- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Analyzes complex claims business problems and issues using data from internal and external sources to provide insight to ... task and workflow analysis. + Interpret customer business needs in the claims space and translate them into application and operational requirements + Communicate… more
- Allied Solutions (Plano, TX)
- …insurance coverage to certain claim types prior to the assignment to a Claims Adjuster or Analyst . The key responsibilities of this job are both ... is responsible for the initial setup and investigation of claims prior to the assignment of the claim to a licensed adjuster. This will include researching and… more
- Molina Healthcare (TX)
- **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst , Configuration Oversight to support our Payment Integrity and Claims ... teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role will focus on identifying, reviewing, and… more
- Rush Enterprises (New Braunfels, TX)
- …as individual claims required. + Perform regular audits of individual claim files and review workers' compensation claims . + Efficiently manage caseload ... The Senior Risk and Insurance Analyst - Workers' Compensation serves as the central...services. Responsibilities + Oversee and manage complex workers compensation claim process, including reporting, medical coordination, lost time and… more
- Molina Healthcare (Fort Worth, TX)
- …Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- CVS Health (Austin, TX)
- …with heart, each and every day. **Position Summary** The Dispute Repricing Analyst will be responsible for the accurate analysis and resolution of provider ... related to Network contracts and agreements. + Research identified issues; submit claim adjustment requests and determine the root cause of disputes. + Serve… more
- Elevance Health (Houston, TX)
- …invoices. + Performs claim and trend analysis, validation and recovery of claims payment errors. **Minimum Requirements:** + Requires a BA/BS and a minimum of ... **Recovery Audit Analyst I** **Location:** _Hybrid1:_ This role requires associates...is responsible for auditing and facilitating the recovery of claims overpayments as identified by our business partners. Responsible… more
- Highmark Health (Austin, TX)
- …resolution of issues related to benefit interpretations, customer service inquiries, claims adjudication, benefits issues, membership and billing activity, etc. This ... relationships with key internal areas, such as Customer Service Operations ( Claims , Dental Benefits, Customer Service, Membership & Billing), Provider Data… more
- Lyric (Austin, TX)
- …support are not available for this position. **Job Summary:** The Clinical Data Analyst - Staff plays a pivotal role in advancing our products and services ... business operations leaders to develop reporting and analyze large-scale healthcare claims and clinical datasets. By leveraging advanced coding, analytic reporting,… more
- Keurig Dr Pepper (TX)
- …and key stakeholders to identify preventative opportunity areas + Assesses all new claims and immediately engage in those that are serious, questionable, or lost ... on workers' compensation ensuring timely return to work + Partners with claims adjusters, nurse case managers, EHS, Risk Management, managers, and employees and… more