- 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
- 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
- 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 (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
- CVS Health (Austin, 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
- 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
- Wells Fargo (San Antonio, TX)
- …the Head of Claims and Recovery. This group is responsible for end-to-end claims processing for all dispute types. This individual will lead the ATM, Debit ... Fargo is seeking a Fraud & Claims Operations Director to report to...transformation initiatives. **Required Qualifications:** + 8+ years of Fraud Claim Investigation or Policy Violations, Risk Management, or Compliance… more
- 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
- 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 (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