- Guardian Life (Plano, TX)
- …ethical business practices. **Responsibilities** + Review & ensure that determination and processing of claims , referralsand appeals meet state regulations, time ... are compliant with applicable state regulations. You will ensure that claims , referrals, appeals, and grievances meet state specific regulations, timeframes, and… more
- Amazon (Austin, TX)
- …with WFM Legal team on regulatory requirements o Reviewing applicable product claims /statements and determining claim validation criteria o Developing and ... - Advanced knowledge of Product/Food Safety for complex products categories and processing environments + Quality Assurance and control processes and workflows -… more
- Sunrise Senior Living (Frisco, TX)
- …internal business controls. + Process and manage unemployment and worker's compensation claims and update claim activity as necessary. + Clearly communicate ... Process payroll and follow established business processes and "Do It Daily" processing activities and submit accurate bi-weekly payroll by established schedule. +… more
- CVS Health (Austin, TX)
- …measuring and monitoring the quality and effectiveness of work processes in claim processing and customer service that impact customer satisfaction, medical ... of problem solving and decision making skills + College degree preferred + Claims experience + DG system experience **Education** + High School Diploma or equivalent… more
- Rush Enterprises (San Antonio, TX)
- …day to day needs, including preparing quotes for policy changes, processing policy changes, keeping detailed records of customer transactions, certificate requests, ... claim filing and answering questions regarding policies and explaining...customers and insurance company regarding ongoing service, policy changes, claims and customer satisfaction. + Follow up on outstanding… more
- Fresenius Medical Center (Plano, TX)
- …function(s). The incumbent is responsible for evaluating and resolving outstanding claim issues in compliance with company policies and procedures. PRINCIPAL DUTIES ... within the assigned function(s). + Review, investigate and resolve outstanding claims in coordination with cross-divisional teams and/or vendors to obtain the… more
- Evolent (Austin, TX)
- …of Actuaries credentials with Group Health track **(Preferred)** + Familiarity with healthcare claim processing **(Preferred)** + 5+ years experience at payer or ... to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication to key… more
- Intermountain Health (Austin, TX)
- …data to the clinical record. Leverages other system functionalities to expediate the claim processing for compliant and optimized hospital accounts. + Evaluates, ... Integrity Analyst II is responsible for appropriate charge capture, assigned account, claim edits and/or charge edits for an assigned service line. This position… more
- Datavant (Austin, TX)
- …resolving complex coding edits efficiently and accurately to ensure timely and compliant claim processing .** **What You Will Do:** + Review medical records and ... and optimizing service outcomes in both hospitals and alternative care settings. ** Claim edit experience is required; Must be proficient in resolving claim… more
- Molina Healthcare (Dallas, TX)
- …years of experience working in the group health business preferred, particularly within claims processing or operations. + A demonstrated working knowledge of ... etc.) + Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems. + Demonstrated ability to use MS Excel/Access platforms working… more
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