- Elevance Health (Houston, TX)
- …Auditor II** is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + ... Examines claims for compliance with relevant billing and processing guidelines...concern. + Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …This role will also encompass document management, learning and development, risk management, data integrity and process excellence. The ideal candidate will ... to monitor Quality performance and drive data-driven decision-making. Maintain risk management toolkit and best practices. + **Process Improvements:** Identify… more
- Molina Healthcare (TX)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Elevance Health (Houston, TX)
- …II** is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. **How you will make an impact:** + ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Molina Healthcare (Austin, TX)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Brink's (Coppell, TX)
- …end-to-end project planning, execution, and delivery for CX initiatives including Claims transformation, customer journeys, measuring success, AI pilots, and Shared ... service strategies. . Develop and maintain project plans, timelines, and risk mitigation strategies. . Track KPIs and report progress to senior leadership. .… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …JNT517, Uli - may require non-traditional distribution requirements). + ** Risk Mitigation & Prioritization:** Lead structured prioritization efforts across the ... strategic adjustments that maintain patient access and minimize revenue risk . + **People Development & Future Planning:** Build team...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Zurich NA (Houston, TX)
- …Diploma or Equivalent and 14 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an Associate ... and 12 or more years of experience in the Claims or Underwriting Support areaAND + Experience with Microsoft...North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …technology transfers to CDMOs, including documentation review, gap analysis, and risk assessment. + Provide expert technical oversight of downstream manufacturing ... and improvements post-approval. + Author and/or review technical reports, protocols, risk assessments, and relevant sections of regulatory submissions (IND, BLA,… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …technology transfers to CDMOs, including documentation review, gap analysis, and risk assessment. + Provide expert technical oversight of upstream manufacturing ... and improvements post-approval. + Author and/or review technical reports, protocols, risk assessments, and relevant sections of regulatory submissions (IND, BLA,… more