36 expert jobs found in Fort Worth

Why GM Financial? GM Financial is the wholly owned captive finance subsidiary of General Motors and is headquartered in Fort Worth, U.S. We are a global provider of auto finance solutions, with operations in North America, South America, and the Asia Pacific region. Through our long-standing relationships with auto dealers, we offer attractive retail financing and lease programs to meet the needs of each customer. We also offer commercial lending products to dealers to help them finance and grow their businesses. At GM Financial, our team members define and shape our culture — an environment that welcomes new ideas, fosters integrity, and creates a sense of community and belonging. Here we do more than work — we thrive. Our Purpose:  We pioneer the innovations that move and connect people to what matters This position will be posted until filled. About the role: The Economist I is responsible for assisting in the data collection and maintenance of data driven...

Higginbotham , a privately held, independent insurance and financial services firm that ranks within the top 20 nationwide, has an immediate opening for an Employee Benefits Strategic Account Executive for our Fort Worth, TX office.  The  Employee Benefits Strategic Account Executive  serves as the strategic leader or member of the client management team for the most complex benefit accounts, and is responsible for client satisfaction, strategic planning, and quality assurance. Position Summary: The Account Executive serves as the strategic leader or member of the client management team for the most complex benefit accounts and is responsible for client satisfaction, strategic planning, and quality assurance. Essential Tasks: Manage a complex book of business comprised of clients with various funding methods, advanced contract features and structures that require a higher level of expertise. Provide strong insurance technical expertise to clients and members...

Why General Motors Insurance? Working at General Motors Insurance is a chance to help reinvent what insurance feels like for GM drivers — standing at the intersection of the larger GM enterprise and a growth business focused on safeguarding the GM consumer and their vehicles. Inside the enterprise, General Motors Insurance is a strategic growth initiative, which means your ideas directly shape the blueprint of an emerging business and its momentum. Powered by unique insights from GM’s connected technology, you’ll transform vehicle and driving insights into a seamless, connected user experience that rewards safer driving and simplifies every step—from quote to policy servicing to claims. You’ll collaborate across GM’s ecosystem of companies, build products and processes at the foundational phase of a rapidly scaling organization, and see your work land in the hands of real customers fast. It’s the kind of environment where curiosity and execution thrive together: experiment,...

Position Summary:   The Employee Response Center (ERC) Benefits and Claims Specialist is a key role in the Financial Services Day 2-ERC Department at Higginbotham. The roles is responsible for ensuring a thorough knowledge of claims, research tools, and resources to serve employees and employers effectively. This role is centered around evaluating and reviewing claims with precision and accuracy. The individual must be meticulous to determine the claims’ validity and ensure that insurance carriers’ payments are made per policy terms and regulatory requirements. The ERC Benefits and Claims Specialist will also support as backup to the ERC Benefits Specialists, take employee calls, and respond to emails and texts as needed during non-peak and peak times. Supervisory Responsibilities:   None Essential Tasks: Maintaining documentation, spreadsheets, products, and services as requirements change Serving as a subject matter expert on reviewing and assessing insurance...

The CERIS Implementation Director is responsible for providing strategic leadership and oversight for the implementation of new and existing client programs, product enhancements, and service expansions. This role ensures the successful execution of complex implementations while aligning implementation strategy with organizational objectives, operational readiness, and long‑term client success. The CERIS Implementation Director works closely with executive leadership, Account Management, Implementation Managers and Coordinators, IT, Operations, Product, and Sales to ensure consistent, high‑quality delivery and a seamless transition to ongoing account management and field operations. This role is also accountable for leading and developing the Implementation team and continuously improving implementation processes across the organization. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides overall leadership and accountability for the...

CERiS in Fort Worth, Texas is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic Related Groups (DRG) QC Clinical Auditor will be responsible for performing quality control DRG validation (clinical/coding) reviews of internal audit team reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination, as well as communicating missed or incorrect information to the auditors in a professional manner. Experience using, ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. This is a remote position. Job Duties and Responsibilities: The Quality Control...

The Training Specialist is responsible for developing the knowledge and presentations skills of CERIS Operations department staff trainers. This role ensures that CERIS is equipped with an Operations workforce that can optimize its current and future goals and objectives, and deliver quality services that can meet our clients’ requirements and service expectations. In order to efficiently execute his/her daily responsibilities, the Training Specialist must first possess a deep understanding of the business to articulate what CERIS does and to clearly demonstrate all aspects of the Operations roles in order to be able to successfully train and oversee the department trainers.   Other duties to be carried out by Training Specialist will include conducting classroom, virtual, and field training to internal employees/colleagues, developing training materials as needed, monitoring new hires, and performing other tasks as required by the Training Manager. This is a hybrid...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to work independently...

