

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. If you're looking for a professional career with an industry leader, that serves an important social purpose, then we invite you to consider becoming an Associate in our Trainee program. We believe in work/life balance and full time here means 35 hours per week. Claims Trainees typically spend 6 - 9 months in training, before beginning a well defined career path with the opportunity for promotion as you meet new performance goals. If you've got the drive to succeed through service we'd love to talk with you. As a Trainee, you will gain skills and experience, via structured learning and on-the-job mentoring: How...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm) Let’s talk about meaningful work, an important role and a career move that can transform your future.  WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. At WellMed, now part of Optum and the UnitedHealth Group family of businesses, we focus on prevention and the complete coordination of care for our patients. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth. Join us and you’ll be part of a team dedicated to patient-centered, safe and effective health care. Your skills and talents will make an important impact on our patients while you open doors for yourself that simply do not exist in any other organization. Times...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM Imagine this. Every day, in claims centers around the world,  UnitedHealth Group  is processing and resolving payment information for millions of transactions. Would you think we have some great technology? Would you think we know how to manage volume? You would be right. No one's better. And no company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look to you to maintain our reputation for service, accuracy, and a positive claims experience. We'll back you with great training, support, and opportunities. This...

$1,500 Sign-On Bonus for External Candidates You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work . SM Imagine this. Every day, in claims centers around the world,  UnitedHealth Group  is processing and resolving payment information for millions of transactions. Would you think we have some great technology? Would you think we know how to manage volume? You would be right. No one's better. And no company has put together better teams of passionate, energetic and all out brilliant  Claims Representatives . This is where you come in. We'll look to you to maintain our reputation for service, accuracy, and a positive claims experience. We'll back you...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) On the one hand, no industry is moving faster than health care. On the other, no organization is better positioned to lead health care forward than Optum and UnitedHealth Group. That’s what makes this opportunity so applause worthy. We have hundreds of business verticals across our matrixed organizations that are bringing thousands of new ideas, services and products to the marketplace every year. Our goal is...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM As a Senior Claims Business Process Consultant in UHC Payment Integrity, you will work on post-service appeals and other projects for Commercial & Medicare-based claims. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.  *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Primary Responsibilities: Investigate, review and provide clinical and/or coding expertise in...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve  your life’s best work.(sm) This is an opportunity that's all about where you've been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look for your experience and expertise to help keep our service levels and accuracy extremely high. We'll also look for your ideas on how to constantly evolve our claims processes. We'll back you with the great training, support and opportunities you'd expect from a Fortune 5 leader. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.  Primary...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) This position is responsible for the testing of system changes as it relates to claim processing, fee schedule updates, contract modifications, enrollment, premium billing, employer group, reconciliation and fulfillment within the Facets system. This position may be involved in day-to-day work as it relates to creating and executing test cases and on large scale initiatives. You’ll enjoy the flexibility to...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM As a Senior Claims Business Process Consultant in UHC Payment Integrity, you will work on post-service appeals and other projects for Commercial & Medicare-based claims. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.  *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Primary Responsibilities: Investigate, review and provide clinical and/or coding expertise in...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work . SM The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As a Specialist, you’ll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues and making and communicating determinations. You’ll authorize the appropriate adjustment ensuring compliance with all requirements and serve as a point of contact for...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve  your life’s best work.(sm) Under the supervision of the Medical Claims Review (MCR) Supervisor, this position is responsible for processing Utilization Management (UM) Inventory. The Sr. MCR Coordinator functions as a subject matter expert, and provides guidance to MCR Coordinators on more complex issues. Sr. MCR Coordinators are responsible for resolution of all claims within their capacity. Sr. MCR Coordinators are responsible for handling claim projects as needed. Sr. MCR Coordinators will be expected to maintain production and quality standards. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Review claims for duplicates, denials and referrals and ensures that claims information is matched to...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) Join the Claims team as a Senior Manager, Software Engineering. The team is responsible for developing, maintaining, enhancing and setting a high-quality bar for web and mobile apps which assists end users in taking control of their healthcare claims and benefits. The team has a strong and integrated relationship with the product team based on strong collaboration, trust and partnership.  Goals for the team are focused on creating meaningful positive impact for our customers through clear and measurable metrics analysis. As a...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) Join the Claims team as a Software Engineer focusing on Full Stack. The team is responsible for developing, maintaining, enhancing and setting a high-quality bar for web and mobile apps which assists end users in taking control of their healthcare claims and benefits. The team has a strong and integrated relationship with the product team based on strong collaboration, trust and partnership.  Goals for the team are focused on creating meaningful positive impact for our customers through clear and measurable metrics analysis....

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Facilitate end to end management of external and internal client audits of pharmacy benefits and pricing Gather PBM plan documentation from internal teams to provide to external audit firm  Read and interpret plan design documents and PBM service agreements...