- Sedgwick (Irving, TX)
- …training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a ... with management projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles, reviews, and… more
- Molina Healthcare (Houston, TX)
- …clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains ... resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to… more
- Sedgwick (Dallas, TX)
- …& Insurance OSS Coordinator **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple office locations; and to ... within assigned group. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Completes examiner update reports, claim adjustments, provider requests and operational expense… more
- CDM Smith (San Antonio, TX)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...such as CPA (Certified Public Accountant), CFE (Certified Fraud Examiner ), or CFF (Certified in Financial Forensics). **EEO Statement:**… more
- Prime Therapeutics (Austin, TX)
- …Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States without the ... or residency sponsorship. **Additional Qualifications** + 3+ years' fraud investigations/ claims experience. + Ability to manage workload while simultaneously working… more
- Highmark Health (Austin, TX)
- …**Required** + None **Preferred** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) ... (AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must have… more