Why GM Financial? GM Financial is the wholly owned captive finance subsidiary of General Motors and is headquartered in Fort Worth, U.S. We are a global provider of auto finance solutions, with operations in North America, South America, and the Asia Pacific region. Through our long-standing relationships with auto dealers, we offer attractive retail financing and lease programs to meet the needs of each customer. We also offer commercial lending products to dealers to help them finance and grow their businesses. At GM Financial, our team members define and shape our culture — an environment that welcomes new ideas, fosters integrity, and creates a sense of community and belonging. Here we do more than work — we thrive. Our Purpose: We pioneer the innovations that move and connect people to what matters. This position will be posted until filled.    About the role: The Access Control Analyst will be a member of the Global Security Technology...

The Itemization Review Supervisor will maintain a positive team building approach with emphasis on reporting, leadership and professional communication with all CERIS departments.    This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Maintain accurate, current data and analytics to support informed decision-making and reliable outcomes Manage and track client appeals as required Oversee the file assignment process and continuously monitor nurse workloads and queues Ensure daily prioritization of all claims is clearly understood and executed Prepare and maintain monthly metrics and reporting Demonstrate working knowledge of CERIS systems and databases Lead and support the team with minimal managerial oversight Foster a collaborative and positive work environment through effective team leadership Ensure strict adherence to HIPAA compliance standards Additional duties as assigned   KNOWLEDGE & SKILLS: Comprehensive...

Description Summary: The CRE Loan Closing Specialist Sr. is responsible for initiating and driving the loan closing process, and for the integrity of the loan closing, due diligence, and documentation while managing and expediting complex and concurrent processes and organizing all necessary documentation to finalize complex Commercial Real Estate loan transactions. The CRE Loan Closing Specialist Sr. ensures accuracy, compliance with regulations, and coordinates activities, decisions, and communications with various parties involved, such as lenders, borrowers, legal teams and other third parties.  This position involves meticulous attention to detail and a thorough understanding of Commercial Real Estate loan terms including legal concepts, collateral acceptability, and final closing conditions. Expertise in review and interpretation of deal structures and legal documentation along with working through “gray...

The Itemization Review Coordinator is responsible for maintaining a consistent workflow by distributing claims to Quality Control and Itemization Review Nurses. Keep track of current volume on an individual basis to ensure even distribution throughout department. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Monitor incoming and existing claims and distribute to staff based on priority and due date Maintain and update departmental spreadsheets and attendance calendar per supervisor request Ensure an even and fair distribution of claims to staff Notify staff of priority claim assignments Notify supervisor(s) of claims requiring/receiving extensions Notify supervisor(s)/management of back log files, late files, low census, and waiting list Update SharePoint website as required Assist supervisor(s)/management to identify potential issues in a pro-active manner Maintaining/updating/assisting with all New Hire documentation/packets...

Description Summary: The CRE Loan Closing Specialist Sr. is responsible for initiating and driving the loan closing process, and for the integrity of the loan closing, due diligence, and documentation while managing and expediting complex and concurrent processes and organizing all necessary documentation to finalize complex Commercial Real Estate loan transactions. The CRE Loan Closing Specialist Sr. ensures accuracy, compliance with regulations, and coordinates activities, decisions, and communications with various parties involved, such as lenders, borrowers, legal teams and other third parties.  This position involves meticulous attention to detail and a thorough understanding of Commercial Real Estate loan terms including legal concepts, collateral acceptability, and final closing conditions. Expertise in review and interpretation of deal structures and legal documentation along with working through “gray...

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims  Identify errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners Perform contract and reimbursement variance analysis Analyze claims data to identify contractual overpayments and billing...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests.  This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to work...

The CERIS Policy & Payment Integrity Coordinator (PPI Coordinator) plays a key role in supporting the Policy and Payment Integrity teams by managing workflow, ensuring timely assignment of appeals, and maintaining accurate tracking systems. This position requires strong organizational skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Manage and monitor general PPI department mailboxes to ensure timely review and routing of incoming correspondence Assign appeals to appropriate team members based on established workflows and production needs Maintain and update appeal trackers to ensure accurate and current data is available for reporting and performance monitoring Track the status of assigned appeals to support timely completion and compliance with internal expectations and external deadlines Identify workflow delays or discrepancies in...

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various healthcare policies....

The Repricing Quality Assurance Analyst is responsible for reviewing, analyzing, and monitoring repricing audit data across multiple platforms to ensure accuracy, compliance, and efficiency. Works closely with internal teams to maintain contractual and organizational standards, enhance operational effectiveness, and improve client satisfaction. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify and resolve quality issues within repricing processes Develop and implement QA policies and procedures Monitor compliance with pricing guidelines and contractual requirements Investigate repricing discrepancies and apply corrective actions Prepare QA reports and documentation Collaborate with stakeholders to align quality objectives Provide training and guidance on repricing standards Conduct risk assessments to mitigate potential errors Maintain confidentiality of client data, PHI, and PII Additional duties as assigned...

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently.    ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receiving and analyzing appeal documentation to determine appropriate actions Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy standards Utilize applicable tools and resources to complete setup Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of Medicare, Medicaid, and commercial insurance guidelines Strong attention to...