- Sedgwick (Irving, TX)
- …naturally empathic and solution-focused. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Makes claim determinations to approve non-complex disability claims or makes ... professional needs. **PRIMARY PURPOSE OF THE ROLE:** To process claims and determine benefits due pursuant to a disability...curriculum. + An assigned mentor and manager that will support and guide you on your career journey. +… more
- Molina Healthcare (San Antonio, TX)
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution ... agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate… more
- VetsEZ (TX)
- …care teams, payers, and providers to improve how patients experience care, how claims are processed, and how care coordination is managed across the continuum. By ... we enable smarter decisions, seamless patient engagement, and more efficient claims management. Together, we are shaping a healthcare ecosystem that delivers… more
- Molina Healthcare (Houston, TX)
- …all payment integrity (PI) solutions. * Independently leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial ... thought partner to health plan leadership, and provides well-reasoned recommendations that support short- and long-term business goals. * Partners with the network… more
- USAA (San Antonio, TX)
- …guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance ... and investigation strategies on any questionable or suspect first or third part claims . + Participates in the development of fraud prevention strategies. + Applies… more
- Cardinal Health (Austin, TX)
- **About Navista** We believe in the power of community oncology to support patients through their cancer journeys. As an oncology practice alliance comprised of more ... than 100 providers across 50 sites, Navista provides the support community practices need to fuel their growth-while maintaining their independence. **_What Revenue… more
- Sedgwick (Austin, TX)
- …Sun/Mon/Tues/Wed/Fri 9:30am-6:30pm EST** **PRIMARY PURPOSE:** To provide exceptional customer support on Sedgwick's primary temporary housing line by assisting ... answer questions. + Accurately and efficiently enters new housing claims into the system. + Monitors inbound email for... into the system. + Monitors inbound email for claim questions, approvals, and new housing requests. + Contacts… more
- Elevance Health (Grand Prairie, TX)
- …paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use ... week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured...of proprietary data and claim systems for review of… more
- Sedgwick (Austin, TX)
- …: To identify and address psychosocial, medical, and employment issues within a claim and be actively engaged in resolution; to work in conjunction with and ... provide recommendations and education to the claims examiner, claimant, and clinical team; to work with...Assesses claimant's situation for psychosocial needs, cultural implications, and support systems in place. + Develops a plan to… more
- Cognizant (Austin, TX)
- …and optimizing benefit, pricing, and configuration solutions that directly enhance claim processing accuracy and auto‑adjudication rates. You will be a valued ... Conduct backend SQL queries to validate configuration accuracy and ensure correct claim processing behavior. + Partner with business teams to provide strategic… more
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