- Sysco (Houston, TX)
- …+ **Return to Work:** Review and audit Return to Work process for claims , including Return to Work transitional program, process with external vendor and internal ... business units to ensure compliance including Return to Work transitional program. + **Documentation Review:** Review medical documentation and other required paperwork to ensure compliance with legal standards. + **Communication:** Serve as a primary point of… more
- Staxmatic, LLC (Addison, TX)
- …with the office of the General Counsel to support insurance procurement, insurance claims and insurance related matters as it pertains to the construction business. ... + Provide legal support to the finance department with respect to payment disputes, collections and/or audit requirements. + Ensure compliance with federal, state, and local laws. + Handle contract modifications, warranties, and risk management. + Collaborate… more
- Baylor Scott & White Health (Dallas, TX)
- …to ensure consistency between contract terms and adjudication of authorizations and claims . - Plays a critical role in overseeing pricing and repricing exercises ... to support TPAs other than that of BSW Health Plan TPA and in support of the enterprise Direct to Employer (DTE)/Employer Solutions strategy - Partners closely with the health plan operations Provider Data Integrity Unit (pricing, configuration, provider data… more
- WTW (Dallas, TX)
- …industries. Working knowledge of insurance functions especially product development, pricing, claims , underwriting and actuarial a plus. + Ability to work ... independently, autonomously and as part of a team in a fast-paced, dynamic environment + Disciplined approach to pipeline develop that includes relationship development skills and value-based sales capabilities + Strong communication, negotiation, and… more
- Houston Methodist (Houston, TX)
- …the Central Business Office and Managed Care department information when claims from commercial and governmental plans require additional information or ... clarification regarding credentialing. + Ensures managed care plans receive documentation timely promptly when completed so providers can commence patient care timely. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Manages the databases continually and improves… more
- Berkshire Hathaway Automotive (Irving, TX)
- …program design, marketing, procurement, and premium allocation. Manage all claims and litigation matters including mediation, involving workers' compensation, ... general liability, auto liability, property damage and personal injury. * Oversee the management of TPA/Insurance companies to accurately set reserves for know exposure. Perform claim audits with TPA/Insurer to validate reserving practices. * Participate in… more
- Humana (Frisco, TX)
- …core insurance operations by developing and maintaining systems for claims processing, underwriting, policy administration, and member enrollment. Projects often ... focus on automating workflows, modernizing legacy platforms, AI chatbots and IVR, and enhancing data integrity to support efficient and accurate insurance services. + **Tech Strategy:** Tech Strategy shapes the vision and roadmap for Humana's technology… more
- University of Texas Rio Grande Valley (Edinburg, TX)
- …variety of accounting documents including invoices, promissory notes, travel expense claims , vouchers and payrolls, and other financial reports. * Prepares original ... accounting entries for journals and ledgers, prepares and audits monthly reconciliation. * Verifies and records accounting and financial data from various sources for analysis. * Prepares various periodic financial reports and verifies the accuracy of entries.… more
- Carrington (Plano, TX)
- …home ownership and avoiding foreclosure, including Loan Modifications, Partial Claims , Repayment Plans, Forbearances and Reinstatements. Perform all duties in ... accordance with the company's policies and procedures, all US state and federal laws and regulations, wherein the company operates. The Target Pay range for this position is $21.00 - $23.00 + monthly bonus. **What you'll do:** + Handle inbound calls routed… more
- VetsEZ (TX)
- …or related degree. + 7+ years Pega PRPC v7.x+ experience (including Smart Claims & Healthcare Foundation). + 3+ years Java development experience. + Certified Senior ... System Architect CSSA certification required; Lead System Architect LSA preferred. + Strong knowledge of Pega architecture and PRPC implementation, including Direct Capture of Objectives DCO, enterprise Class Structure, Ruleset design and REST/SOAP… more