- Humana (Austin, TX)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- USAA (San Antonio, TX)
- …multi-tasking, and problem-solving skills. + Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims . + Ability to ... and framework, responsible to adjust attorney-involved, moderately complex bodily injury claims , and UM claims to include confirming coverage, determining… more
- The Cigna Group (Houston, TX)
- …channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, ... Cigna's competitive position. + Creates and manages initiatives that improve total medical cost and quality. + Drives change with external provider partners by… more
- Elevance Health (Grand Prairie, TX)
- …not eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical ... into effective and accurate reimbursement criteria.** PRIMARY DUTIES: + Review medical record documentation in support of Evaluation and Management CPT codes.… more
- Houston Methodist (Houston, TX)
- …with Clinical Research Billing Compliance. + Provides oversight and performs detailed claims analysis and medical record review as necessary, including the ... protocols, study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review. - Reviews...etc. - Performs detailed claims testing and medical review. - Reviews Medicare Coverage Analysis to ensure… more
- Baylor Scott & White Health (Temple, TX)
- …on position type and/or level **Job Summary** Manages detailed assessments of high-risk claims with a medical /legal plan to prevent claim elevation. Reviews and ... for Baylor Scott & White Health (BSWH). Collaborates with leadership, clinicians, medical providers, and team members on risk management initiatives to minimize the… more
- CVS Health (Austin, TX)
- …for complaints and appeals received by the organization. This includes denied claims , coverage issues, medical necessity, service quality, or other concerns ... Excel, PowerPoint, Outlook). **Preferred Qualifications** + Prior experience working with claims . + Prior experience in health insurance. + Prior experience in… more
- Urology Clinics of North Texas (Mesquite, TX)
- …working Medical collections, both insurance and patient + Urology/Oncology and medical terminology + Knowledge of insurance plans, claims , and billing ... is looking for a customer-focused office professional to perform collections, filing claims , handle appeals, and correspondence with payers. This position will focus… more
- Evolent (Austin, TX)
- …of 1 years of experience in technical quality assurance and database testing, medical benefits, provider, enrollment, and / or claims data. + Demonstrable ... experience with Testing, Writing Test cases, Test Plans, and good understanding on what needs to be tested + Demonstrable experience in verbal and written communication with domain teams and program leadership + Demonstrable experience working concurrent… more
- Robert Half Legal (Houston, TX)
- …legal research, drafting, and trial preparation. Responsibilities: * Analyze and assess medical malpractice and product liability claims to determine case ... looking for a highly skilled Attorney with expertise in medical malpractice and product liability litigation to join our...and be in good standing. * Proven experience handling medical malpractice and product liability cases. * Strong skills… more