- Highmark Health (Austin, TX)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... claim rejection and the proper action to complete the...effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of… more
- Sedgwick (Irving, TX)
- …naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes ... professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability...disability offsets; and to ensure the ongoing processing of claims . **ARE YOU AN IDEAL CANDIDATE?** We are looking… more
- Sedgwick (Irving, TX)
- …under ADA, state, and/or client requirements for a qualifying condition. + Makes claim determinations to approve non-complex ADA claims or makes a recommendation ... Drive Eden Prairie, MN 55344 **PRIMARY PURPOSE** **:** To process claims and determine accommodation options following written guidelines and procedures pursuant… more
- Highmark Health (Austin, TX)
- …inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- Sedgwick (Austin, TX)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more
- Molina Healthcare (Dallas, TX)
- …and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from ... JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and...that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine… more
- UTMB Health (Galveston, TX)
- …Specialist will be responsible for billing all third party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital ... claims . Identifies billing issues affecting hospital and/or physicians ...and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues… more
- UTMB Health (Galveston, TX)
- …Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital ... claims . Identifies billing issues affecting hospital and/or physicians ...and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues… more
- Sedgwick (Austin, TX)
- …& Insurance Adjuster Regional Marine **PRIMARY PURPOSE** **:** To handle losses or claims regionally unassisted up to $10M, including having the ability to address ... and non-complex National Accounts. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines claim forms and other records to determine insurance coverage. +… more
- Elevance Health (Grand Prairie, TX)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines… more
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