- Sedgwick (Austin, TX)
- …qualified opinion as to the cause of loss. + Receives and reviews new claims and maintains data integrity in the claims system. **ADDITIONAL FUNCTIONS and ... A comprehensive benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and life insurance, employee… more
- Intermountain Health (Austin, TX)
- …Requirements + Workflow Process + Communication + Insurance Processing and Issues + Medical Terminology + Claims Processing + Collaboration + Time Management + ... **Essential Functions** + Oversees the day-to-day revenue cycle functions including claims processing, denials, payments, customer service, and follow up on… more
- USAA (San Antonio, TX)
- …assistance is not available for this position. **These positions will support Claims Litigations.** **What you'll do:** + Develop and implement strategic customer ... to collect and analyze data. **What sets you apart:** + P&C Litigation Claims Operations and/or Optimization experience. + 2+ years Manager, Claims Operations… more
- Humana (Austin, TX)
- …data mining, detects anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and our financial recovery. ... provider contract payments in our payer systems, and by ensuring correct claims payment. Begins to influence department's strategy. Makes decisions on moderately… more
- Evolent (Austin, TX)
- …team at Evolent. This individual will be primarily focused on distilling medical economics insights from product strategy analyses and translating them to complex ... fostering trust, expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate… more
- Sedgwick (Dallas, TX)
- …combination of education and experience required to include two (2) years of claims management, managed care or other related experience. **Skills & Knowledge** + In ... depth knowledge of claims management, managed care and/or absence management processes and...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- CenterWell (Austin, TX)
- …+ Know and continually review medication brand and generic names, medical terminology, and pharmaceutical calculations. + Medication adherence outreach, auditing, ... + Assist clinical pharmacists in troubleshooting prescription third party claim rejections by accessing and understanding formulary restrictions, plan limitations,… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …customer engagement platforms, starting with, but not limited to, Otsuka's Medical Affairs Disease State Engagement platforms (PsychU, PsychUsim, ADPKDsim, and ... align our platform initiatives to corporate, above brand and medical strategies. This successful candidate will need strong project...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Sharecare (Austin, TX)
- …eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, ... including but not limited to medical , dental, and vision plans + Provider search (PCP,...resolution with providers, payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization… more
- Sumitomo Pharma (Austin, TX)
- …company's new and established programs. This position reports to the Chief Medical Officer. **Job Duties and Responsibilities** + Strategic thought partner including ... and operational leadership to the Marketing Brand Teams, Legal, Medical Affairs and Clinical Research in the development of...the adequacy of clinical evidence provided to support proposed claims and assess consistency of proposed claims … more