Blue Cross and Blue Shield of Florida Jobs & Careers

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18 Blue Cross and Blue Shield of Florida jobs found on Monster.

Jobs 1 to 18 of 18
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: Role Summary IT Insert Operator II will support the organizations production inserting schedule to meet daily service goals for mail distribution and follow US Postal Regulations for metered or permit mail. Insert Operators insert staged mail products with high efficiency and a HIPAA compliant operation, which follows strict adhe...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: - Identifies, investigates and evaluates moderate to complex potential fraud, waste or abuse, including pre-pay and/or post-pay medical claim reviews to determine valid cases for appropriate action; documents findings, and prepares case referrals, letters, etc. if applicable. - Ensures investigative data requests are compliant, d...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: The Senior Director of Strategic Provider Partnerships is the primary business partner between the Enterprise and current and future GuideWell Health managed entities. Position includes, but is not limited to, enabling formation and execution of strategic, growth, financial, and business plans. Significant part of role will be fo...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Responsible for communicating, planning, driving, motivating and providing direction and leadership for an end-to-end customer experience for multicultural markets across business segments and within functional areas. This includes planning, scope development, solution design and help with implementation. Job duties include but are not limited to the following: - Leads and manages empl...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: A senior level position in the facility audit function. - Independently performs comprehensive, multi-dimensional audits for facility inpatient and outpatient claims, both field and in-house for all lines of business. - Ensures claims are paid according to the provider’s contract, standard claims processing procedures, proper cod...
Blue Cross and Blue Shield of Florida Ft. Lauderdale, FL
Description Roles in Health Data Analytics research, extract, model, manipulate, compile, analyze, evaluate and validate financial, clinical and network statistical data using advanced statistical, risk and financial analytical skills in order to identify and quantify impacts to medical cost trends. Job duties include but are not limited to the following: Incumbents assist more experienced analyst...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description : Responsible for leading the development of new products by creating non-technical business requirements, supervising multifunctional teams through product-build to achieve business specifications. Manages the process from product development to product launch, ensuring execution is in line with business objectives. Health Insurance Support: - Demonstrates in depth knowledge of health...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: - Develops business relationships and integrates activities with other IT departments, i.e., Security, Database Administrators, etc., to ensure successful implementation and support of project efforts. - Provides Subject Matter Expertise (SME) input to fellow IT staff on “workability” of designs, architecture, and testing. Resear...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: The work of a Specialist II is subject, wholly or in part, to practices and procedures covered by precedents or well-defined policy and/or supervisory review. Incumbents determine their own priorities and may deviate from established procedures and practices as long as the end results meet standards of acceptability. Representati...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description This role will focus on implementing and managing work efforts associated with the technology integration strategy, direction and standards to continually enhance the health of the systems landscape. Manages oversight and participates in governance process to review and approve technology solutions ensuring adherence to standards, regulatory and security requirements. Ensures complianc...
Blue Cross and Blue Shield of Florida Miami, FL
Description Major responsibilities: - Responsible for telephonic outreach and identifying potential at risk pregnancies of Florida Blue members - Administer the telephonic risk assessment tools to members identified with high risk and potentially at-risk pregnancies - Monitor, evaluate, and documentation of identified high-risk and potential high-risk participants. - Responsible for the ongoing te...
Blue Cross and Blue Shield of Florida Tallahassee, FL
Description Job duties include but are not limited to the following: *Provide a customer friendly service experience for customers with questions regarding health care, health insurance (benefits, claims, premium payments, and enrollment) or other related topics *Respond to telephone and web-based inquiries and initiate telephonic follow-up when appropriate *Use web-based tools and other aids to f...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: The duties of the Claims Adjuster include: - Responsible for the timely investigation of compensability and payment of Florida Workers’ Compensation claims resulting in claims acceptance or denial. - Adjust lost time workers’ compensation claims in accordance with Florida Statutes 440 and supporting rules. - Coordinate with and p...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description * REPOST - PREVIOUS QUALIFIED APPLICANTS REMAIN UNDER CONSIDERATION AND NEED NOT REAPPLY * Senior Health Data Analytics Analyst V (Analysis of Data not IT) Roles in Health Data Analytics research, extract, model, manipulate, compile, analyze, evaluate and validate financial, clinical and network statistical data using advanced statistical, risk and financial analytical skills in order...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: The Principal provides direction and leadership to strategic investments and business development initiatives, including mergers/acquisitions, joint ventures/alliances, strategic analysis, business consulting and strategic investments. The Principal engages in extensive interaction with a wide range of external business executive...
Blue Cross and Blue Shield of Florida Miami, FL
Description *Please note: This position is located in South Florida – Miami Dade County* *Local travel between hospital, practices and BCBSF locations are required (AMS/Baptist ACO)* Job duties include but are not limited to the following: *Serve as a primary clinical point of contact for hospital system, physician practices (single or multispecialty) and outpatient facilities for the specific mem...
Blue Cross and Blue Shield of Florida Ft. Myers, FL
Description * Opportunity to work remotely after at least six months of working in a Florida Blue location. * * Four opportunities available* * Florida Blue locations: Ft. Meyers, Miami, Tampa, West Palm Beach* Job duties include but are not limited to the following: - Focus on Medicare Advantage Membership: - To close gaps in care - To encourage members to receive Medicare recommended Preventive...
Blue Cross and Blue Shield of Florida Jacksonville, FL
Description Job duties include but are not limited to the following: - Researches, extracts, analyzes, validates, reconciles, prepares and interprets data for medical cost initiatives - Responsible for working through corporate governance process to produce data extracts for outside vendors with strict adherence to governance requirements - Works with project managers to produce relevant data and...
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