- Molina Healthcare (Fort Worth, TX)
- …operations that involve clinical HCS staff. Communicates findings to the Supervisor or Manager , HCS Department for resolution . + Maintains a minimal caseload as ... determined by leadership to ensure communication and adherence to appropriate guidelines and support staff who have an ongoing member case load for regular outreach and management. + As a Lead RN provide support, recommendations, and education as appropriate… more
- Molina Healthcare (San Antonio, TX)
- …7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/ resolution , including 2 years in a manager role. * Experience ... reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals/grievance and/or claims… more
- Mass Markets (Killeen, TX)
- …answer customer questions + Escalate complex issues to the appropriate team or manager + Ensure first-call resolution through effective problem-solving + Stay ... current on program updates, systems, and processes by attending training and team meetings + Maintain regular attendance and adhere to your assigned schedule CANDIDATE QUALIFICATIONS WONDER IF YOU ARE A GOOD FIT FOR THIS POSITION? It's about building… more
- Travelers Insurance Company (Houston, TX)
- …coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution ) including maintaining full compliance with internal and external ... facts or allegations of each case. + Consult with Manager on use of Claim Coverage Counsel as needed....expense reserves. + Recognize and implement alternate means of resolution . + Manages litigated claims. + Develop litigation plan… more
- Travelers Insurance Company (Fort Worth, TX)
- …including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and ... cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution ) including maintaining full compliance with internal and external… more
- CVS Health (Austin, TX)
- …heart, each and every day. **Position Summary** The Product Implementation Manager supports Product Application Strategy and Operations within the Aetna Commercial ... related to systems supported including escalating to appropriate technology partners when resolution requires further intervention. + You will act as a product… more
- Caterpillar, Inc. (Irving, TX)
- …overall performance of assigned digital products and handle customer issues through resolution . As part of the Cat Digital Operations Team, primary focus will ... Provide integrations technical support including but not limited to service level manager for the managed service providing application support to ensure meeting… more
- CVS Health (Corpus Christi, TX)
- …of Pharmacy regulations at all times; escalating issues or concerns to the Pharmacy Manager and/or Rx DL for timely resolution if/as needed + Remaining flexible ... for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you...additional bottles needed to fill a prescription + Issue Resolution : + Identifying challenging patient or colleague interactions and… more
- Texas Health Resources (Arlington, TX)
- …expert (SME) for training, performance management, workforce planning, conflict resolution , change management, and the grievance and investigation processes. Serves ... as a project manager on major strategic HR projects as assigned by...creating solutions. + Displays excellent coaching, facilitation and conflict resolution skills. + Displays analytical skills with ability to… more
- Methodist Health System (Dallas, TX)
- …issues and report to the Team Lead, Director, or VP promptly with resolution or recommendations. Ability to identify and recommend solutions for new and unfamiliar ... and teamwork. Long hours may be required for the resolution of system issues impacting patient care; weekend availability...the application team in conjunction with the SHI, TL, Manager , Director, and VP. Duty 10: Assesses, plans, designs,… more