- 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 (Fort Worth, 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
- 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
- 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
- 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
- PNC (Dallas, TX)
- …have an opportunity to contribute to the company's success. As a Loan Support Analyst Senior within PNC's Midland organization, you will be based in office within ... and also supports remote and hybrid work environments As a Loan Support Analyst Senior in PNC Midland's Insurance department you will be responsible for determining… more
- Molina Healthcare (Fort Worth, TX)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Maintains SharePoint… more
- Molina Healthcare (Fort Worth, TX)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Demonstrate Healthcare… more
- Molina Healthcare (Fort Worth, TX)
- …to staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + Reviews regulatory ... or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of SQL… more