- The Hartford (San Antonio, TX)
- …and successfully investigating, reserving, recommending and implementing strategies to resolve claims consistent with corporate claim standards, policies and ... execute file strategies including investigation, valuation, disposition and settlement of assigned claims , in a manner consistent with corporate claim settlement… more
- Molina Healthcare (Fort Worth, TX)
- …is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it ... applied to the appropriate modules within the core processing system (QNXT). * Conducts focal healthcare Medical claim...+ Knowledge of verifying documentation related to updates/changes within claims processing system . + Experience using… more
- CVS Health (TX)
- …day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject ... customer service inquiries and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority… 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. ... claims per day. This position ensures that all claim documentation is thoroughly reviewed and assessed for coverage...This position will also review database information found in systems such as Unitrac, insurance company websites, Lexis Nexis,… more
- Molina Healthcare (Fort Worth, TX)
- …* Apply previous experience and knowledge to verify accuracy of updates to claim /encounter and/or system update(s) as necessary. * Works with fluctuating volumes ... updates/changes to member enrollment, provider contract, provider demographic information, claim processing guidelines and/or system configuration requirements.… more
- Highmark Health (Austin, TX)
- …and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, ... to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves … more
- Cognizant (Austin, TX)
- ** Claims Process Executive (remote)** **JOB PURPOSE:** Claim Processors will review claim submissions, verify information, adjudicate the claim as per ... regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing… more
- The Hartford (San Antonio, TX)
- …, ensuring all claim handling meets quality and compliance standards. Manage Claim Files: + Handle assigned claims in a manner consistent with corporate ... and timely reserves. + Manage all aspects of assigned claims , which includes initial claim contact, reserve...adapt to change and to learn and utilize multiple systems to manage claims + Computer literacy… more
- Lincoln Financial (Austin, TX)
- …and applying knowledge. You will analyze and manage a caseload of appeals claims . You will review, investigate, and make claim determinations regarding coverage, ... to Claims management & teams regarding products, claims processes, regulations, and applicable systems for...& obtaining a wide range of complex information. Apply claim policies & procedures and engages intervention of internal/external… more
- Baylor Scott & White Health (Dallas, TX)
- …approval of lost wages for payroll and for all approvals of medical bills per claim file. + Pay and process claims within designated authority level. + Performs ... Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well....and/or level **Job Summary** + Under the Safe Choice Claims Manager, the Safe Choice Claims Specialist… more