This is a remote role. Candidates must reside in the state of Florida. When you join the team as an ... This includes completing benefit investigations, tracking prior authorizations / denial appeals ...
This is a remote role. Candidates must reside in the state of Florida. When you join the team as an ... This includes completing benefit investigations, tracking prior authorizations / denial appeals ...
Executive Case Manager (Remote)
Orlando, FL · On-site +1
This is a remote role. Candidates must reside in the state of Florida. When you join the team as an ... This includes completing benefit investigations, tracking prior authorizations / denial appeals ...
Executive Case Manager (Remote)
Orlando, FL · On-site +1
This is a remote role. Candidates must reside in the state of Florida. When you join the team as an ... This includes completing benefit investigations, tracking prior authorizations / denial appeals ...
Case Manager
Orlando, FL · Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Orlando, FL) Pay ... Exhibit strong investigational and analytical abilities and communicate proficiently in both ...
Quick apply
Case Manager
Orlando, FL · Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Orlando, FL) Pay ... Exhibit strong investigational and analytical abilities and communicate proficiently in both ...
Case Manager
Orlando, FL · Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Orlando, FL) Pay ... Exhibit strong investigational and analytical abilities and communicate proficiently in both ...
Quick apply
Case Manager
Orlando, FL · Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Orlando, FL) Pay ... Exhibit strong investigational and analytical abilities and communicate proficiently in both ...
AVP, Special Investigations Unit
Tampa, FL · On-site +1
USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Responsible for the affirmative litigation philosophy and individual decisions on case filing in ...
AVP, Special Investigations Unit
Tampa, FL · On-site +1
USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Responsible for the affirmative litigation philosophy and individual decisions on case filing in ...
Mgr - SIU (Field)
Jacksonville, FL · Remote
... traditional investigative techniques with advanced analytics to enhance case development ... May be deployed to remote locations and/or extended hours for extended periods to support SIU ...
Mgr - SIU (Field)
Jacksonville, FL · Remote
... traditional investigative techniques with advanced analytics to enhance case development ... May be deployed to remote locations and/or extended hours for extended periods to support SIU ...
Surveillance Epidemiologist
Tallahassee, FL · On-site +1
WiredPeople is open to remote candidates residing within Florida state lines. Essential Functions ... disease case investigations. Coordinate laboratory testing and report data to CDC as needed.
Surveillance Epidemiologist
Tallahassee, FL · On-site +1
WiredPeople is open to remote candidates residing within Florida state lines. Essential Functions ... disease case investigations. Coordinate laboratory testing and report data to CDC as needed.
Civil Defense Litigation Attorney (Remote)
Miami, FL · On-site +1
$100K - $150K/yr
... case management, from initial investigation through trial preparation and resolution. Practice ... Fully remote work environment * Competitive compensation commensurate with experience * Performance ...
Quick apply
Civil Defense Litigation Attorney (Remote)
Miami, FL · On-site +1
$100K - $150K/yr
... case management, from initial investigation through trial preparation and resolution. Practice ... Fully remote work environment * Competitive compensation commensurate with experience * Performance ...
Communicate with investigating agencies and entering parties to confirm that case information is ... Work to be performed remote. Other: * Occasional travel may be required. * Equal Opportunity ...
Quick apply
Communicate with investigating agencies and entering parties to confirm that case information is ... Work to be performed remote. Other: * Occasional travel may be required. * Equal Opportunity ...
... investigations when a case demands it. • Serve as the key cross-functional interface: Ground Ops and Remote Ops on field readiness and on-site or remote incidents, R&D and Product on fixes and ...
... investigations when a case demands it. • Serve as the key cross-functional interface: Ground Ops and Remote Ops on field readiness and on-site or remote incidents, R&D and Product on fixes and ...
Discovery Paralegal
Miami, FL · On-site +1
This position offers a flexible, hybrid or remote working arrangement and can be located in any ... This role will assist with investigations, collections, and the organization, and maintenance of ...
Discovery Paralegal
Miami, FL · On-site +1
This position offers a flexible, hybrid or remote working arrangement and can be located in any ... This role will assist with investigations, collections, and the organization, and maintenance of ...
Major Case General Liability Claims Consultant
Lake Mary, FL · On-site +1
$84K - $127K/yr
Responsibilities include, but are not limited, to: - Conducting investigations and analyzing and ... This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office ...
Major Case General Liability Claims Consultant
Lake Mary, FL · On-site +1
$84K - $127K/yr
Responsibilities include, but are not limited, to: - Conducting investigations and analyzing and ... This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office ...
With four Investigational Device Exemptions (IDEs) approved and actively enrolling patients ... Support commercial team with case support and /or enable delivery of scientific data to help with ...
With four Investigational Device Exemptions (IDEs) approved and actively enrolling patients ... Support commercial team with case support and /or enable delivery of scientific data to help with ...
