- The Cigna Group (Austin, TX)
- …to Have** + Prior **PBM/specialty pharmacy** platform knowledge (eg, claims /benefit management, care coordination, specialty workflows). + Earlier **hands‑on ... engineering** (software, data, or platform) before moving into architecture leadership. + Industry credentials (eg, **TOGAF** , Azure/AWS architecture) and/or published architecture patterns. **Leadership Competencies** + Strategic Mindset, Drives Results,… more
- Fresenius Medical Center (Irving, TX)
- …project specifications and review methodologies. Analyses will include review of claims data, analysis of medication utilization for global contracts and analysis ... of rate structure conversion. + Consolidates patient insurance download data including developing standards for field review of data and reporting. + Provides consolidated business / payer mix / revenue by payer / treatment mix on a monthly basis including… more
- Molina Healthcare (Fort Worth, TX)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Kyndryl (Austin, TX)
- …Partner with CCaaS architects to build future-proof architectures with EHR, CRM, and claims system integrations. The compensation range for the position in the US is ... $159,240 to $286,560 based on a full-time schedule. Your actual compensation may vary depending on your geography, job-related skills and experience. For part time roles, the compensation will be adjusted appropriately. The pay or salary range will not be… more
- Southland Industries (Carrollton, TX)
- …Set-up and maintain w/c claim filing system. + Assist with case management of open claims through to closure; notify safety director of safety manager of status ... Brandt's/Southland safety department, with heavy emphasis on workers compensation claims management. **Position Details** + Provide administrative support to group… more
- Zurich NA (Dallas, TX)
- …128018 Zurich is seeking an experienced Executive Underwriter OR AVP, Underwriting Director - Excess Casualty. We are looking for talented professionals in the ... per week. As an Executive Underwriter OR AVP, Underwriting Director - Excess Casualty you will have the opportunity...and 10 or more years of experience in the Claims , Underwriting support areaOR + Zurich Certified Insurance Apprentice… more
- Marriott (Houston, TX)
- …* Works with the unemployment services provider to respond to unemployment claims ; reviews provider reports for accuracy and corrects errors. * Prepares, audits ... are referred to the Department Manager for resolution or escalated to the Director of Human Resources/Multi-Property Director of Human Resources. * Partners with… more
- Public Consulting Group (Austin, TX)
- …through claim issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist ... through claim issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …external regulations. This position reports directly to the Associate Director , CNS Scientific Communications. **Job Description** **Key Responsibilities Include:** ... Content Development** + Under the guidance of the Associate Director , Medical Communications, draft and maintain high-priority, foundational scientific communication… more
- Stantec (Plano, TX)
- …System selection to be based on Project/Client needs as well as proactive Claims /Risk mitigation. - Oversee and approve development and management of the Project ... written communications, including Change notifications, Change Requests, responses to Claims notifications, etc. within the timeframes required by the Contract… more