- Mass Markets (Killeen, TX)
- …1-3 years of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a ... 736), Business Process Management (BPM), Business Process Outsourcing (BPO), Claims Processing , Collections, Customer Experience Provider (CXP), Customer… more
- Elevance Health (Houston, TX)
- …+ Requires a HS diploma or GED and a minimum of 3 years of claims processing experience; or any combination of education and experience which would provide ... **I** is responsible for pre and post payment and adjudication audits of high dollar claims for...and stop loss submission, including decision methodology, system or processing errors, and monetary discrepancies. + Provide feedback on… more
- Sedgwick (Houston, TX)
- …growth, and inclusion. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE:** + Analyzing and processing claims through well-developed action plans to an appropriate ... behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and… more
- Sedgwick (Austin, TX)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | General Liability BI | Captive | Remote As a Claims … more
- Sedgwick (Plano, TX)
- …exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and ... Fortune Best Workplaces in Financial Services & Insurance Bodily Injury | Claims Examiner **PRIMARY PURPOSE** : To analyze complex or technically difficult general… more
- BrightSpring Health Services (Grand Prairie, TX)
- …calculations (eg, converting milligrams) + May resolve issues of denials identified through adjudication , and follow-up claims in Point of Sale (POS) + Maintains ... 8am - 5pm We offer: DailyPay Flexible schedules Competitive pay Shift differential Health , dental, vision and life insurance benefits Company paid STD and LTD… more
- CVS Health (Austin, TX)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, ... At CVS Health , we're building a world of health...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.… more
- Molina Healthcare (TX)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication , QNXT system navigation, and strong analytical acumen. Experience ... compliance of Coordination of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...or equivalent experience Prior experience in Payment Integrity and/or COB/ Claims roles at a health plan or… more
- CVS Health (Austin, TX)
- …dollar amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, ... At CVS Health , we're building a world of health...organizational, and interpersonal skills. **Preferred Qualifications** + DG system claims processing experience. + Demonstrated ability to… more
- Sedgwick (Austin, TX)
- …compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. **ESSENTIAL ... FUNCTIONS and RESPONSIBILITIES** + Adjusts medical-only claims and low- to mid-level lost-time workers compensation claims under close supervision. + Supports… more