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claim representative medical only

CCMSI

<div><h2 class="jobSectionHeader"><b>Overview
</b></h2><div><div><div><div><b>Claim Representative, Medical Only</b></div><div><b>
Location:</b> Houston, Texas</div><div><b>
Schedule: </b>8:00 am - 4:30pm (CST) - Hybrid Schedule after initial training period (2 days in- office per week)</div><div><b>
Salary Range: </b>$20-24/hour</div><p></p><div><b>
Build Your Career With Purpose at CCMSI</b></div><div></div><div><br>
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.</div><div></div><div><br>
We don&rsquo;t just process claims&mdash;we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified <i>Great Place to Work&reg;</i>, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.</div><div></div><div><b><br>
Job Summary</b></div><div></div><div><br>
Manages designated medical-only claims and supports claims staff, with opportunity for development and promotion to Medical Only Claim Representative II or Claim Associate I. Accountable for delivering quality claim services that meet CCMSI corporate standards and client expectations.</div><br>
<div></div>
</div></div></div><h2 class="jobSectionHeader"><b>Responsibilities
</b></h2><div><div><div><ul><li>Set up and manage medical files only in accordance with corporate claim standards and law.</li><li>
Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.</li><li>
Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.</li><li>
Request and monitor medical treatment of designated claims in accordance with corporate claim standards.</li><li>
Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.</li><li>
Close claim files when appropriate.</li><li>
Retrieve closed claim files and re-file in storage, as requested.</li><li>
Provide support to claim staff on client service teams.</li><li>
Compliance with Corporate Claim Standards and special client handling instructions as established.</li><li>
Performs other duties as assigned.</li></ul>
</div></div></div><h2 class="jobSectionHeader"><b>Qualifications
</b></h2><div><div><div><div><b>Required:</b></div><ul><li>
Associate degree OR two (2) years of related business experience</li><li>
Ability to manage medical‑only claims cradle‑to‑grave</li><li><b>
Active Texas Adjuster License</b></li><li>
Strong attention to detail and organization skills</li><li>
Ability to follow established procedures and meet deadlines</li><li>
Proficiency with Microsoft Office (Word, Excel, Outlook)</li><li>
Strong written and verbal communication skills</li><li>
Reliable, predictable attendance during scheduled hours</li><li>
Ability to work in a fast‑paced, in‑office environment</li></ul><div><b>
Nice to Have:</b></div><ul><li>
Prior medical‑only or workers&rsquo; compensation claims experience</li><li>
Knowledge of medical terminology</li><li>
Experience working with multiple clients or industries</li><li>
Prior experience in a TPA environment</li><li><b>
Bilingual (Spanish)</b> Proficiency- Highly valued for communicating with claimant, employers, or vendors. Not required.</li></ul><h2 class="jobSectionHeader"><b>
Why You&rsquo;ll Love Working Here</b></h2><ul><li>4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year</li><li>Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance</li><li>Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)</li><li>Career growth: Internal training and advancement opportunities</li><li>Culture: A supportive, team‑based work environment</li></ul><h2 class="jobSectionHeader"><b>
How We Measure Success</b></h2><div>
At CCMSI, medical‑only claim professionals succeed through accuracy and consistency. Success in this role is measured by:</div><div><ul><li><br>
<b>Queue management</b> &ndash; timely handling of assigned medical‑only claims</li><li><b>Audit performance</b> &ndash; compliance with corporate standards and NM regulations</li><li><b>Accuracy &amp; documentation</b> &ndash; clear, complete, and timely claim notes</li><li><b>File progression</b> &ndash; appropriate reserve activity and timely claim closure</li><li><b>Team support &amp; reliability</b> &ndash; responsiveness and dependable in‑office attendance</li><li><b>Cultural alignment</b> &ndash; recognizing that every claim represents a real person</li></ul></div><div></div><div><b><br>
This is where we shine, and we hire claim professionals who want to shine with us.</b></div><div></div><div><b><i><br>
Compensation &amp; Compliance</i></b></div><div></div><div><i><br>
The posted salary reflects CCMSI&rsquo;s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.</i></div><div><i>
CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.</i></div><div></div><div><i><br>
CCMSI posts internal career opportunities in compliance with applicable state and local promotion transparency laws.</i></div><div></div><div><b><i><br>
Visa Sponsorship:</i></b><i> CCMSI does not provide visa sponsorship for this position.</i></div><div><b><i>
ADA Accommodations:</i></b><i> CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.</i></div><div><b><i>
Equal Opportunity Employer:</i></b><i> CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.</i></div><div></div><div><i><br>
Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.</i></div><div></div><div><b><br>
Our Core Values</b></div><div>
At CCMSI, we believe in doing what&rsquo;s right&mdash;for our clients, our coworkers, and ourselves. We look for team members who:</div><div><b><br>
Lead with transparency</b> &ndash; We build trust by being open and listening intently in every interaction.<br>
<b>Perform with integrity</b> &ndash; We choose the right path, even when it is hard.<br>
<b>Chase excellence</b> &ndash; We set the bar high and measure our success. What gets measured gets done.<br>
<b>Own the outcome</b> &ndash; Every employee is an owner, treating every claim and decision as our own.<br>
<b>Win together</b> &ndash; Our greatest victories come when our clients succeed.</div><div></div><div><b><br>
We don&rsquo;t just work together&mdash;we grow together. If that sounds like your kind of workplace, we&rsquo;d love to meet you.</b></div><div></div><div><br>
#CCMSICareers #EmployeeOwned #GreatPlaceToWorkCertified #ESOP #TPA#MedicalOnlyClaims #WCClaims #ClaimsRepresentative #InsuranceJobs #WorkersCompensation #EntryLevelClaims #ClaimsCareers #TPACareers #HoustonJobs #TexasJobs #HealthcareClaims #HiringNow #IND123 #LI-Hybrid</div></div></div></div></div>

