22 liability claims manager jobs found in Fort Worth, TX

Position Summary:   The Commercial Lines Account Executives have leadership/mentorship and advisement responsibilities over Account Managers and their respective books of business/client groups to include gathering information from clients, servicing clients, and setting expectations of timeline for completion of work tasks. Supervisory Skills:  None Essential Tasks: Collectively or independently plans, designs and implements appropriate insurance programs for clients that coincide with agency guidelines Maintains knowledge of new developments or changes with various carriers and new Federal/State laws that may affect how our clients conduct business; consults, informs and educates clients about coverage, exclusions and exposures: documents electronic filing accordingly Generating premium allocations for clients; advanced Microsoft Excel proficiency Negotiating rate terms and conditions with Carriers on behalf of clients Provides technical support to Producers...

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...

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.  Job Description Job Description Inside Property Adjuster - Trainee - Hybrid – DFW, TX A day in the life of an inside Property Adjuster, and what it takes to do the job!   As a Moderate Inside Property Adjuster, you will provide exceptional service to our policyholders. Working in this hybrid environment, your primary responsibility will involve virtually inspecting damages, investigating coverage, preparing estimates, and settling claims promptly and accurately. You will be interacting with customers, contractors, and vendors...

The Hospital Bill Audit Manager is responsible for planning, leading, and coordinating multiple teams of nurse auditors and associated billing staff in a fast paced, productivity-based environment. This role oversees auditors performing varying types of medical bill audits including, but not limited to, medical record audits, hospice, implant, and outpatient or ancillary facility claims. This team also performs onsite and remote hospital bill audits. Must be willing to travel for onsite facility audits and other meetings as needed.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Utilize nursing education, experience, and industry best practices to lead a team of registered nurses to plan, execute and deliver timely and accurate results Assist the Hospital Bill Supervisor in the training, professional development, and retention for the nurse auditors Ensure accuracy of audits through acquired knowledge of client policies, provider contract information, and other...

The Recovery Supervisor is responsible for analysis and monitoring of claims audit data across multiple platforms. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and claims processing. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.     This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Manage team performance by setting and communicating standards and deadlines, measuring results, and providing feedback. Maintain positive morale by leading the team through example and accountability with a focus on helping each member achieve their best performance...

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.  This is a remote position. 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...

The Procurement Trainer is responsible for educating new and existing staff on Procurement procedures and client-specific protocols. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for Training of New Staff in the Following Areas: New hire orientation, including company and departmental policies Setup and proper use of communication tools  MedCheck Select system Specific client systems used in the Procurement process Pre-/Post-Training Responsibilities: Maintain all training guides Remain available to teams for questions Update the manager and/or supervisor on all trainees’ progress Conduct periodic refresher classes as needed General Procurement Support: Assist Support Team with quality control, distribution, email, and documenting procedures Assist co-workers, supervisor, or management to accomplish product goals and identify any potential issues in a proactive manner Maintain HIPAA compliance...

Why would you join GM Protection as a Sr. Operational Claims Analyst?   Are you passionate about the automotive service industry and how vehicle service claims keep the world moving? Do you have experience both as a service department technician, advisor, or manager? Have you spent time applying your technical skills and operational knowledge with a vehicle service contract provider or administrator? Do you thrive on helping others perform at the top of their potential? GM Protection is looking for an analyst with these qualities to join our growing team and help drive claims performance at both the dealership and administrator levels. technologies to enhance learning experiences. Strategic thinking, creativity, leadership skills, excellent communication, and your ability to enhance dealership and administrator performance with data driven methods that align with our Strategic Priorities and Core Values will be essential to your success.   At GM Financial, our team members...

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  with precision Identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners. Performs contract and reimbursement variance analysis. Analyzes claims data to identify...

The CERIS Operations Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:  Ensures timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Directs a designated group of employees in their day-to-day operations Monitors employee and unit quality control Ensures daily compliance with metrics Tracking and reporting of department metrics to Director of Operations on a monthly basis or as required Handles scheduling and monitoring of staff’s attendance Ensures timely distribution of...

The Procurement Coordinator is responsible for maintaining a consistent workflow by distributing claims to Procurement Analysts. This role keeps track of current volume on an individual basis to ensure even distribution throughout the department. The Procurement Coordinator is a detail-oriented contributor performing   Quality Control (QC) reviews for incoming and outgoing files. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: File distribution to all Procurement staff (initial distribution and redistribution as necessary) QC/Review of incoming and outgoing files  for accuracy before distribution to end users Generate   and   send   mail, e-mail, reports, and forms to inter-office personnel; may as needed send reports to clients, managers, and other CorVel offices Document procedures and all client-specific protocols Additional duties as assigned   KNOWLEDGE & SKILLS: Proficient in Microsoft Office...

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...

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...

The Payment Integrity Supervisor is responsible for the daily activities of payment integrity team related to quality assurance and provider appeals. The Supervisor manages and prioritizes staff daily work assignments necessary to ensure the timely and accurate processing of internal and external requests, interdepartmental quality audits and appeals. Additionally, the supervisor works to reduce response timeframes and mitigate future inquiries or escalations by being proactive, taking ownership of challenges, and formulating solutions to improve overall department activities while maintaining a focus on improving how we deliver service to our customers.  This is a remote position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Supervises all daily activities of payment integrity team related to quality assurance and provider appeals Ability to assist team with problem-solving, payer policy and clinical questions regarding audits performed by CERIS Ability to...

Position Summary: The Sr. Claims Operations Specialist is responsible for driving operational excellence within the claims function. This role focuses on improving efficiency, streamlining workflows, and optimizing processes within the insurance broker Claims Advocacy Service Model. The position works closely with the Claims Leadership Team to support strategic initiatives, provide operational insights, and implement scalable solutions that enhance productivity and effectiveness. Supervisory Responsibilities:   None Essential Tasks: Analyze existing claims operations workflows to identify inefficiencies, gaps, and areas for improvement to enhance the Claims Advocacy Service Model. Develop, implement, and monitor process enhancements to optimize claim intake, review, and tracking. Collaborate closely with the Claims Leadership Team to align operational initiatives with business goals and strategic priorities. Partner with IT, analytics, and business teams to...

The Correspondence Department Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a hybrid position reporting to Fort Worth, TX. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible for monitoring quality control of results per employee as well as the entire unit overall Responsible for ensuring Metrics are in compliance daily Responsible for tracking and reporting of department metrics to Director...

The Implementation Manager will be responsible for enhancement to existing products and development of new products to broaden current service offerings. This role will also be accountable for project management and implementation management with new and existing clients.  The primary purpose of the role is to work closely with the assigned Account Manager, Implementation Coordinators, IT, and Operations to complete the implementation of client programs and to facilitate the transition to field operations and account management personnel for ongoing servicing.   We offer a competitive salary and benefits package. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Participates in oral presentations Prepares and manages implementation plan from prospect presentation through conclusion Identifies required resources Develops and prepares information necessary for setup of customer across all CorVel systems Coordinates all internal meetings on a...

The Document Processing Department Manager is responsible for overseeing all aspects of the department including Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and department expectations. Works collaboratively with other department managers to achieve departmental requirements and goals. This is a hybrid role reporting to Fort Worth, TX. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:  Ensure timely and accurate communication of information, in written and electronic forms, that are directed to internal company contacts, clients and providers Responsible for directing a designated group of employees in their day-to-day operations Responsible for monitoring quality control of results per employee as well as the entire unit overall Responsible for ensuring Metrics are in compliance daily Responsible for tracking and reporting of department metrics to Director of Operations...

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 position. 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...

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...