Claims Examiner - Adjudication & Fraud Detection
Molina Talent Acquisition
Molina Healthcare is seeking a Claims Examiner Support to assist in adjudication evaluation, ensuring accurate coding and detecting potential fraud or errors. You will manage a caseload, gather records, and support investigations to resolve claims efficiently. The role emphasizes data entry, organizational skills, and strong communication, with MS Office proficiency and a focus on meeting quality and production standards in a managed care environment. #J-18808-Ljbffr Molina Talent Acquisition
- Molina Healthcare in Florida is seeking a Senior Claims Examiner to provide expert support in adjudication, coding accuracy, fraud prevention, and compliance with state and federal regulations. The role manages a varied caseload, procures medical records, and recommends...FraudWork at office
- Molina Healthcare in Florida is seeking a Claims Examiner to support claims examination activities, evaluating adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. The role involves managing...FraudWork at office
- Community Care Plan is seeking a dedicated claims adjudicator in Sunrise, FL to accurately process health insurance claims. You will adjudicate, review coverage, coding, COB issues, and pricing for Medicaid/Medicare and other lines, ensuring timely, accurate payments in...Suggested
- Molina Healthcare is seeking a claims examiner to provide senior support in evaluating adjudication of claims, identifying coding issues, abuse and fraudulent billing, and resolution of processing errors. The role involves procuring medical records, maintaining detailed...SuggestedWork at office
$21.78 per hour
...Department of Defense restrictions. Our Claims Examiner III LPN protects the integrity of the... ...investigating, and preventing potential fraud, waste, and abuse. They blend clinical expertise... ...analysis to evaluate medical necessity, detect unusual utilization patterns, and ensure...FraudContract workFor contractorsLocal areaImmediate startRemote workMonday to FridayFlexible hoursShift work- ...purpose of this job: Verify member submitted claims forms, member’s eligibility and pharmacy... ...time is met. Assess accuracy of system adjudication and alert management of potential... ...processing. Analyze claims for potential fraud by member or pharmacy. May be required to...FraudContract workFor contractorsShift work
$16 per hour
...check us out at Job Description Business Claim Specialist Location 255 Technology Park... ...time is met. Assess accuracy of system adjudication and alert management of potential... ...processing. Analyze claims for potential fraud by member or pharmacy. May be required to...FraudHourly payContract work$15 - $16 per hour
...Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary,... ...time. Assess accuracy of system adjudication and alert management of potential problems... ...processing. Analyze claims for potential fraud by member or pharmacy. May be required...FraudHourly payPermanent employmentTemporary workImmediate startMonday to Friday$15 - $16 per hour
...Kelly Services is currently seeking several Claims Specialist for our client's Lake Mary,... ...time is met. Assess accuracy of system adjudication and alert management of potential... ...processing. Analyze claims for potential fraud by member or pharmacy. May be required to...FraudHourly payWeekly payPermanent employmentTemporary workImmediate startMonday to Friday- ...cost containment knowledge into the adjudication of global health claims and comprehensive cases. ESSENTIAL JOB... ...to decide compensability Examine with accuracy policy and member information... ...pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility...FraudWork experience placementWork at office
- Principal Data Scientist - Remote, AI, Machine Learning, Fraud Detection & Risk Modeling Principal Data Scientist, Artificial Intelligence (AI), Machine Learning, Fraud Detection, Risk Modeling, Generative AI, Large Language Models (LLMs), Predictive Analytics, MLOps, Python...FraudTemporary workFor contractorsWork at officeRemote workFlexible hours
$62k - $67k
Department: Claims Administration & Adjusting Location: Remote, FL Compensation: $62,000 - $67,000 / year Description Our Story Imagine... ...requirements, and client service standards. Identify potential fraud indicators and escape concerns when appropriate. Skills,...FraudTemporary workFor contractorsLocal areaRemote work- ...not owned or affiliated with a health plan or provider system. Position Summary The Claims Analyst is responsible for the analysis of claims data to identify any potential adjudication recommendations or recoupment opportunities on behalf of the Health Plan clients. Requirements...Full timeWork at office
$47k - $78k