Claim Representative, Medical Only

IQVIA

<div>Houston, United States of America | Full time | Home-based | R1537654</div>
<br><div><div><b>Bi-lingual Pharmacy Support Call Center Representative</b><br>
<i>Contract Remote Role &ndash; Location (Open to Remote US)</i></div><div>
As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma, medical device and diagnostic companies get their therapies to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product&rsquo;s value to payers, physicians, and patients. A significant part of our business is providing patient support programs on the behalf of our customers. With the right experience, you can help provide support to patients in need of available therapies.</div><div>
IQVIA has the world&rsquo;s largest Commercial Sales &amp; Medical Solutions (CSMS) organization dedicated to the launch and marketing of pharmaceutical and medical products. With a focus on providing talent for patient support, field/inside sales, medical device support, clinical support, and medical affairs our CSMS division has 10,000+ field professionals in more than 30 countries addressing physician and patient needs.</div><div>
We are excited to announce that currently we are looking for a 100% remote (work from home&mdash;WFH) contract <b>Pharmacy Support Call Center Representative </b>to join our team. In this position, you will provide payment assistance solutions such as co-pay cards or vouchers. The <b>Pharmacy Support Call Center Representative </b>is primarily responsible for fielding requests such as: card activation, program eligibility, explanation of program benefit and explanation/troubleshooting of submission rejection. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.</div><div><b>
Role Purpose:</b></div><ul><li>
Primary Call Center contact for patients, pharmacies and medical professionals utilizing an Opus Health program. Call Center Representatives are responsible for fielding requests such as: card activation, program eligibility, explanation of program benefit and explanation/troubleshooting of submission rejection.</li></ul><div><b>
Job Responsibilities:</b></div><ul><li>
Provide initial support for customer requests via telephone, email, fax, or other available means of contact to the Support Center</li><li>
Quickly assess the user's issue and provides first level support for problem resolution</li><li>
Document information specific to the resolution and escalate unresolved issues expeditiously to the appropriate area</li><li>
Recognize operational challenges and suggest recommendations to management, as necessary</li><li>
Ability to work 40 hours per week under moderate supervision</li><li>
Multiple shifts available:</li></ul><h3 class="jobSectionHeader"><b>
8:00 am - 5:00 pm EST
</b></h3><h3 class="jobSectionHeader"><b>9:00 am &ndash; 6:00 pm EST</b></h3><h3 class="jobSectionHeader"><b>
10:00am &ndash; 7:00pm EST</b></h3><h3 class="jobSectionHeader"><b>
11:00 am &ndash; 8:00pm EST</b></h3><div><b>
Minimum Education &amp; Experience:</b></div><ul><li>
High School Diploma or equivalent</li><li>
Pharmacy Technician experience required</li><li>
HIPAA certified</li><li>
Call center experience required (3+ years preferred)</li><li>
Experience in medical claim processing is a plus</li><li>
Bi-lingual (English/Spanish)</li></ul><div><b>
The pay range for this role is $18.00 per hour. To be eligible for this position, you must reside in the same country where the job is located.</b></div><div><b>
IQVIA</b> is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100+ countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.</div><div>
#LI-CES</div><div>
#LI-Remote</div><div>
#LI-DNP</div><div>
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com</div><div>
IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe</div><div>
IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.</div>
The potential base pay range for this role is $18.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.</div>

