- Molina Healthcare (TX)
- …execute effective Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as well as ... Clinician. This includes assessing medical documentation, itemized bills, and claims data to ensure appropriate payment levels, optimize resource utilization,… more
- Molina Healthcare (Dallas, TX)
- **Job Description** **Job Summary** The Health Plan Operations, Payment Integrity Program Manager is an individual contributor role designed for a highly capable ... operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to...for all PI solutions. + Lead efforts to improve claim payment accuracy, claim referrals, adjustment analysis… more
- Travelers Insurance Company (Houston, TX)
- …evaluating, reserving, negotiating and resolving assigned serious and complex General Liability claims . Provides quality claim handling throughout the claim ... is designed to support flexibility. **What Will You Do?** CLAIM HANDLING: + Directly handle assigned severe claims...facts or allegations of each case. + Consult with Manager on use of Claim Coverage Counsel… more
- Molina Healthcare (Fort Worth, TX)
- …and financial outcomes for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance ... a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more
- Southland Holdings (Grapevine, TX)
- …demands strong contract expertise, strategic thinking, and problem-solving skills. The manager supports dispute resolution, claims , and contract compliance, ... Job Title: Construction Contract Manager Reports To: Director of Commercial Management Location:...responses. + Draft formal contract correspondence, including notices and claims , to protect company entitlements. + Collaborate with scheduling… more
- Molina Healthcare (TX)
- …background in payment integrity-either at a health plan or vendor-is strongly preferred . **Knowledge/Skills/Abilities** + Review Medicaid COB claims for correct ... Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination… more
- HCA Healthcare (Conroe, TX)
- …coverage; + * You will work with defense legal counsel to coordinate claim investigations; Process claims against the facility, including the preparation of ... Houston Healthcare Conroe have the opportunity to make a real impact. As a(an) Manager Risk Management you can be a part of change. **Benefits** HCA Houston… more
- HCA Healthcare (Houston, TX)
- …coverage;** + You will work with defense legal counsel to coordinate claim investigations; Process claims against the facility, including the preparation ... **Introduction** Do you have the career opportunities as a Manager Patient Safety you want in your current role?...required.** + Master's degree in nursing or healthcare field preferred ** + Current Registered Nurse License in the State… more
- Kemper (Dallas, TX)
- …Specialist will investigate, evaluate and handle to conclusion all assigned litigated claims . The Litigation Specialist will have advanced claim handling skills ... and be able to effectively manage the litigation claim process. Open positions in several office locations, Birmingham,...programs to advance knowledge in the area of insurance claims . + Work closely with the manager ,… more
- Towne Park (Grapevine, TX)
- …(http://www.townepark.com/wp-content/uploads/2023/06/CCPA-CPRA-Notice-at-Collection-Applicants\_Towne-Park-Careers.pdf) . The Account Manager directly oversees one ... may be subject to a specific plan or program terms. **JOB SUMMARY** The Account Manager directly oversees one Tier 1 or 2 Towne Park account and is responsible for… more