- Metro One Loss Prevention Services Group (Plano, TX)
- …of all new hire paperwork, following-up as required. . Manage all workers' compensation claims - work directly with our insurance carrier to file and provide all ... claim information and identify training or process improvements to reduce future claims . . Administer benefits program - ensure accuracy of all benefits enrollments… more
- Humana (Austin, TX)
- …in Texas and other states. This is accomplished by analysis and adjudication of claims , appeals, and potential quality of care issues. The Dental Director - Texas ... review policies, procedures, and performance standards. o Review dental claims consistent with current ADA CDT terminology and current...care reviews, as needed o Work with Specialty Quality Manager on annual quality work plan o Chair quarterly… more
- Bechtel Corporation (Sugar Land, TX)
- …owned affiliate of Bechtel Group, serves as the construction equipment asset manager across all Bechtel business lines. BEO supports projects with estimating and ... teams, suppliers, and other BEO functional departments to resolve performance issues, claims , and contractual matters. + Ensure invoices are reviewed in a timely… more
- Baylor Scott & White Health (Lakeway, TX)
- …and equipment maintenance and repairs, as needed and in conjunction with the Manager or Supervisor. + Performs quality assurance audits. + Orders supplies as ... patient registration procedures and documentation. + Knowledge of medical insurance claims procedures and documentation. Needs to have thorough understanding of the… more
- CVS Health (Irving, TX)
- …with a collaborative, close-knit reporting team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... of the reporting. You will report to the Sr. Manager within the Reporting Solutions team. To be successful...AWS/ Azure + Experience working with medical and/or pharmacy claims data + Experience in healthcare industry, including health… more
- CVS Health (Austin, TX)
- …work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information ... and the team is highly collaborative. You will report to the Senior Reporting Manager within the Compliance Pharmacy Payments team. To be successful in this role,… more
- Elevance Health (Grand Prairie, TX)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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
- Humana (Austin, TX)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Utilities Service, LLC (Longview, TX)
- …the crew. + May be delegated the authority to investigate incident reports, damage claims , etc., and to settle minor damage claims . + Maintains accurate records, ... benefits available for this role, please contact the recruiter or hiring manager . **Individuals with a disability who desire a reasonable accommodation can contact… more