- 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
- Elevance Health (Grand Prairie, 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...documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for… 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