- AON (Houston, TX)
- …guiding clients through both routine decisions and major inflection points, such as claims or new ventures. Cross-functional teamwork is part of the rhythm: whether ... guiding clients through both routine decisions and major inflection points, such as claims or new ventures. Cross-functional teamwork is part of the rhythm: whether… more
- CVS Health (Austin, TX)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... Linux OS, GCP/ AWS/ Azure. + Experience working with medical and/or pharmacy claims data. + Experience in healthcare industry, including health insurance, PBM or… more
- Sedgwick (Austin, TX)
- …for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The ... advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With… more
- Elevance Health (Grand Prairie, TX)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions as… more
- Amentum (Austin, TX)
- …appropriate insurance coverage and risk mitigation strategies. + Lead complex claims management, including litigation strategy and resolution in coordination with ... defense sectors.** + Deep knowledge of insurance products, risk financing, claims management, and enterprise risk practices. + Strong negotiation, communication, and… more
- Humana (Austin, TX)
- …an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing and ... researching medical claims + Proficient in Microsoft Office (Word, Excel, Access, PowerPoint) + Working knowledge of SQL + Familiarity with EDI X12 formats… more
- Molina Healthcare (San Antonio, TX)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- Mass Markets (El Paso, TX)
- …and provide accurate solutions. + Use internal systems to manage accounts, process claims , and update records. + Follow scripts and procedures to ensure compliance ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing, Collections, Customer Experience Provider (CXP), Customer Service,… more
- TEKsystems (West Lake Hills, TX)
- …data scientists, and legal consultants to shape the future of medical claims review and healthcare resource optimization. Job Responsibilities: * Analyze healthcare ... impact assessments. * Collaborate on the design of predictive tools for claims review and risk stratification. * Prepare reports and presentations for clients,… more
- UIC Government Services and the Bowhead Family of Companies (San Antonio, TX)
- …and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... based on the provisions contained within The Alaska Native Claims Settlement Act. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. All… more