25 manager claims jobs found in Fort Worth

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...

Why would you join GM Protection as a Fixed Operations Consultant?   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 a consultant with these qualities to join our growing team and help drive claims performance at the dealership level. Strategic thinking, creativity, leadership skills, excellent communication, and your ability to enhance dealership 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 define and shape our culture — an environment that welcomes new ideas, fosters integrity,...

About HUB: HUB International is a global insurance broker providing a broad array of property, casualty, risk management, life and health, employee benefits, investment and wealth management products and services. HUB has more than 650 offices across the United States, Canada and Puerto Rico with more than 21,000 employees. Our regional offices throughout North America are dedicated to helping individuals and businesses evaluate and manage their risks and insurance needs.  We are a company dedicated to superior customer service with employees committed to adding value to every client activity. Summary: The Commercial Lines Account Manager will provide professional, courteous, and knowable account management and brokerage services to assigned clients, having the primary responsibility for account retention and satisfaction. Working alongside Producers and Account Executives (aka “Client Executives / Sales”) as assigned, the AM shall be principally...

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 Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

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...

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 Senior 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 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...

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...

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 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...

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....

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...

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,...

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...