- Capgemini (El Paso, TX)
- …meeting service levels, key measurement targets of the team and delivers a high quality and cost effective customer service to the client. Performs tasks in line ... meeting service levels, key measurement targets of the team and delivers a high quality and cost effective customer service to the client. Performs tasks in line… more
- Capgemini (El Paso, TX)
- …meeting service levels, key measurement targets of the team and delivers a high quality and cost effective customer service to the client. Performs tasks in line ... with the written procedures or assigned by senior staff under supervision. Deepening knowledge in one process or more. General Responsibilities / Accountabilities: * Contacts overdue customers and chases for payment in accordance with rules set by the… more
- Sedgwick (Irving, TX)
- …reviews, and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training,...contract requirements, and quality standards. + Acts as second level of appeal… more
- Sedgwick (Austin, TX)
- …Compiles reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... multiple teams of examiners and technical staff for liability claims for clients; to monitor colleagues' workloads, provide training,...contract requirements, and quality standards. + Acts as second level of appeal… more
- USAA (San Antonio, TX)
- …and design methodologies, eg Six Sigma and Lean, business operations, risk management, quality assurance and control, or internal audit (in addition to the minimum ... years of experience required) may be substituted in lieu of degree. + 8 years business process execution/knowledge/experience, consulting, and/or process engineering/optimization. + 3 years of direct team lead, supervisory or management experience. +… 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 - ... review policies, procedures, and performance standards. o Review dental claims consistent with current ADA CDT terminology and current...input and interpretation to all Humana departments o Provide quality of care reviews, as needed o Work with… more
- Molina Healthcare (Fort Worth, TX)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (Fort Worth, TX)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Centene Corporation (Mcallen, TX)
- …years of managed care or medical group experience, provider relations, quality improvement, claims , contracting utilization management, or clinical operations. ... for issue resolution. Drive optimal performance in contract incentive performance, quality , and cost utilization. + Serve as primary contact for providers… more
- Centene Corporation (Austin, TX)
- …of recommendations to providers that would improve utilization and health care quality . + Reviews claims involving complex, controversial, or unusual or ... the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. + Provides medical… more