The Claims Examiner is responsible for the daily processing and adjudication of medical, dental, vision, and mental health claims. This role also involves investigating claims, managing overpayments, and ensuring compliance with policy guidelines and clinical edit logic.
The RN Case Manager is responsible for creating, implementing, and monitoring treatment plans to help members achieve their healthcare goals. They will coordinate care, assess clinical status, and identify cost-effective resources while maintaining compliance with medical necessity guidelines.
The Renewals Account Manager will develop and implement strategies for renewing health insurance groups of 50-499 employees. They are responsible for maintaining agent relationships, coordinating marketing efforts, and educating stakeholders on Florida Blue products and processes.
Provide comprehensive legal counsel on healthcare regulatory matters and serve as a primary advisor to business units on federal and state requirements. Monitor regulatory trends, conduct risk assessments, and develop compliance policies to mitigate organizational risk.
