- 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)
- …Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims . The Senior Quality Analyst assists the Claims ... claims environment, and respond positively to change.** **The Senior Quality Analyst performs all duties in a manner...and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based… 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
- 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 ... Senior Risk Manager. The ideal candidate will be familiar with insurance and claims programs, and insurance policies, have a history of success in procurement,… 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
- 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 ... **Clinical Fraud Investigator Senior ** **Location:** _Hybrid1:_ This role requires associates be...regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on… more
- Mass Markets (Killeen, TX)
- …such as quality assurance, training, IT, and recruiting. + Develop and audit quality assurance strategies to ensure the delivery of world-class service + ... sometimes even cars! + Health Benefits: Full-time employees are eligible for comprehensive medical , dental, and vision coverage after 90 days of employment, and all… more
- 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 ... performance metrics using customer lens to provide upwards recommendation to management, senior leadership, and customers on how to improve customer experience +… more
- Humana (Austin, TX)
- …inquiries. + Has 6-7 direct reports including Associate Directors, Managers, and Senior Professionals + Provides strategic direction and leadership to the various ... operational goals, including regulatory compliance requirements + Promotes and builds an " Audit Ready Every Day" culture + Further simplifies and improves processes… more
- New Jersey Resources (Houston, TX)
- …and safety laws and regulations, company policies and operating procedures. Assist senior management in promoting a safety and compliance culture. Align with the ... changes to address deficiencies, improve programs and ensure company maintains an audit -ready status at all times. * Develop and maintain excellent working… more