- 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
- 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
- Highmark Health (Austin, TX)
- …ensuring Highmark compliance with all adjustment processes based on SOX remediation and Regulatory and legal guidelines. In addition, the Analyst will identify ... Must Be Able to Read and Comprehend Spanish Medical Terminology The Quality analyst is responsible for compiling and analyzing data relevant to the handling of… more
- Prime Therapeutics (Austin, TX)
- …passion and drives every decision we make. **Job Posting Title** Sr. Market Pricing Analyst - REMOTE **Job Description** The Senior Market Pricing Analyst serves ... new and revised financial pricing strategies based on analysis of pharmacy claims data, average wholesale drug prices (AWP), health plan margin target guidelines… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- Position Information Posting NumberSRGV8219 Working TitleCOMPLIANCE CODING AND BILLING ANALYST Number of Vacancies1 LocationMcAllen, Texas DepartmentOffice of the ... laws and regulations and UTRGV policies. To review and analyze medical records, claims , and workflow processes to ensure accuracy, completeness, and compliance with … 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
- Prime Therapeutics (Austin, TX)
- …and drives every decision we make. **Job Posting Title** IT Business Systems Analyst - ScriptMed - Remote **Job Description** The IT Business Systems Analyst ... experience with understanding of Medicare, Medicaid, the Exchanges along with regulatory compliance requirements (HIPAA and/or PCI) + Experience working in an… more
- Phillips 66 (Houston, TX)
- …Overseeing the broker in the processing to assemble, audit, and file duty drawback claims . The analyst will be responsible for proactively advising the business ... **Phillips 66 & YOU - Together we can fuel the future** The **Drawback Analyst , Foreign-Trade Zones** works directly with customers and internal team members in for… more
- Prime Therapeutics (Austin, TX)
- …decision we make. **Job Posting Title** Sr. Applied Stars and Quality Analytics Analyst - Remote **Job Description** The Senior Health Data Analyst provides ... STARS experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical, and/or financial data + Intermediate SAS or SQL coding skills +… more
- Molina Healthcare (San Antonio, 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
- Highmark Health (Austin, TX)
- …5 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 3 years of project leadership ... trends concerning health insurance, healthcare delivery, provider relationships and regulatory issues + Sophisticated knowledge of how organizations work and… more
- Molina Healthcare (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
- Highmark Health (Austin, TX)
- …7 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 5 years of project leadership ... trends concerning health insurance, healthcare delivery, provider relationships and regulatory issues + Sophisticated knowledge of how organizations work and… more