- Humana (Austin, TX)
- …community and help us put health first** Design and maintain Medicaid claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims ... Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. Maintain dashboards to communicate key trends to stakeholders. The… more
- CVS Health (Austin, TX)
- …a highly skilled and experienced Senior Product Owner to join our Commercial Claim Adjudication engineering team. As a Senior Product Owner, you will contribute to ... by: + Leading the development and enhancement of Commercial Claim products or services. + Conducting market research. +...Will consider 100% remote in the US **Must work hours based on Eastern Time Zone.** **Required Qualifications** +… more
- Elevance Health (Grand Prairie, TX)
- **Location:** Grand Prairie TX, Nashville TN, Durham NC, Overland Park KS ** Hours :** Monday - Friday **Travel:** This role requires associates to be in-office 1 - 2 ... recover corporate and client funds paid on fraudulent Medicaid claims . **How You Will Make an Impact:** + Responsible...company health plan, line of business and/or state + Claim reviews for appropriate coding, data mining, entity review,… more
- Sedgwick (Austin, TX)
- …Services & Insurance Adjuster **PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + ... + Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim . + Consults police and hospital records and inspects property damage… more
- Sedgwick (Irving, TX)
- …payments and/or adjustments for client paid leave plans ensuring that on-going claim management is within company service standards and industry best practices. ... and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Establishes FMLA claims ; tracks and codes documentation in accordance with internal workflow… more
- USAA (San Antonio, TX)
- …and framework, responsible to adjust attorney-involved, moderately complex bodily injury claims , and UM claims to include confirming coverage, determining ... liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge… more
- USAA (San Antonio, TX)
- …**Injury Examiner** , you will be responsible to adjust complex bodily injury claims , UM/UIM, and small business claims to include confirming coverage, ... determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a… more
- AUI Partners (TX)
- …and job-sites to detect existing or 3) Incident Investigations: + Conduct Utility Claim Investigations within 24 hours and provide report for safety files ... possible + Assist HR, Legal and Compliance on Worker Compensation claims and other claims involving the public, vehicles, utilities, and equipment. + Transport… more
- AUI Partners (TX)
- …safety policy/OSHA regulations as guidelines. Accident and Incident Investigations + Conduct Utility Claim Investigations within 24 hours and provide a report to ... and tool inspections. + Investigate accidents, incidents, and worker compensation claims , ensuring timely and effective resolution. + Coordinate and conduct safety… more
- CVS Health (TX)
- …+ 1 year experience that includes both HMO and Traditional claim platforms, products, and benefits, patient management, product, compliance and regulatory ... service or audit experience. **Preferred Qualifications** + Medicare experience + Claims experience + Experience in reading or researching benefit language in… more
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