- TEKsystems (Dallas, TX)
- …of the servicer and/or client + Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits + Reviews MI claim ... and research curtailment reasons for potential rebuttal + Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI… more
- Molina Healthcare (Austin, TX)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
- Providence (TX)
- …Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims . The Senior Quality Analyst assists the Claims ... and regulations pertaining to self-insured health care organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance… more
- Molina Healthcare (Fort Worth, TX)
- … claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads ... claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual… more
- USAA (Plano, TX)
- …Relocation assistance is not available for this position. **Several new positions within the Claims Data and Analytics team to support the build out of omni channel ... and adjuster interactions across multiple channels. This work will be critical to the Claims 2030 strategy and our ability to identify deeper and rich insights to… more
- Cognizant (Austin, TX)
- …IT organization and lead changes to such specifications (with senior business analyst oversight through peer reviews); Develop an informed knowledge of the business ... all regulations and requirements. **Essential Functions:** + 3+years Medicare/Medicaid regulatory healthcare experience + Knowledge of claim adjudication processes… more
- Zelis (Plano, TX)
- …interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer ... an accurate and timely fashion. What you'll do: + Research and decipher regulatory sources such as legislative rules, state registers, waiver programs and bulletins… more
- Prime Therapeutics (Austin, TX)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... our passion and drives every decision we make. **Job Posting Title** Business Systems Analyst Senior - Remote **Job Description** The Business Systems Analyst Sr… more
- Allied Solutions (Plano, TX)
- …applicability of insurance coverage to certain claim types prior to the assignment to a Claims Adjuster or Analyst . The key responsibilities of this job are both ... is responsible for the initial setup and investigation of claims prior to the assignment of the claim to...process; + Ability to interpret and comply with all regulatory mandates within individual jurisdictions, including state adjusting licensing… more
- Prime Therapeutics (Austin, TX)
- …and drives every decision we make. **Job Posting Title** Recovery & Resolution Analyst **Job Description** The Recovery & Resolution Analyst is responsible for ... coordination with an external collection agency + Evaluate audits, investigations and/or claims identified for potential recoupment to verify that results are final… more