- Molina Healthcare (Austin, TX)
- …statuses and risks, and facilitating calls with cross-functional teams + Claims processing , provider contacting, health data analysis and reporting, ... rejection inventory, and works with other areas including IT, health plan, claims , provider, enrollment, regulators, and external vendors, as needed, to remediate… more
- CVS Health (Richardson, TX)
- …role in ensuring the stability, scalability, and modernization of our pharmacy claims processing systems. These systems handle millions of prescriptions daily, ... with Synon and ALDON. + Experience with RxClaim or similar pharmacy claim adjudication systems. + Background in Healthcare or Pharmacy Benefit Management (PBM).… more
- Highmark Health (Austin, TX)
- …analytical and communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
- Molina Healthcare (Dallas, TX)
- …appeals experience. **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing /resolution, including ... Medicare standards and requirements related to non-contracted provider dispute/appeals processing . * Establishes member and non-contracted provider grievance/dispute and… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …as the primary technical subject matter expert (SME) for downstream processing (chromatography, TFF/UFDF, viral clearance/filtration, etc.). + Lead and manage the ... regulatory submissions (IND, BLA, MAA, etc.) related to downstream processing . + Collaborate closely with Upstream MSAT, Validation MSAT,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Walmart (Fort Worth, TX)
- …by ensuring proper policies and procedures are followed Ensures the timely processing of claims forexample damaged defective returned liquidated items and ... Manages facilitylevel training and execution of asset protection safety and claims and receiving procedures by reviewing the application of policiesprocedures… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …in ERP system. + Manage 3PL processes for inventory, returns and claims , recall activities and reporting, and product destructions. + Manage inventory reporting ... distribution state license submissions and renewals with Legal and processing vendor. + Manage international and intercompany order and...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Robert Half Legal (Mckinney, TX)
- …effectively with clients, court officials, and other legal professionals. * Support claim administration tasks, ensuring timely processing and resolution. * ... * Strong communication skills, both written and verbal. * Experience with claim administration and related legal processes. * Proficiency in using legal software… more
- Health Care Service Corporation (Mesquite, TX)
- …Ability to travel to the client(s) office/facility on a regular basis. + Prior claim processing /health insurance experience + Ability to work in a fast-paced, ... Luminare Health office. The associate meets face-to-face with members to resolve claim issues, assist with understanding of benefits, assist with Open Enrollment… more
- Molina Healthcare (Dallas, TX)
- …Ensure that provider information is loaded accurately to allow for proper claims processing , outbound reporting and directory processes. **JOB QUALIFICATIONS** ... for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims… more