Bi-lingual Pharmacy Tech Support/Call Center Rep (Work from Home)

Bluefire Insurance Services, Inc.

<div><p>$65000 - $70000 / year</p><br>
<p></p>
<p><b>
About Us:</b></p>
<p>
Bluefire is part of the Confie family of insurance companies. At Bluefire, our employees enjoy a positive, dynamic, inclusive, and collaborative workplace where performance is rewarded, continued learning is promoted, and employees have exciting opportunities for advancement. Confie is one of the top five insurance brokers in the United States, but we didn&rsquo;t achieve this milestone by chance. We believe that our success is due to the talented people on our side and our positive corporate culture. We also have one of the most diverse employee teams in the insurance industry. Our employees enjoy competitive pay and a convenient work-life balance in their schedules. We also offer a robust benefits package that includes:</p>
<ul>
<li><b>Health Care:</b> Choices among several medical, dental, and vision plans.</li>
<li><b>Retirement Plan:</b> A 401K plan with a percentage of company-matched contributions.</li>
<li><b>Fitness:</b> A corporate gym discount to make staying active more accessible.</li>
<li><b>Mental Health Support:</b> 12 therapy sessions and 13 additional psychiatric sessions.</li>
<li><b>Employee Assistance Program:</b> Confidential assistance to you or anyone in your household who is experiencing personal or professional problems &mdash; at no cost.</li>
<li><b>Flexible Schedule:</b> Monday to Friday</li>
<li><b>Extra Perks:</b> Access to disability, hospital indemnity, universal life, critical illness, and accident insurance plans. We even offer pet insurance.</li>
</ul>
<p>As we continue to grow and extend our reach, our priority is focused on recruiting talented and driven people to add to our team and build them up for success.</p><br>
<p></p>
<p><b>
Purpose</b></p>
<p>
Prepares and documents accurate vehicle damage appraisals. Responsible for coordinating with appropriate claim resources on coverage issues, subrogation, salvage, and potential fraud opportunities to achieve optimum final claim resolution</p>
<p><b>
Essential Duties &amp; Responsibilities</b></p>
<p>
Independently completes timely and accurate estimates in accordance with the organization's standards, procedures, and guidelines</p>
<p>
Completes timely and accurate loss in accordance with the organization's standards, procedures, and guidelines</p>
<p>
Prepares and documents accurate vehicle/equipment damage appraisals, actual Cash and Replacement values according to insurance department regulations and Affirmative's Estimating Standards and Best Practices guidelines</p>
<p>
Achieves authorization to provide settlement amount to the assigned Claim Representative for payment. This may include presentation of facts gathered to appropriate leadership, depending on settlement amount and authority level</p>
<p>
Manages repair time to improve cycle time</p>
<p><b>
Qualifications and Education Requirements</b></p>
<p>
High School Diploma or equivalent required; 4-year degree preferred</p>
<p>
3 - 5 years Insurance or Shop estimating experience preferred</p>
<p>
Valid driver's license and good driving record</p>
<p>
Intermediate to advanced knowledge and skill in Microsoft Office products</p>
<p><b>
Preferred Skills</b></p>
<p>
Ability to read, analyze and interpret general business periodicals, technical journals/procedures, and financial reports and data</p>
<p>
Ability to effectively present information and respond to questions from management, employees, clients, customers, and the general public</p>
<p>
Demonstrated strong interpersonal and communication skills, both verbal and written</p>
<p>
Maintain continuous and effective communication with customers, agents, and claim staff</p>
<p>
Ability to calculate figures and amounts such as discounts, proportions, and percentages</p>
<p>
Ability to work independently, think creatively and exercise strong, sound judgment</p>
<p><b>
Preferred Skills</b></p>
<p>
Knowledge of auto repair and repair techniques, including thorough understanding of auto terminology and construction</p>
<p>
Knowledge of claim appraisal systems and overall claims operations</p>
<p>
Ability to get along with diverse personalities in a tactful manner</p>
<p>
Ability to resolve issues effectively. Understands when to handle an issue and when to escalate</p>
<p>
Ability to prioritize activities and projects while staying organized</p>
<p>
Ability to process high volumes of work while meeting deadlines</p>
<p>
Possesses ability to manipulate multiple computer systems and estimating databases</p>
<p>
Maintain appropriate technical expertise, certifications and regulatory required licenses through successful completion of company and industry classes and training</p>
<p>
Participates in special projects as assigned</p>
<p><b>
Other Duties</b></p>
<p>
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.</p></div>

