- Elevance Health (Houston, TX)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
- Providence (TX)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and...Insurance terminology + Legal concepts + Liens + Electronic claims databases + Medical terminology **Skills required… more
- Conduent (Dallas, TX)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Molina Healthcare (Houston, TX)
- …and improvements. + Provides oversight of research and analytics associated with medical claims processing requirements (1500 and UB04), provider and benefit ... **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage… more
- Public Storage (Plano, TX)
- …workers' compensation matters + Interface with employees, managers, insurance carriers, medical personnel and attorneys regarding workers' compensation claims , ... and compliance with state filing requirements + Oversee medical utilization + Review and analyze all claims...resolution + Assist in developing systems to track, monitor, audit and prepare reports regarding workers compensation + Interpret… more
- PennyMac (Fort Worth, TX)
- …to inquiries by internal and external clients and property preservation service providers + Audit all resolved claims to ensure the claim was settled fairly and ... complete mortgage journey. A Typical Day The Hazard Insurance Claims Specialist will be responsible for filing insurance ...have you covered. Some key benefits include: + Comprehensive Medical , Dental, and Vision + Paid Time Off Programs… more
- CRC Insurance Services, Inc. (Flower Mound, TX)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- CRC Insurance Services, Inc. (TX)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- Wells Fargo (San Antonio, TX)
- …is seeking a Head of Fraud Prevention and Partnership (M5) within Fraud and Claims Management. **In this role, you will:** + Provide vision and set direction for ... execution and management of a risk based fraud and claims program across the enterprise with significant risk and...with cross channel business leaders, as well as legal, audit , and multiple US or non US regulators to… more