- Providence (TX)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... to department leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and training observations +… more
- Conduent (Dallas, TX)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Sedgwick (San Antonio, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Liability Bodily Injury **PRIMARY PURPOSE** : To supervise the… more
- PennyMac (Fort Worth, TX)
- …to inquiries by internal and external clients and property preservation service providers + Audit all resolved claims to ensure the claim was settled fairly and ... complete mortgage journey. A Typical Day The Hazard Insurance Claims Specialist will be responsible for filing insurance ...Claims Specialist will be responsible for filing insurance claims on vacant, damaged homes in active foreclosure to… more
- Highmark Health (Austin, TX)
- …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- Sedgwick (Austin, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- Elevance Health (Houston, TX)
- …Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an...you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding… more
- Elevance Health (Houston, TX)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims and ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
- Molina Healthcare (Houston, TX)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more