10 senior clinical quality analyst jobs found in Fort Worth

The Closing Team Lead is responsible for monitoring and tracking all closing processes. This role runs queries, maintains reports, and supports the trainers while keeping up with the training material. The Closing Team Lead may assist supervisors with additional projects/tasks. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Run queries to collate data; maintain reports and Excel spreadsheets as needed Monitor and track completion of files and special tasks Oversee the training for all new Closing Analysts Responsible for keeping training material up to date Assist Team of Closing Analysts with questions and escalations Required to close files when needed Serve as a final Quality Control for Closing Analyst files as needed Track analyst errors and create coaching measures Lead meetings and conduct presentations as needed Additional duties as assigned   KNOWLEDGE & SKILLS:...

The CERIS Operations Supervisor is responsible for managing daily production for the department, which may include one or more of the following functions:  human resources, customer service, and promoting positive mentorship for the team. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Accountable for maintaining highest quality of service Handle human resources matters directly related to employees supervised Maintain employee confidence and protect operations by keeping sensitive information confidential May be required to travel overnight to attend meetings May perform daily, weekly and monthly reviews of various reports, invoices, logs and expenses Approve Electronic time cards for employees Assist Manager in establishing employee schedules  Oversee quality control and tracking or error rates Maintaining HIPAA compliance in all aspects of...

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...

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...

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 Punctual and consistent attendance required Additional duties as...

Why Global Procurement at GM Financial?   Do you excel at building and maintaining critical relationships, enjoy strategic sourcing, and are a successful negotiator? If so, then GM Financial Global Procurement Department is the place for you.   Global Procurement at GM Financial is a strategic, high-impact team that manages sourcing, contracts, and supplier relationships across the organization. You’ll work with advanced processes, tools, and policies to drive efficiency and innovation, while collaborating with business units and suppliers worldwide. The role offers opportunities for professional growth, leadership, and exposure to diverse procurement operations, making it an ideal environment for those seeking to deliver value and shape the company’s future.   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....

Description Senior Property Adjusters investigate commercial property claims, evaluate damages, determine coverage, set accurate loss cost estimates, control the insured's exposures and losses, manage consultants, and achieve a prompt, fair and equitable settlement according to fair claims handling requirements. Negotiate settlement of claims with varying complexity and perils. Training is a critical component to your success and that success starts with reliable attendance.  Attendance and active engagement during training is mandatory Responsibilities: Conducts a prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin, and extent of loss losses. Reviews and utilizes financial statements to adjust complex business interruption losses. Conduct on-site appraisal or direct independent adjuster to determine facts relevant causation, damages and exposure. Engages and manages consultants as required...

 Why Global Procurement at GM Financial?   Do you excel at building and maintaining critical relationships, enjoy strategic sourcing, and are a successful negotiator? If so, then GM Financial Global Procurement Department is the place for you.   Global Procurement at GM Financial is a strategic, high-impact team that manages sourcing, contracts, and supplier relationships across the organization. You’ll work with advanced processes, tools, and policies to drive efficiency and innovation, while collaborating with business units and suppliers worldwide. The role offers opportunities for professional growth, leadership, and exposure to diverse procurement operations, making it an ideal environment for those seeking to deliver value and shape the company’s future.   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....

The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for the injured worker. This position includes a moderate volume of inbound calls and a high volume of outbound calls. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receive incoming calls, emails and faxes from the Medical Access Assistant line Communicate clearly and professionally with providers and other stakeholders via phone and email Provide excellent customer service...

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...