- 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)
- **Description** ** Senior Claims Manager - Employment Practice Liability \*Remote * Candidates residing in Alaska, Washington, Montana, Oregon, California, Texas ... or New Mexico are encouraged to apply.** The Senior Claims Manager- Employment Practice Liability ("EPL")...- they're invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused,… more
- CRC Insurance Services, Inc. (TX)
- …following job description:** Responsible for managing and resolving complex insurance claims involving litigation, coverage disputes, and high exposure. This role ... then hire attorney for coverage counsel for coverage analysis. 2. Settle claims within settlement authority, where applicable. 3. Work with adjusters, insureds,… more
- Cardinal Health (Austin, TX)
- …with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, ... medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles… more
- Amazon (TX)
- …program around the world across all of its various use cases. Amazon's Last Mile Claims team is seeking a talented claims professional to support our rapidly ... You will lead strategy on complex bodily injury auto claims , handling pre-litigation disputes and resolving litigated claims...a successful candidate will support and report to a Senior Risk Manager and be enthusiastic about driving change,… more
- Molina Healthcare (Houston, TX)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... lists by helping identify and validate source data required for medical record collection. This is an ideal opportunity for an early-career analyst with a strong… more
- CRC Insurance Services, Inc. (TX)
- …5. Train claims staff on new policies or procedures. 6. Oversee and audit claims process ensuring proper documentation was created in the system and/or ... order to provide account loss ratios and claims history to senior management....of CRC Group offering the position. CRC Group offers medical , dental, vision, life insurance, disability, accidental death and… more
- Ascension Health (Austin, TX)
- …requirements established by Health and Human Services Commission. Perform routine and/or targeted audit of claims to ensure payment accuracy and adherence to ... that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine appeal outcomes....of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- **Position Summary** The Senior Manager, Fleet & Samples Operations oversees the execution of field fleet logistics and pharmaceutical sample distribution. The role ... day to day operations and issue resolution. Escalate issues as appropriate to senior management. + Proactively source and develop ideas to improve fleet program,… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- **Job Summary** The Senior Director of Quality Strategy and Operations will be responsible for developing and delivering the Global Quality strategic plan, ... optimization, continuous improvement and governance to areas such as training and audit . Foster a culture of operational excellence, ensuring best practices are… more
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