- CVS Health (Austin, TX)
- …each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. They ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- CVS Health (Austin, TX)
- …and financial accuracy. **Required Qualifications** + 1-2+ years of experience in a quality audit or claims testing environment. + Working knowledge ... day. **Position Summary** The Senior Claim Benefit Specialist serves as a quality champion and...process improvements. + Participate in special projects and targeted quality audit initiatives. + Provide subject matter… more
- Molina Healthcare (Austin, TX)
- …programs. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified ... Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims...audit , provider disputes, appeals, and 1500 & UB04 claim experience are highly preferred. Ability to apply state… more
- Sedgwick (Austin, TX)
- …; ensures appropriate recommendations are made on claims . + Consistently achieves appropriate quality audit scores. + Acts as clinical resource to claims ... of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Acts as a backup for… more
- Sedgwick (Austin, TX)
- …providers to discuss employee's clinical status, progress and work status. + Achieves appropriate quality audit scores on a consistent basis. + Acts as clinical ... Fortune Best Workplaces in Financial Services & Insurance Disability Clinical Specialist **PRIMARY PURPOSE** : To perform clinical evaluations, consult providers and… more