- CVS Health (Austin, TX)
- …strong organizational and decision-making skills. + Provide technical expertise in claims adjudication, business rules, network structures, and testing support. + ... of network programs and procedures, including retail pharmacy operations and claims adjudication + Intermediate to advance Microsoft Access database experience +… more
- Walgreens (Waxahachie, TX)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Walgreens (Bee Cave, TX)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Sedgwick (Austin, TX)
- …for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The ... advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With… more
- Kemper (Houston, TX)
- …collaborating with peers in the sales organization, State Product Managers, Claims , Agency Support and Licensing, Marketing, and Customer Service/Underwriting. + The ... Bilingual English/Spanish a plus. + Working knowledge of insurance operations: underwriting, claims , marketing, and product. + Must have and maintain an acceptable… more
- Evolent (Austin, TX)
- …accounts + Strong knowledge of health plan operations, care/utilization management, claims processing, value-based care, and the levers to optimize financial ... be leveraged to identify opportunities and actions (including EMR, clinical, authorization, claims , SDoH, etc.); understanding of how to translate data and insights… more
- TAD PGS, Inc. (Plano, TX)
- …navigating sensitive or complex leave scenarios. + Analyze FMLA, STD and WC claims to determine eligibility and certification in compliance with State and Federal ... FMLA, ADA, personal leave, and company-specific time-off policies. Analyzing FMLA claims to determine eligibility and certification in compliance with state and… more
- Actalent (Fort Worth, TX)
- …quickly and accurately. This role involves handling calls, processing insurance claims , and resolving copay issues-all while delivering excellent customer service. ... inbound/outbound calls with patients, providers, and insurers. + Process live insurance claims and assist with copay programs. + Update patient insurance info and… more
- Zelis (Plano, TX)
- …team to refine into user stories with acceptance criteria, including creating test cases/ claims with expected pricing outcomes . + Perform analysis of various data ... understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing, contracting, preferred-provider organizations,… more
- Elevance Health (Grand Prairie, TX)
- …requirements. + Develop and analyze business performance reports (eg, for claims data, provider data, utilization data) and provides notations of performance ... Microsoft Excel experience. + Facets systems knowledge considered a plus. + Claims and/or Encounters experience preferred. + Experience with Medicaid data preferred.… more