- Sedgwick (Irving, TX)
- …payment information and claims status by phone, written correspondence and/or claims system . + Communicates with the claimants' providers to set expectations ... aspects of claims process by phone, written correspondence and/or claims system . + Coordinates investigative efforts ensuring appropriateness; provides… more
- Houston Methodist (Houston, TX)
- …medical records to verify and substantiate diagnosis and procedures for charge review, claim edit(s) and/or denied claims and submits clinical appeal or ... physician record and reviews and corrects charge review and claim edit related coding errors in the electronic health...system - one of the nation's leading health systems - the Primary Care Group offers efficient access… more
- Syms Strategic Group, LLC (SSG) (San Antonio, TX)
- …+ Implement continuous improvement methodology through the use of Information Technology (IT) systems or procedures + Maintain inventory of system assets + ... + Strong proficiency in Linux/Unix and Windows operating systems + Experience with system administration tasks...environments Desired experience Electronic Data Interchange X.12 (EDI) Medical Claims + X.12 medical claims (837, 834,… more
- Sedgwick (Austin, TX)
- …of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Acts as a backup for ... Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- Sedgwick (Fort Worth, TX)
- … for multiple lines of business, including but not limited to, expediting the claims process, and providing detailed claim notes on all calls, resolving issues ... with one call/one person response. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Assigns new claims to the appropriate claim 's handler. + Enters verbal and… more
- Sedgwick (Austin, TX)
- …Consultant opportunity plays a key role in supporting our general liability claims team. The ideal candidate will bring strong clinical expertise and analytical ... skills to help evaluate medical-related components of claims . Completion of Legal Nurse Consultant certification or coursework...**PRIMARY PURPOSE** **:** To handle complex or high exposure claim issues; to provide medical knowledge of the health… more
- Sedgwick (Irving, TX)
- …to inquiries about jurisdiction- and claim -specific issues. + Enters data into claims system (s) and ensures claim files are properly documented and ... in accordance with designed guidelines and policies. + Communicates claims status and current claim activity with...policies. + Communicates claims status and current claim activity with client and appropriate medical contact; responds… more
- VetsEZ (TX)
- …models that support secure, interoperable data exchange across care coordination and claims systems . + Translate business and clinical requirements into ... HL7, X12) and data governance in regulated environments; prior experience with claims adjudication, care coordination, or patient engagement systems is highly… more
- Sedgwick (Fort Worth, TX)
- …equivalent combination of education and experience required. Experience in multi-line claims management processes and system requirements strongly preferred. ... Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance IT Systems Analyst Specialist Sr **PRIMARY PURPOSE OF THE ROLE** : To lead the… more
- Molina Healthcare (Austin, TX)
- …and knowledge to research and resolve claim /encounter issues and pended claims , and updates system (s) as necessary. * Loads and maintains contracts, ... reference table information into the claims payment system and other applicable systems . * Participates in defect resolution for assigned component(s). *… more