46 risk management jobs found in Fort Worth

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...

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 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 Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collects supporting data and analyzes information to make decisions regarding accuracy of billing Appropriately documents work and final conclusions in designated computer program Understanding of Surgical Implants Meets department's expectations and standards  Additional duties as assigned   KNOWLEDGE & SKILLS: Understanding of Itemization Review for designated clients Understanding of CERIS systems and Data Base informatics Understanding of HIPAA regulations Exceptional organizational skills with the ability to handle stressful situations and adapt accordingly Demonstrated leadership skills; ability to work with Leadership Team(s) within a positive team environment...

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....

Position Summary: The Project Manager will oversee and manage high-impact projects from inception to completion, ensuring they meet organizational goals, are delivered on time, within scope, and on budget. The ideal candidate will possess extensive experience in marketing and communications project management, demonstrate strong technology and organizational capabilities, and have a proven track record of managing complex, fast-paced projects.   Supervisory Responsibilities:   Only projected related Essential Tasks: Project Planning: Develop detailed project plans, including scope, objectives, deliverables, timelines, and resource requirements; Coordinate and lead project activities, ensuring milestones and deliverables are met; Identify project risks and develop mitigation strategies Stakeholder Management: Act as the point of contact for project stakeholders; Communicate project goals, progress, and changes effectively to ensure alignment and manage...

The Customer Service Representative is responsible for addressing client and/or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions.  This role requires internet upload and download speeds of at least 80Mbps.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Answer phone calls, return phone calls Answer emails from clients, providers and internal referring offices Review previous history of the provider in MedCheck, Scheck and SalesCloud Consult with Supervisor or other departments to clarify answers to inquiries Contact provider to discuss findings at the appropriate level Maintain reports and spreadsheets as needed Additional duties as assigned   KNOWLEDGE & SKILLS: Knowledge of Workers Compensation fee schedules and regulations Effective verbal and written communication skills Good organizational skills and ability to multitask...

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 20,000 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. Purpose of Position: The Employee Benefits Account Executive shall recommend appropriate lines of coverage, monitor client’s plan expenditures throughout the year and make recommendations to control costs if needed.  Maintain knowledge of legislative updates and advise clients as to how they will affect plan designs and costs. Essential Functions: Develop...

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...

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 Account Manager is responsible for interacting with customers on an executive level and acting as an extension of the client; understanding and communicating agreed upon expectations to field offices and increasing the market share of business by providing service that meets and exceeds customer expectations, stewardship reporting, commitment to customer goals, and introducing/selling/implementing additional services.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide consultative customer services for one or more new or established accounts Introduce new services independently or with assistance as needed Handle local or regional accounts Manage accounts with revenue in one region and a minimum revenue amount of $1m per account with a combined revenue for all accounts of over $3m. Revenue growth with existing accounts Accounts Receivable - Responsible for all aspects of collections in conjunction with the respective operations management Client...

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...