• Claims Processing Specialist

    Kelsey-Seybold Clinic (Pearland, TX)
    …Services Supervisor, the Claim Edit Follow-Up Representative is responsible for processing the electronic claims edits, "front end "edits, as well as ... claims edits from secondary claims . In the event a claim edit...standards and performance measures for this position **Job Title: Claims Processing Specialist** **Location: Pearland Administrative Office**… more
    Kelsey-Seybold Clinic (08/01/25)
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  • Patient Support Medical Biller/ Claims

    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
    IQVIA (07/23/25)
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  • General & Product Liability Complex Claim

    Sedgwick (Houston, 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
    Sedgwick (08/08/25)
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  • General Product and Liability Complex Claim

    Sedgwick (Fort Worth, 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
    Sedgwick (08/08/25)
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  • Senior Claim Benefit Specialist

    CVS Health (Austin, TX)
    claim or reconsideration. **Required Qualifications** + 2+ years of medical claim processing experience. + Previous experience in a production environment. + ... competently, accurately and efficiently. **Preferred Qualifications** + Self funded medical claim processing experience. + DG system knowledge. + Associate's… more
    CVS Health (08/15/25)
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  • Senior Claim Benefit Specialist

    CVS Health (Austin, TX)
    …competently, accurately and efficiently. **Preferred Qualifications** - 18+ months of medical claim processing experience - Self-Funding experience - DG system ... every day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a… more
    CVS Health (08/01/25)
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  • Claims Investigator

    Allied Solutions (Plano, TX)
    Position Summary; This position is responsible for the initial setup and investigation of claims prior to the assignment of the claim to a licensed adjuster. ... others as assigned. This position will involve the initial processing and investigation of 20-40 claims per...claims per day. This position ensures that all claim documentation is thoroughly reviewed and assessed for coverage… more
    Allied Solutions (07/13/25)
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  • Claims Specialist Sr , Professional…

    Sedgwick (Austin, TX)
    … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim ...depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client;… more
    Sedgwick (08/14/25)
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  • Claims Advisor, Professional Liability

    Sedgwick (Dallas, TX)
    … by investigating and gathering information to determine the exposure on the claim ; manages claims through well-developed action plans to an appropriate and ... and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim ...depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client;… more
    Sedgwick (06/08/25)
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  • Director, Appeals & Grievances (Medicare…

    Molina Healthcare (San Antonio, TX)
    …Contracted Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility ... from start to finish of the claim disputes to include intake, processing , decisioning,...IPA. + 2 years supervisory/management experience with appeals/grievance and/or claims processing within a managed care setting.… more
    Molina Healthcare (07/18/25)
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