- Sedgwick (San Antonio, TX)
- …**Skills & Knowledge** + Knowledge of TCP/IP services + Knowledge of audit and compliance + Knowledge of vulnerability management + Knowledge of penetration ... 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… more
- Molina Healthcare (San Antonio, TX)
- …software and medical record vendors, and other Molina departments, such as Claims , Enrollment, IT etc,. to get appropriate responses and manage contracts and ... + Maximizes use of information from multiple sources, including claims /encounters, pharmacy, utilization management, clinical indicators, industry benchmark, and/or… more
- Molina Healthcare (Fort Worth, TX)
- …+ Responsible for encounters accuracy & completeness (ie, Encounter Production, Audit , Production Vendor Oversight) for assigned lines of business. Responsible for ... Ability to influence across multiple organizational functions - Payment Integrity, Claims , Encounters, Finance, and Actuarial + Proven experience in managing complex… more
- New Jersey Resources (Houston, TX)
- …changes to address deficiencies, improve programs and ensure company maintains an audit -ready status at all times. * Develop and maintain excellent working ... response analysis reviews. * Assist in managing Workers' Compensation Claims , Return to Work programs, accident reports, claims... Claims , Return to Work programs, accident reports, claims and lead root cause analysis. * Interface with… more
- Molina Healthcare (San Antonio, TX)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- Houston Methodist (Houston, TX)
- …Compliance and other committees as required. Works collaboratively with the Internal Audit and Business Practices to respond to deficiencies and to strengthen ... Clinical Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the following:… more
- Ryder System (Frisco, TX)
- …and supporting documentation. + Track and follow up on open returns and claims ; escalate issues when appropriate. + Maintain detailed records of all return and ... OS&D activities for audit and reporting purposes. + Provide timely updates and...follow up effectively. + Experience with OS&D processes or claims management in a logistics setting. + Exposure to… more
- Citigroup (Irving, TX)
- …+ Possible interaction with other counterparties around positions and outstanding balances/ claims + Supports an expansive and/or diverse array of products (risk ... monitors errors to suggest solutions to reduce errors, and to adhere to audit and control policies. Often related, but not limited to loan documentation processes.… more
- Walgreens (Lubbock, TX)
- …Quality Improvement Program. + Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with ... companies as well as medical providers and conducts or participates in 3rd party audit . + Assists and supports Store Manager and Pharmacy Manager in analyzing and… more
- Elior North America (Houston, TX)
- …Generate regular and ad hoc reports on leave metrics for HR leadership. + Audit leave records for accuracy and adherence to company policies and legal requirements. ... with third-party administrators and insurance carriers for disability and leave claims . + Provide clear, empathetic communication to employees navigating leave… more