- 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
- 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)
- …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
- Guidehouse (Lewisville, TX)
- …in Lieu of Diploma / GED. + 0-2+ year's experience in office, business, operations , customer service or healthcare field. **What Would Be Nice To Have** ... **:** + Previous experience working in insurance portals + PC skills in a Windows environment. + Knowledge and utilization of desktop applications to include Word and Excel is essential. + Ability to initiate and follow through on projects and work… more
- Molina Healthcare (Dallas, TX)
- …trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... **Job Description** **Job Summary** The Health Plan Operations , Payment Integrity Program Manager is an individual...operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to… more