- Amazon (Austin, TX)
- …The Program, Project, Product, and Vendor Management Team within Amazon's Logistics Claims Management and Operations group is seeking a motivated and experienced ... The ideal candidate will be familiar with insurance and claims programs, and insurance policies, have a history of...Bachelor's degree or equivalent - 6+ years of compliance, audit or risk management experience - Knowledge of Microsoft… more
- Elevance Health (Houston, TX)
- …Indices), complex clinical guidelines and maintaining objectivity in the performance of medical audit activities. + Draws on extremely advanced ICD-10 coding ... including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit...environment preferred. + Broad, deep and niche knowledge of medical claims billing/payment systems provider billing guidelines,… more
- Sedgwick (Austin, TX)
- …work restrictions/accommodations. + Performs standard disability clinical reviews of referred medical claims based on client requirements to ensure accurate ... the United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client… more
- Highmark Health (Austin, TX)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Sedgwick (Austin, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- Highmark Health (Austin, TX)
- …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... :** GENERAL OVERVIEW: Applicants Must Be Able to Read and Comprehend Spanish Medical Terminology The Quality analyst is responsible for compiling and analyzing data… more
- Sedgwick (Fort Worth, TX)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Fresenius Medical Center (Abilene, TX)
- …or other situations change. + Completes and follows up with paperwork when claims are disputed for non-payment. + Collects necessary documents to completed initial ... work progress on caseloads; Analyzes patient reports from billing systems as an audit check to ensure the correct insurance information is entered into the billing… more
- Highmark Health (Austin, TX)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- HCA Healthcare (Austin, TX)
- …This position is incentive eligible. **Job Summary and Qualifications** HCA Graduate Medical Education is one of the nation's largest providers of residency and ... HCA GME is building a leading network of innovative, patient-centered graduate medical education programs. We believe graduate medical education is much… more