- Sedgwick (Irving, 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)
- …claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers ... eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
- Sedgwick (Austin, TX)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance VP Internal Audit **PRIMARY PURPOSE** **:** Ensures the global plan of coverage for all ... risks are properly planned and assess where and when audit resources are required through close work with business...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Cardinal Health (Austin, TX)
- …with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and ... This position will also support the Director with transactional audit diligence and integration planning, as well as the...records. + Availability to assist with research of denied claims . + Maintains a functional knowledge of enterprise EMRs,… more
- Amazon (TX)
- …program around the world across all of its various use cases. Amazon's Last Mile Claims team is seeking a talented claims professional to support our rapidly ... auto program. You will lead strategy on complex bodily injury auto claims , handling pre-litigation disputes and resolving litigated claims with cross-functional… more
- Molina Healthcare (Houston, TX)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... gain exposure to end-to-end RADV workflows and contribute to meaningful audit readiness efforts. **Knowledge/Skills/Abilities** + Assist with the identification and… 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
- Elevance Health (Houston, TX)
- …unit/brand as appropriate regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Assists ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Robert Half Legal (Dallas, TX)
- …Compensation is competitive and based on experience. Responsibilities Include: Review and audit existing and incoming general liability claims for quality, ... Description We're hiring Active Licensed Liability Claims Adjusters to support a high-impact project focused...focused on auditing and resolving a backlog of complex claims . This fully remote, contract-to-hire role is ideal for… more
- CRC Insurance Services, Inc. (Flower Mound, TX)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more