- Sedgwick (Austin, TX)
- …behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY Jurisdictional Knowledge & NY Licensing Required Are you… more
- Sedgwick (Austin, TX)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Multi-Line | Public Entity | Remote...the same assisting our public entity clients with their claims ! If you are an agile multi-line examiner with… more
- Sedgwick (Irving, TX)
- …individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication ; and to maintain a diary on claims ... for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication . + Compiles, reviews, and analyzes management reports… more
- Elevance Health (Grand Prairie, TX)
- … systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Perform pre- adjudication claims reviews ... position is not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies,… more
- NTT America, Inc. (Plano, TX)
- …and work on weekend's basis business requirement. **Roles and Responsibilities:** + Process Adjudication claims and resolve for payment and Denials + Knowledge ... pre-established guidelines **Requirements:** + 1-3 years of experience in processing claims adjudication and adjustment process + Experience of Facets is an… more
- CVS Health (Austin, TX)
- …1+ years' experience with pharmacy appeal related processes and state regulations, and claims adjudication , including claims adjudication logic ... updates are operationalized. This role requires a thorough knowledge of claim adjudication , internal MAC & non-MAC related processes, and being a leader working… more
- Molina Healthcare (Austin, TX)
- …+ Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required ... encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's… more
- CVS Health (Austin, TX)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory &… more
- Oracle (Austin, TX)
- …The consultant will configure business rules within OHI applications to facilitate claims adjudication , customizing rules to each payer's needs using programming ... translated into a working system within OHI applications, including Claims , Policies, Authorizations, Product Definition, and Oracle Insurance Gateway. Configuration… more
- Health Care Service Corporation (Richardson, TX)
- …Lotus Notes. PREFERRED REQUIREMENTS: Knowledge of product, marketing, sales, and claims adjudication . Written, executive presentation, verbal communication, and ... interpersonal skills. **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service Corporation, you will be part of an organization committed to… more