...contributor role operates under broad authority to manage commercial claims of low to moderate complexity and exposure within the Auto... ...Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making...FraudWork experience placementWork at officeLocal areaFlexible hours$72k - $141k
...business and interact with these key customers. Our Healthcare Claims team is seeking Complex Claims Consultants to support varying segments... ...and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making...FraudWork experience placementWork at officeLocal areaFlexible hoursShift work- ...Fraud Investigator II – Accounting & Finance, Vaco Overview We are seeking a Fraud Investigator II to join our Corporate Fraud Investigations... ...crimes. Strong knowledge of AML/BSA regulations, fraud detection, and investigative techniques. Excellent communication,...FraudFull time
- Sedgwick Claims Management Services Ltd seeks a Claims Examiner - Liability to analyze complex general and product liability claims, determine benefits due... ...and manage high-exposure cases. The role involves adjudication, negotiations, and collaboration with clients Ideal...Remote job
$60k - $80k
...® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Liability | General and Product Liability | Jurisdiction:... ...involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices...Remote workFlexible hours- Sedgwick is seeking a Claims Examiner to analyze complex liability claims, negotiate settlements, and ensure timely adjudication. You will handle high-exposure cases, collaborate with clients, and support ongoing subrogation opportunities while meeting service expectations...Remote job
- Sedgwick is seeking a Claims Examiner - Workers Compensation to adjudicate complex claims and support litigation processes within a high-exposure environment. The role emphasizes collaboration, timely resolutions, and adherence to client service requirements in a hybrid...
- Fortune Best Workplaces in Financial Services & Insurance Claims Examiner I Workers Compensation (REMOTE) I FL, GA, NC or SC experience... ...your workers compensation examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic...Remote jobFlexible hours
- Sedgwick is seeking a Claims Examiner to analyze and adjudicate workers’ compensation claims for clients across jurisdictions. You will determine benefits due, manage timely resolutions, and work within client service requirements. Role requires 5+ years in claims management...Remote jobFlexible hours
$63k - $88k
...® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation | Jurisdiction: Southeast states | Licensing... ...Compensation & supervisory knowledge and experience to adjudicate complex customer claims in the context of an energetic...Work at officeFlexible hours- Sedgwick is seeking a Claims Examiner I for Workers' Compensation (REMOTE) supporting clients across FL, GA, NC or SC. You will analyze claims to determine benefits due and adjudicate within service expectations and client requirements, investigating information to assess...Remote job
$42k - $50k
...FL, US Salary Range: $42,000.00 To $50,000.00 Annually Position Summary: Responsible for the accurate and timely adjudication of health insurance claims in accordance with established production and quality department standards by performing the following duties: Qualifications...Full timeRemote work$60.23k - $85k
...Fortune Best Workplaces in Financial Services & Insurance Claims Examiner I Workers Compensation (REMOTE) I FL, GA, NC or SC experience... ...your workers compensation examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic...Remote jobFull timeFlexible hours$24.7k - $35.3k
Medical Claims Recovery Specialist (Subrogation) - Hybrid EST / CST Date: Oct 12, 2026 Location: Any city, FL, US, 99999 Great companies... ...makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in...FraudFull timeContract workWork at officeFlexible hours$65k - $88.6k
...our caring community The Fraud and Waste Professional is responsible... ...to support successful adjudication, where appropriate. Conducts... ...reimbursement structures to detect irregularities and support investigative... ...stakeholders. Review claims, provider billing patterns,...FraudFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- Sedgwick is seeking a Claims Examiner for Workers' Compensation to adjudicate complex claims within a Southeast jurisdiction, with Florida licensing. The role includes supervisory responsibilities and opportunities to grow in a global leader known for service. Flexibility...
- Molina Healthcare is seeking a Senior Claims Examiner in the United States (Florida) to provide senior-level support for claims examination, including evaluation of adjudication for incorrect coding, abuse, fraud, waste, overpayments, and processing errors. The role requires...Fraud
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