- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in… more
- CDM Smith (Fort Worth, TX)
- …and Evidence Gathering: Collect and organize all necessary documentation to support claim amounts. This includes gathering invoices, receipts, contracts, ... Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related… more
- Rexel USA (Dallas, TX)
- …compensation claims + Liaise with National Safety Manager on Workers Compensation claims analysis in support of Safety and prevention initiatives and OSHA ... and processes to control the cost of insurance and claims . **What You'll Do:** + Provide best practices in...Legal, Outside Counsel, and Finance + Participate in quarterly claim reviews and best practice audits with Third Party… more
- USAA (San Antonio, TX)
- …of liability, setting and managing services throughout life of the claim while providing excellent service. Within defined guidelines and framework, you ... are responsible to adjust moderately complex auto insurance claims presented by or against our members to include...(now or in the future) you will need immigration support (ie, H-1B, TN, STEM OPT Training Plans, etc.).**… more
- USAA (San Antonio, TX)
- …responsible to adjust attorney involved moderately complex bodily injury claims to include confirming coverage, determining liability, investigating, evaluating, ... negotiating, defending, and settling claims in compliance with state laws and regulations. Accountable for delivering a concierge level of best in class member… more
- 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
- 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