- Mass Markets (Killeen, TX)
- …trusted partner in the industry. We are seeking a detail-oriented and analyticalOn-SiteClaims Adjudication Specialist to join our team! If you have strong ... of experience in one or more of the following: call center, claims adjudication , insurance adjusting, or technical customer service (preferably in a high-volume… more
- CVS Health (Austin, TX)
- …Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims ; adjudicates complex, sensitive, and/or specialized claims in accordance ... amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete… more
- Allied Solutions (Plano, TX)
- …Losses ; refer timely and accurately to more senior level adjusting staff for adjudication and collection; + Adjudicate claims within the guidelines of the ... Position Summary; This position is responsible for the initial setup and investigation of claims prior to the assignment of the claim to a licensed adjuster. This… more
- CVS Health (Austin, TX)
- … claims on HRP system in accordance with claim processing guidelines. Claims adjudication results should meet/exceed production and quality standards in line ... CMS and Aetna compliance and business requirements. Analyzes and approves routine claims that cannot be auto adjudicated. - Applies medical necessity guidelines,… more
- Customs and Border Protection (Edinburg, TX)
- …(GS-09, Step 1) to $79,443.00 (GS-09, Step 10). The Mission Support Specialist (Workforce Management) provides direct support and advise to employees at all ... Compensation processes and procedures, duties and responsibilities include: Evaluate all claims against the five required elements of a compensable claim and… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …and entering the completed referral into the electronic medical record system for claims adjudication to ensure services are validated. Description of Duties + ... Position Information Posting NumberSRGV8223 Working TitlePRIOR AUTHORIZATION AND REFERRAL SPECIALIST (UT Health RGV Cancer and Surgery Center) Number of Vacancies1… more