• Manager, Consulting - Legal Bililing Operations

    Wolters Kluwer (Houston, TX)
    …platforms. In addition, during heavy periods of incoming invoice volume, conduct the initial audit and/or quality assurance invoice review audit up to 15% of the ... prior supervisory experience, preferably in a legal billing or claims environment. + 5+ years' experience in the legal...and to exercise discretion and sound judgment when making audit and adjustment decisions. + Understanding of legal terminology… more
    Wolters Kluwer (05/14/25)
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  • VP Network and Member Services, Health Plan

    Baylor Scott & White Health (Dallas, TX)
    …provider network growth, and enhanced provider and member relations. Creates medical delivery objectives that align BSWH Health Plan, members, physicians, and ... medical facility interests. Directs and monitors network performance and...the responsibility of the pricing, configuration, provider data and audit function (the provider data integrity unit). This position… more
    Baylor Scott & White Health (05/17/25)
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  • Litigation Case Manager

    Robert Half Legal (Addison, TX)
    …internal and external parties * Prepare responses to informal demands and claims * Coordinate with outside counsel on litigation or threatened litigation, deposition ... and document collection and review * Assist with employee-related claims (eg, EEOC and DOL charges) * Assist with...outside attorneys' bills * Work with accounting department during audit time for audit letters and document… more
    Robert Half Legal (06/05/25)
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  • Investigator

    Highmark Health (Austin, TX)
    …or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated funds paid ... for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into… more
    Highmark Health (05/08/25)
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  • Paralegal (Dallas, TX) - Austin Industries

    Austin Industries (Dallas, TX)
    …support, corporate services support, labor and employment matters, litigation, and claims . + Support corporate governance functions for Austin Industries and its ... internal and external audits, internal and external investigations, pre-litigation claims /complaints, administrative matters, and litigation matters, including, without limitation,… more
    Austin Industries (03/14/25)
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  • Manager - Case Management & Social Services

    Houston Methodist (Sugar Land, TX)
    …and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service-level goals ... and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with medical and clinical… more
    Houston Methodist (04/24/25)
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  • Clinical Fraud Investigator Senior

    Elevance Health (Grand Prairie, TX)
    …for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related ... unit/brand as appropriate regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Trains… more
    Elevance Health (06/03/25)
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  • Contract Close-out Administrator

    CACI International (San Antonio, TX)
    …Air Force bases in the continental United States, also supporting Air Force medical contracting, the Air Force Civil Engineering Support Agency and the Defense ... through various other information systems; + Coordinate with the Defense Contract Audit Agency (DCAA) and Defense Contract Management Agency (DCMA), if applicable to… more
    CACI International (05/17/25)
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  • (USA) Area Manager Asset Protection - All DC/FC

    Walmart (Baytown, TX)
    …evaluating air water and waste pollution Supports regulatory visits and prepares audit reports for management review Participates in evaluating pollution control and ... for accidents Reports safety violations and accidents Implements internal and external audit requirements within assigned area of work Creates action plans to… more
    Walmart (05/16/25)
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  • First VP Post Sale Risk Management

    PennyMac (Fort Worth, TX)
    …including identifying workflow for a loan prior to claim filing, filing claims for reimbursement of expenses and incentives, reconciliation of claim proceeds and ... filing supplemental claims as needed, and management of claim receivables, including...process and control infrastructure; policies, procedures, and operational routines, audit functions; and quality assurance of key processes, to… more
    PennyMac (05/24/25)
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