- Elevance Health (Houston, TX)
- …with fraud and abuse. **How you will make an Impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- USAA (San Antonio, TX)
- …P&C Claims Operations and/or Optimization experience. + 2+ years of MCO ( Manager , Claims Operations) experience. + Deep operational knowledge of end-to-end ... claims processes. + Demonstrated knowledge of new and emerging industry technology solutions. + Proven ability to use analytical tools and data to inform business… more
- Elevance Health (Grand Prairie, TX)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Grand Prairie, TX)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …Texas DepartmentLegal Affairs FTE1 FLSAExempt Scope of Job An individual contributor and manager of a team of attorney(s) and risk-management staff handling a broad ... reimbursements, including governmental and private payors; accreditation-related issues; false claims ; tax; anti-trust; tissue or organ transplantation; collections; risk… more
- Zurich NA (Dallas, TX)
- …be filled at either the Account Executive or Senior level. The hiring manager will determine the appropriate level based upon the selected applicant's experience and ... and 6 or more years of experience in the Claims or Underwriting Support area + Zurich Certified Insurance...and 4 or more years of experience in the Claims or Underwriting Support areaAND + Knowledge of line/s… more
- Sedgwick (Bedford, TX)
- …Automotive Customer Case Coordinators. We help auto customers through the manufacturing claims process. **_We offer benefits on day one:_** + **_401K_** + ... + Escalate customer, dealer or 3rd party issues to manager as appropriate + Ensure quality of service on...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Meta (Temple, TX)
- …will review and approve all Extension of Time (EOT) requests and support the Area Manager and Area Cost Lead on the review and approval of schedule related changes ... risks are identified and communicated up to their Area Manager and the Capacity Planning process. This position will...for Delay Tracking, Extension of Time (EOT) requests and claims . Coordinate the change evaluation in collaboration with the… more
- Molina Healthcare (TX)
- …models to support analytical and operational use cases, including healthcare claims and utilization data. * Collaborate with cross-functional teams, including data ... monitor, and troubleshoot Hadoop-based infrastructure using tools such as Cloudera Manager , Ambari, and Zookeeper. * Enforce data quality, security, and compliance… more
- HCA Healthcare (Conroe, TX)
- …Specialists (CARS), and/or CDI Liaisons with day-to-day operations + Assists Coding Manager in the review and improvement of processes and services + Ensures ... timely to ensure cashflow, sustain accuracy, and meet filing deadlines and claim submission deadlines utilizing various tools (eg, eRequest, Bill 49 tool(s), HIM… more