- Sedgwick (Austin, TX)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation (REMOTE - Southeast State Exp Required) ... **PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims … more
- Sedgwick (Austin, TX)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner Liability **PRIMARY PURPOSE** : To analyze complex or ... technically difficult general liability claims to determine benefits due; to work with high...to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication… more
- Sedgwick (Austin, TX)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner , Bodily Injury (Auto) **PRIMARY PURPOSE** : To analyze and ... process complex auto and bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.… more
- Intermountain Health (Austin, TX)
- **Job Description:** The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims , in a timely and ... to and supports the corporation's quality improvement efforts. Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely… more
- Amazon (Austin, TX)
- …program around the world across all of its various use cases. Amazon's Last Mile Claims team is seeking a talented claims professional to support our rapidly ... auto program. You will lead strategy on complex bodily injury auto claims , handling pre-litigation disputes and resolving litigated claims with cross-functional… more
- Molina Healthcare (Austin, TX)
- …or GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + 1-3 years' experience in claims adjudication, Claims Examiner II, or other relevant work ... **Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines,… more
- Sedgwick (Austin, TX)
- …training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a ... with management projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles reviews and… more
- Sedgwick (Austin, TX)
- …training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a ... with management projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles reviews and… more
- Sedgwick (Austin, TX)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for managing SIU investigations ... Bachelor's degree from an accredited college or university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI), or Certified… more
- Sedgwick (Austin, TX)
- …Suite 100, Austin, TX 78758.** **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple office locations; and to ... within assigned group. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Completes examiner update reports, claim adjustments, provider requests and operational expense… more
- Sedgwick (Austin, TX)
- …Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing ... to advance to the next round, a recruiter will be in touch. \#claimsexaminer # claims _As required by law, Sedgwick provides a reasonable range of compensation for… more
- Prime Therapeutics (Austin, TX)
- …and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively ... compliance with federal, state and local laws pertaining to investigations and fair claims handling practices; evaluate risk to determine how best to proceed with… more
- Prime Therapeutics (Austin, TX)
- … claims processing environment **Preferred Qualifications** + Certified Fraud Examiner or Accredited Health Care Fraud Investigator + National Pharmacy Technician ... and client initiatives; engage in cross functional analysis of medical and pharmacy claims ; lead FWA investigations for federal employee program + Stay current on… more
- Highmark Health (Austin, TX)
- …**Required** + None **Preferred** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) ... (AHFI) **SKILLS** + Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency + Must have… more
- Molina Healthcare (Austin, TX)
- …Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation pertinent to investigations. + Detects ... Associate (HCAFA). + Accredited Health Care Fraud Investigator (AHFI). + Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in… more