Director, Clinical Claims & Risk Management
Health First
Health First in Florida seeks a Director, Claims Management to oversee investigation, evaluation and resolution of medical, professional, and general liability claims, applying clinical judgment in line with Health First’s guidelines and best practices. You will lead collaboration with outside counsel, inform reserve decisions, manage reporting, audits, and trend analysis to support clinical risk management and patient safety initiatives. #J-18808-Ljbffr Health First
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Director, Clinical Claims & Risk Management in Tallahassee, FL vacancy
$74.8k - $112.2k
...Independently reviews and interprets clinical information and utilizes... .... Advises on highly complex claims at multidisciplinary clinical... ...symptomatology present in claimants being managed. Leverages resources such as vocational rehabilitation, risk management unit, physician...ClaimsTemporary workWork at officeRemote work3 days per week- ...PCS is one of the largest high net worth managing general underwriters in the market today.... ...casualty personal insurance solutions and risk management services that meet the unique... ...within the insurance domain (e.g., premiums, claims). This individual is comfortable working...ClaimsWork at officeRemote work
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...OPEN COMPETITIVE EMPLOYMENT OPPORTUNITY***** POSITION TITLE: WORKERS COMPENSATION SPECIALIST DIVISION: RISK MANAGEMENT BUREAU: STATE EMPLOYEE WORKERS COMPENSATION CLAIMS CITY: TALLAHASSEE COUNTY: LEON Requirements: At least six (6) months experience working in a...ClaimsPermanent employmentWork experience placementWork at officeImmediate startMonday to Friday- ...Work Shift: 1st Shift (United States of America) The Complex Claims Manager manages complex Construction Defect claims processes, including... ...practices. Prepare and present reports on claim status, trends, and risk exposure to management. Education and Experience Bachelor’s...ClaimsFull timeTemporary workShift workDay shift
- ...class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a... ...contact for all liability and general insurance administration claims and processing including administration of worker’s compensation...ClaimsWork at officeLocal area
- CRC Group is seeking a Complex Claims Manager to lead investigations, evaluations, and resolution of high-severity Construction Defect claims... ...with standards and regulations while reporting trends and risk exposure to management. #J-18808-Ljbffr 200 CRC Insurance Svcs...Claims
$23 - $27 per hour
...Experience: ~3 years clinical nursing experience.... ...organizational skills and time management ~ Excellent... ...memo to the claims office advising of the... ...which may include high risk OB clinical and memo the... ...projects as directed by the Director of Utilization Review....ClaimsHourly payHome office$75k - $90k
Commercial Lines Account Manager 3 plus years experience working as a Commercial Lines Account... ...embraces the reality that managing risk is all about the details. Our core values... ...assessment through to client advocacy in claims matters. Innovation is our passion. We approach...Claims- ...benefits broker, providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth... ...experience-based judgment to resolve except when an established claim servicing protocol exists Manages, organizes, and conducts...ClaimsTemporary workWork at officeLocal area
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Tallahassee, FL1 day ago - ...low, high, and medically high-risk WIC participants. They conduct... ...supervising nutrition staff in all clinic locations and providing... ...search for creative solutions and manage resources wisely. C... ...educational requirements. Candidates claiming Veterans’ Preference must attach...ClaimsLocal areaMonday to Friday
$58k - $61k
...low, high, and medically high-risk WIC participants. They conduct... ...nutrition staff in all clinic locations and providing ongoing... ...search for creative solutions and manage resources wisely. C... ...educational requirements. Candidates claiming Veterans’ Preference must attach...ClaimsLocal areaFlexible hoursState of Florida
Tallahassee, FL7 days ago- ...duties to ensure that the WIC clinic runs smoothly, and policies... ...education and counseling to low risk, high risk, and medically... ...year or more of supervisory, management, or leadership experience. Preferred... ...requirements.Candidates claiming Veterans’ Preference must...ClaimsWork experience placementWork at officeMonday to Friday
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...condition, and other characteristics to assess risk for a book of business consisting of... ...advisor by providing financial and risk management support to sales as well as strategic insight... ...accordingly to cover questionable claim patterns or unusual situations not otherwise...ClaimsContract workFor contractorsWork at officeLocal areaHighmark Health
Tallahassee, FL4 days ago- ...the workers' compensation industry, Key Risk delivers innovative and responsive solutions... ...visit Responsibilities The PEO Risk Management Specialist provides occupational risk assessment... ...with PEO clients, brokers, underwriting, claims, and service teams to identify, evaluate,...ClaimsWork at office
- Job Description - Business Office Manager Home Health (2613417) Business Office Manager Home Health - 2613417 Description Business... ...billing. Work on billing reports daily to ensure timely filing of claims. Ensure accuracy of daily census. Track and maintain...ClaimsFull timeWork at officeFlexible hours
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...Foundation Risk Partners , one of the fastest growing insurance brokerage and consulting... ...firms in the US, is adding a Clinical Account Manager to their ARMSRx team . Job Summary... ...and support related to high-cost claims, specialty utilization, prior authorization...ClaimsContract workFoundation Risk Partners
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Squaremouth
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$40.14k
...COMPETITIVE EMPLOYMENT OPPORTUNITY*** POSITION TITLE: SENIOR WORKERS COMPENSATION EXAMINER DIVISION: RISK MANAGEMENT BUREAU: STATE EMPLOYEE WORKERS COMPENSATION CLAIMS CITY: TALLAHASSEE COUNTY: LEON High School diploma or equivalent is required. Preferences: Six (6) months...ClaimsWork at officeImmediate startMonday to Friday- Ardán, A Community of Companies is seeking a Claims Counsel to handle title insurance and related claims. The role demands strong communication and organizational skills, along with a detail-oriented approach. You will investigate, evaluate, and negotiate resolutions for...ClaimsFull time
- BCA Financial Services, Inc. is seeking an Insurance Claim Collector to work remotely with creditor clients, determining denials and initiating documentation to resolve non-payment. The role emphasizes healthcare billing and claims follow up in a HIPAA-compliant environment...ClaimsRemote job
- ...licensed adjusters and career-entry applicants, with no prior experience required for entry. With continued storm activity, independent claims adjusting remains in demand and there are roster opportunities for experienced adjusters as well. New entrants can access licensing...Claims
- ...insurance balances on hospital patient accounts. This remote role requires learning multiple hospital systems, researching complex claims, and working with third-party payors to secure payment while using AI-enabled tools responsibly. You will handle 40-50 accounts daily...ClaimsRemote job
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