- Acosta Group (Lewisville, TX)
- **DESCRIPTION** This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be ... responsible for analyzing claims and making decisions about their validity. The position..., assesses the reason for the escalation, and provides resolution in priority order as directed by the Supervisor.… more
- AIG (Dallas, TX)
- Senior Claims Management Analyst Join us as a Senior Claims Analyst to grow your experience in handling complex claims . Make your mark in Claims . ... and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported… more
- Molina Healthcare (Houston, TX)
- …with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution . Interprets and presents in-depth ... **Job Description** **Job Summary** Serves as claims subject matter expert. Assist the business teams...subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages… more
- Ascension Health (Austin, TX)
- …insured and defense counsel. + Investigate and process general and professional liability claims from first notice of loss through resolution including coverage, ... the time of the offer._ **Responsibilities** Oversee medical professional liability claims and litigation for the Ascension Health Alliance Professional Liability… more
- Prime Therapeutics (Austin, TX)
- …our passion and drives every decision we make. **Job Posting Title** Recovery & Resolution Analyst **Job Description** The Recovery & Resolution Analyst ... accounts that are subject to collections; coordinate with Senior Recovery and Resolution Analyst to support driving collections activities conducted by a… more
- Elevance Health (Houston, TX)
- **Rating/ Claims System Advisor** **Location:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, while ... and adaptable workplace. Alternate locations may be considered. The **Rating/ Claims System Advisor** will be responsible for providing support, configuration,… more
- Prime Therapeutics (Austin, TX)
- …every decision we make. **Job Posting Title** Specialty & Home Delivery Program Analyst - Remote **Job Description** The Specialty & Home Delivery Program Analyst ... partners and Pharmacy Match product which may include implementations, projects, claims & performance guarantee monitoring, and testing. This position is responsible… more
- Highmark Health (Austin, TX)
- …group administrators, brokers, and Agent Plan personnel to ensure the resolution of issues related to benefit interpretations, customer service inquiries, ... claims adjudication, benefits issues, membership and billing activity, etc....experience rated and community rated dental groups.The Client Benefit Analyst is responsible for providing or coordinating prompt support… more
- Centene Corporation (Austin, TX)
- …Provider Data Quality. Responsible for distilling provider issues as they relate to claims payment problems that come in through the Provider Relations teams and ... work with manager to ensure quick resolution . Function as the subject matter expert when questions...Provider Data Quality (PDQ) issues which resulted in erroneous claims payment. Working with health plan & corporate PDQ… more
- Robert Half Technology (Houston, TX)
- …We are offering an exciting opportunity for a Senior PeopleSoft Functional HCM Analyst in the Energy/Natural Resources industry, based in Houston, Texas. As a Senior ... PeopleSoft Functional HCM Analyst , your role will be crucial in managing and...* Oversee claim administration to ensure timely and accurate resolution * Conduct AB Testing to validate system enhancements… more
- UTMB Health (Galveston, TX)
- Senior Revenue Integrity Analyst (Partial Remote/Local) - Revenue Integrity & Reimbursement **Galveston, Texas, United States** Business, Managerial & Finance UTMB ... related experience required. **Preferred Qualifications:** Bachelor's degree and/or Financial Analyst experience. **Job Summary:** Develops and tracks meaningful metrics… more
- Molina Healthcare (Houston, TX)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards… more
- CVS Health (Austin, TX)
- …of escalations from internal business units to include client management, claims , eligibility, network operations, customer service, audit, and Aetna. The Senior ... Business Analyst is a strong individual contributor with the opportunity...and assemble all data used in making determinations for resolution . + Ensure end-to-end traceability and document timelines. +… more
- Molina Healthcare (Houston, TX)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards… more
- Highmark Health (Austin, TX)
- … claims processing problems, perform initial problem identification and resolution activities, and debug benefits and medical policy program coding. Document ... and scalability and reusability of benefit configurations. Develop and execute claims testing plan, scenarios, documentation and defect management to ensure minimal… more
- CVS Health (Austin, TX)
- …to company policies regarding confidentiality. -Assist in the research and resolution of claims payment issue **Required Qualifications** Effective ... day. **Position Summary** -Responsible for initial review and triage of claims tasked for review. -Determines coverage, verifies eligibility, identifies and… more
- Molina Healthcare (Houston, TX)
- …organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to derive proper courses ... and requests, utilizing technical tools as necessary to provide feedback and resolution within the Service Level Agreement. + Assist with research, development and… 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 ... ensuring the highest quality on every project/request. Responsible for error resolution , follow up and performance metrics monitoring. + Provides peer review… more
- ManpowerGroup (San Antonio, TX)
- …+ Determine Supply Chain Communication Strategies; + Identify and Process Supplier Claims and participates in conflict resolution under the boundaries, + ... Reviews and corrects any system error. **Environmental, Health &** **Safety:** + Support the protection of the environment, personal safety, prevention of pollution and the continual improvement of the Environmental Management System. + Providing leadership to… more
- Highmark Health (Austin, TX)
- …progress and accuracy of work. + Provide technical leadership in first-line resolution of complex technical problems. + Provide Staff Management oversight. + Hire, ... of experience specific to the Dental Solutions Application Portfolio (eg, Concordia Claims Processing & RENO, Portal applications, UCD billing, etc.) may be… more