- Sedgwick (San Antonio, TX)
- … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim ...directions in a professional and timely manner. + Communicates claim activity and processing with the claimant… more
- IQVIA (Houston, TX)
- **Patient Support Medical Claims Processing Representative** _Contract Remote Role - Location (Open to Remote US)_ As the only global provider of commercial ... 100% remote (work from home-WFH) contact **Patient Support Medical Claims Processing Representative** to join our team....+ High School Diploma or equivalent + Experience in claim processing required + Medical Billing Certification… more
- Molina Healthcare (Fort Worth, TX)
- …updates/changes to member enrollment, provider contract, provider demographic information, and/or claim processing guidelines. Evaluates the accuracy of these ... communicate written and verbal + Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using claims … more
- Sedgwick (Austin, TX)
- …expertise preferred. **Skills & Knowledge** + Subject matter expertise in worker's compensation claims and/or liability claims processing + Ability to obtain ... FUNCTIONS and RESPONSIBILITIES** + Proactively and strategically manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional… more
- CVS Health (TX)
- … claim or reconsideration. **Required Qualifications** - 18+ months of medical claim processing experience. - Experience in a production environment. - ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
- Sedgwick (Austin, TX)
- …FUNCTIONS and RESPONSIBILITIES** + Processes auto property damage and lower level injury claims ; assesses damage, makes payments, and ensures claim files are ... and pursues subrogation opportunities; secures and disposes of salvage. + Communicates claim action/ processing with insured, client, and agent or broker when… more
- TEKsystems (Dallas, TX)
- …Must score 94% or above Preferred Experience + Experience in charge entry or claims processing + Familiarity with healthcare data and HIPAA compliance Work ... Data Operations Analyst to support our Charge Entry & Claims Submission processes. This role is ideal for someone...be responsible for transforming raw data into clean, accurate claim files ready for automated submission. Key Responsibilities +… more
- Molina Healthcare (San Antonio, TX)
- …appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing . + Identifies and reports quality of care issues. + ... to providers. **Job Duties** + Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Molina Healthcare (Fort Worth, TX)
- …independently reviewing and processing simple to moderately complex High dollar claims and knowledge of all claim types of reimbursements not limited ... updates/changes to member enrollment, provider contract, provider demographic information, claim processing guidelines and/or system configuration requirements.… more
- Highmark Health (Austin, TX)
- …and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, ... **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health… more