4 complex claims specialist jobs found in Fort Worth, TX

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...

About the role: A Senior Procurement Analyst applies analytical, technical, and industry knowledge, standards and practices to complex projects in an assigned account or geographic area.  S/he works closely with assigned business partners to identify the best business solutions, which address priority business needs or issues. S/he manages specific projects and initiatives aimed at improving the efficiency of services. S/he is accountable for managing moderate risks and resource requirements. A Senior Procurement Analyst is capable of building strong working relationships with business partners, professional peers, and other team members and operating level relationships with contractors, suppliers, and other external stakeholders.  S/he is a resource for colleagues with less experience (shares knowledge/has a level of expertise). In this role you will: Contract Management - management of contracts with vendors and includes negotiating the terms and conditions in contracts...

Overview **Extended hours may be required during catastrophes or spike claims volume.  Flexibility to travel on short notice, up to 50% of the time, and ability to be on call required. **if selected for this role, in addition to the 10% added to your base hourly rate you are eligible for while on the CAT/Spike Team, the Company is adding a temporary, incentive of 5% to your base hourly rate, for a total incentive of 15%.  The temporary incentive amount is reviewed annually and the Company reserves the right to abandon, amend or modify the incentive at anytime .     Position Summary:   If you’re passionate about helping people restore their lives when the unexpected happens to their homes and providing the best customer experience, then our Mercury Insurance Property Claims team could be the place for you! Upon completion of the training program, ideal candidates will transition into a property claims field adjusting position traveling to loss sites...

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...