- Humana (Austin, TX)
- … healthcare industry + 2+ years of demonstrated expertise in end-to-end healthcare claims operations , including claim ingestion, processing, system ... This is your opportunity to lead cross-functional initiatives, apply your expertise in healthcare claims , and shape the future of operational excellence in a… more
- Molina Healthcare (Houston, TX)
- …equivalent combination of education and experience **PREFERRED EXPERIENCE:** 3+ years Healthcare Claims Adjudication **PHYSICAL DEMANDS:** Working environment is ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- Sanofi Group (Houston, TX)
- …detail-oriented problem solver with deep operational knowledge of the US healthcare system, including formulary operations , claims adjudication, ... **Job Title:** Associate Director, National Account Operations CVS - US Remote **Location:** Remote/Field Based...and contract performance tracking. We are an innovative global healthcare company, committed to transforming the lives of people… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Analyzes complex claims business problems and issues using data from internal and external sources to provide insight to ... with multiple types of business data. May be internal operations -focused or external client-focused. **KNOWLEDGE/SKILLS/ABILITIES** + Elicit requirements using… more
- Providence (TX)
- …statements for services and take proper steps to pay vendors + Inform Senior Manager Operations of large or complex claims and claims with potential for ... empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, evaluate, and manage professional, general,… more
- NTT DATA North America (Plano, TX)
- …methodology/ fee schedule **Required Skills/Experience** + 1+ years hands-on experience in Healthcare Claims Processing + 2+ years using a computer with ... have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our...an overall sourcing strategy. NTT DATA currently seeks a ** Claims Processing Associate** to join our team for a… more
- Cognizant (Austin, TX)
- …variety of business operations . We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical** ** Claims Processor** is ... responsible for the timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to … more
- Conduent (Dallas, TX)
- …Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will ... part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like to… more
- Guidehouse (Lewisville, TX)
- …experience in lieu of diploma/GED + 0-2+ years relevant experience within healthcare , insurance, business and/or revenue cycle operations . **What Would Be ... three days from home._** **Essential Job Functions** + Hospital Claims + Account Review + Appeals & Denials +...with UB04, appeals & denials. + Hospital or EOB claims emphasis + PC skills in a Windows environment.… more
- Guidehouse (Lewisville, TX)
- …lieu of Diploma / GED. + 1-3+ year's experience working in an office, business, operations , customer service or healthcare field. **What Would Be Nice To Have** ... denials for trends and issues and reports findings to supervisor + Bills or re-bills claims as necessary + Ensures the client follows all state and federal rules and… more
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