Claims Analyst Salary at Sunshine Health BETA

ABOUT US Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources. Position Summary The Business Analyst/Reimbursement Specialist, Provider Data Management is responsible for taking a leading role in the coordination and loading of all physicians, hospital, and ancillary contracts for all Medicaid and Medicare clients. Essential Functions Responsible for the data integrity of all provider set-ups and reimbursement configurations Respo

Job Title: Operations Manager (Salary depends on experience.) Industry: Healthcare Revenue Cycle Management (RCM) About the Company: Healthcare Retroactive Audits, Inc. is a specialized healthcare consulting firm focused on identifying and recovering missed revenue on zero-balance accounts for hospitals and health systems. We operate at the intersection of audit intelligence and automation, delivering tangible financial results and building tools that drive efficiency and visibility across the revenue cycle. Position Summary: We are seeking a results-driven Operations Manager with strong technical acumen to oversee day-to-day operations, manage a team of auditors and analysts, and partner with leadership and development teams to optimize workflows. This role requires a solid understanding of RPA workflows, SQL-based data insights, and the ability to work in a rapidly evolving, technology-enhanced environment. Key Responsibilities: - Team Leadership: Manage and coach auditors and analys

We Support a large international REINSURANCE COMPANY IN Miami, Fl looking for a REINSURANCE ANALYST for the US Headquarters. This role will require someone bilingual in Spanish and with 1 plus year of experience in a reinsurance or insurance carried with applicable experience. IDEAL CANDIDATE MUST HAVE A MATH, ACTURARIAL SCIENCE OR FINANCE DEGREE Risk Assessment: Evaluate and analyze various risks related to insurance policies, ensuring that the company’s offerings align with market conditions and emerging trends. Data Analysis & Reporting: Perform detailed data analysis to assess the financial stability of insurance portfolios, and generate reports to guide decision-making. Claims Management: Monitor and assess insurance claims processes, ensuring that claims are processed efficiently and in compliance with industry standards and regulations. Policy Evaluation: Analyze existing policies and suggest improvements to minimize financial risks while optimizing the coverage for clients.e Ma

Job Description Position: Insurance Collection Rep. Job Description: Review CMS and Insurance bulletin newsletters of coding updates, issues, trends and changes applicable to provided services, providing information for financial clearance and billing purposes Work and manage Insurance claims through Revenue Cycle and Denial Management to a timeline that is determined by commercial, managed care, and governmental insurance providers Review Insurance claims for effective payment and timely billing turnaround for claim adjudication Provide timely notation of actions and remediation practices taken on patient accounts. Electronic claims submission and paper claim submission according to insurance file order for payment and collection activities across all payor types Re-bill claims with additional ICD-10 codes from Medical report and records when needed Communicate between departments to facilitate uninterrupted cash flow from payors and patients for balances due and pre-payments for serv

Job Description Job Description Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. Performs hospital length of stay reviews to determine reasonable and necessary care, and appropriateness of stay. Recommends appropriate payments of dispute of billing, as necessary. Provides second review of bills on which providers question the appropriateness of payments authorized. Evaluates claims referred for medical management and makes recommendations for follow-up, further investigation or documentation as necessary. Trains and assists claims staff on quality health care cost containment and utilization reviews. Company Description Leading specialty benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substant

Job Description Job Description Our client in the healthcare space is looking for a Claims Analyst to join their team to help analyze and manage the healthcare claims to ensure accuracy and timely reimbursement. The Claims Analyst will review, process, and resolve claims issued while ensuring compliance with payer guidelines and company policies. What Your Day-to-Day will look like: Identifies and investigates claim denials and rejections. Analyzes trends and patterns in claims data to identify potential issues or areas for improvement. Develops and implements strategies to resolve issues and reduce the rate of denials. Prepares and submits appeals as necessary. Generates reports to support decision-making and optimize the revenue cycle process. Works closely with billing, coding, and patient financial services teams to address and resolve claims-related issues. Facilitates communication between healthcare providers and payers. Ensures compliance with healthcare regulations, payer poli

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Memorial is seeking a candidate who possesses strong proficiency in both the technical aspects of report writing and business intelligence, as well as a deep understanding of the operational side of Supply Chain Management. The ideal candidate will integrate data analysis and reporting tools with real-world business operations, ensuring that actionable insights are effectively communicated and utilized to drive operational efficiency. A solid grasp of how supply chain processes work in practice, coupled with the ability to leverage advanced reporting techniques to optimize performance and inform strategic decision-making, is crucial. This position requires a well-rounded individual who can b

Document Management Analyst I Employment Type: Full Time, Entry-level Department: Legal Services Here at CGS, we are seeking an entry-level Document Management Analyst/ General Clerk to facilitate the case closing process and data archiving of Federal Records material. The Document Management Analyst will help in the organization of important documents and help the attorneys prepare for trial. CGS brings motivated, highly skilled, and creative people together to solve the government's most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success: - Create detailed indexing of case files; - Drafting procedures for accomplishing litigation sup