Claims Major Case Director
Sarasota, FL · On-site +1
$92K - $130K/yr
... remote arrangements for the ideal candidate. This role is a true complex claims handling role that ... Directs and manages use of independent investigators, appraisers, and experts. Selects, directs and ...
Claims Major Case Director
Sarasota, FL · On-site +1
$92K - $130K/yr
... remote arrangements for the ideal candidate. This role is a true complex claims handling role that ... Directs and manages use of independent investigators, appraisers, and experts. Selects, directs and ...
Senior Insider Threat Engineer
Miami, FL · On-site +1
$109K - $150K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Miami, FL · On-site +1
$109K - $150K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Tampa, FL · On-site +1
$108K - $148K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Tampa, FL · On-site +1
$108K - $148K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Miami, FL · On-site +1
$109K - $150K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Miami, FL · On-site +1
$109K - $150K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Tampa, FL · On-site +1
$108K - $148K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Tampa, FL · On-site +1
$108K - $148K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
*Role is eligible to be remote* We are Lennar Lennar is one of the nation\'s leading homebuilders ... Responsibilities include managing subpoena/civil investigative demand intake and response workflows ...
*Role is eligible to be remote* We are Lennar Lennar is one of the nation\'s leading homebuilders ... Responsibilities include managing subpoena/civil investigative demand intake and response workflows ...
Senior Insider Threat Engineer
Tampa, FL · On-site +1
$108K - $148K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Senior Insider Threat Engineer
Tampa, FL · On-site +1
$108K - $148K/yr
... threat investigations, legal hold requests, and HR/Legal inquiries, including case creation ... Travel: While this is a remote position, occasional travel to Humana's offices for training or ...
Remote Cold Case Investigator information
What is a remote cold case investigator?
How do remote cold case investigators typically collaborate with law enforcement and other team members when working from a distance?
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What cities in Florida are hiring for Remote Cold Case Investigator jobs?
Cities in Florida with the most Remote Cold Case Investigator job openings:

Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 16 days ago
Job description
A typical day in this role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.
The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Case Manager responsibilities include education on the access and reimbursement support tools available from PharmaCord and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.
- Relationship Management
- Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.
- Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.
- Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
- Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
- Manages all client inquiries as appropriate, such as case specific statuses.
- Manages HCP inquiries, as applicable, pursuant to business rules.
- All communications with the client’s field teams will remain compliant and adhere to ways of working protocols outlined between PharmaCord and the client teams. Inbound Call Management
- Manages inbound calls as directed by the program-approved FAQs
- Triage patients to internal or external resources as appropriate.
- Personalized Case Management
- Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.
- Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
- Identifies and communicates patient’s plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
- Serves as a subject matter expert to internal team as required and appropriate.
- Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome.
- Coordinates nurse teach with nurse educators, as applicable to program.
- Supports adherence services as applicable to program.
- Identifies peer support resources for patients.
- Proactively communicates needs for reverification of prior authorization or re-enrollment.
- Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules.
- Documents all activities within the PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
- Generate reports and analysis as needed to identify trends and opportunities for improvement.in accordance with business requirements.
- Utilize Valeris’ values as the driving force behind the team’s success
- On time adherence to training deadlines for all corporate policies and procedures
- Ensure all SOPs are followed with consistency
- Perform additional tasks or projects as assigned
- Completion of Bachelor's degree (or higher) required
- A degree in healthcare administration, social science or similar related fields is strongly preferred.
- Minimum two years of experience in healthcare access delivery or management is strongly preferred.
- 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
- Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
- Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
- Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient centric results.
- Excellent attention to detail and organizational skills.
- Ability to prioritize tasks and work efficiently in a fast-paced environment.
- Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
- Demonstrates the ability to think critically and issue resolution.
- Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
- Bi-lingual skills are a plus.
- Remote work eligibility is subject to all work from home criteria met and based on business need
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
- Although very minimal, flexibility to travel as needed is preferred.
- This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
- Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
- Additional health support, including telehealth and Employee Assistance Program (EAP) services
- Company match on Health Savings Account contributions
- Free Basic Life and AD amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
- Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
- 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
- Paid Time Off (PTO) and Sick Leave to support work-life balance
- Team members receive nine paid holidays plus two floating holidays
- Opportunities for advancement in a company that supports personal and professional growth
- A challenging, stimulating work environment that encourages new ideas
- Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
- A mission-driven, inclusive culture where your work makes a meaningful impact
Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official @pharmacord.com and/or @valeris.com, @echo.newtonsoftware.com email address regarding next steps in our interview process.
Please Note:- PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @valeris.com, @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
- We will never request your bank account information at any stage of the hiring process.
- We will never send a check (electronic or physical) to purchase home office equipment.
If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at careers@pharmacord.com