- 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
- Honeywell (Houston, TX)
- …Documentation of all inquiries, including the solutions * Liaison with Technology, ISC, Quality and Customers * Manage Customer Escalations and Case Loads * Do ... Complete & Process Customer's Warranty claims * Verification and Validation of Hardware & Software...Validation of Hardware & Software products * Liaise with Quality on Issues reported & Root cause analysis. *… more
- Methodist Health System (Dallas, TX)
- …physicians and office staffs. * Must demonstrate understanding of medical claims billing and coding practices. * Ability to analyze problems/issues/questions and ... physicians and office personnel on the health plan contracts, fee schedules, claims processes, and regulatory requirements. * Serves as liaison between MHS… 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 ... supporting state and federal compliance reporting. You will continuously improve quality control and accuracy of reported data, increase reporting efficiency, and… more
- Sedgwick (Austin, TX)
- …regulations, and client service requirements and assure efficient, cost effective, quality program delivery for medical and disability management. + Coordinating and ... Pension Board + Review of identified appeal cases for quality assurance purposes + Voting member to determine if...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Meta (Temple, TX)
- …team and ensure that all project schedule reporting meets or exceeds the expected quality . Area Schedule Lead will work directly with CW Schedule team and Project ... change management/Extension of Time (EOT) approval, delay tracking, schedule metric/ quality , schedule delay mitigation, and risk facilitation 2. Responsible for… 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 ... reporting using SQL and SAS. You will continuously improve quality controls and accuracy of reported data, looking for...AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health… more
- BrightSpring Health Services (San Angelo, TX)
- …needs of our clients across various lines of business. If your passion is to ensure quality care to help our clients live their best life we encourage you to apply ... rights of the person(s) served to achieve an enhanced quality of life + Follow agency procedures to promote...consultant services, etc + Monitors worker's compensation and unemployment claims for assigned service site(s) + Is proactive in… more
- Molina Healthcare (TX)
- …models to support analytical and operational use cases, including healthcare claims and utilization data. * Collaborate with cross-functional teams, including data ... as Cloudera Manager, Ambari, and Zookeeper. * Enforce data quality , security, and compliance standards using tools such as...working in the healthcare industry with familiarity in clinical, claims , or care management data. * Experience with cloud… more
- Molina Healthcare (Fort Worth, TX)
- …Ability to influence across multiple organizational functions - Payment Integrity, Claims , Encounters, Finance, and Actuarial + Proven experience in managing complex ... implement efficient enterprise-wide processes and governance structures that span claims , encounters, clinical, finance and actuarial functions. + Identifies,… more