Appraiser

Allied Universal Compliance and Investigations

<div><p>SIU Investigator</p><h2 class="jobSectionHeader"><b>
Overview</b></h2><p>
Company Overview:
</p><p>Advance Your Career in Insurance Claims with Allied Universal&reg; Compliance and Investigation Services. Allied Universal&reg; Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.</p><h2 class="jobSectionHeader"><b>
Job Description</b></h2><p>
Allied Universal&reg; is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.</p><p><br>
</p><ul><li><b>Join a well-established company with a strong reputation in the industry!</b></li><li><b>
Auto Allowance and Company Credit Card for fuel and travel!</b></li><li><b>
Must possess a valid driver's license with at least one year of driving experience</b></li></ul><br>
<p></p>
<p><b>RESPONSIBILITIES:</b>
</p><ul><li>Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability</li>
<li>Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance</li>
<li>Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed</li>
<li>Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct</li>
<li>Run appropriate database indices if necessary and verify the accuracy of results found</li>
<li>Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor</li></ul><p><b>
QUALIFICATIONS (MUST HAVE):</b>
</p><ul><li>Must possess one or more of the following:</li><li><ul><li>
Bachelor's degree in Criminal Justice</li>
<li>High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud</li></ul></li><li>
Ability to be properly licensed as a Private Investigator as required by the state where work Is completed</li>
<li>Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li>
<li>Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims</li>
<li>Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.</li>
<li>Proficient in utilizing laptop computers and cell phones.</li>
<li>Special Investigative Unit (SIU) Compliance knowledge</li>
<li>Ability to type 40+ words per minute with minimum error</li>
<li>Flexibility to work varied and irregular hours and days including weekends and holidays</li></ul><p><b>
PREFERRED QUALIFICATIONS (NICE TO HAVE):</b>
</p><ul><li>Military experience</li>
<li>Law enforcement</li>
<li>Insurance administration experience</li>
<li>Familiarity with California SIU regulations</li>
<li>One or more of the following professional industry certifications:</li><li><ul><li>
Certified Fraud Investigator (CFE)</li>
<li>Certified Insurance Fraud Investigator (CIFI)</li>
<li>Fraud Claim Law Associate (FCLA)</li>
<li>Fraud Claim Law Specialist (FCLS)</li>
<li>Certified Protection Professional (CPP)</li>
<li>Associate in Claims (AIC)</li>
<li>Chartered Property Casualty Underwriter (CPCU)</li></ul></li></ul><p><b>
BENEFITS:</b>
</p><ul><li>Medical, dental, vision, basic life, AD&amp;D, retirement plan and disability insurance</li>
<li>Seven paid holidays annually, sick days available where required by law</li>
<li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul><h2 class="jobSectionHeader"><b>
Closing</b></h2><p>
Allied Universal&reg; is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com
</p><p>If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.</p><h2 class="jobSectionHeader"><b>
Requisition ID</b></h2><br>
2026-1574656</div>

SIU Investigator

Mustang Cat

Building Texas… Powering the World.
<br><br>
Since 1952, Mustang has proudly served the construction, oil & gas, power generation, marine, and manufacturing industries as the authorized Caterpillar® dealer for Southeast Texas. Start your career with Mustang Cat - one of America's Greatest Midsize Workplaces of 2025!
<br><br>
Mustang Cat is seeking a detail-oriented and analytical Finance Analyst to support our financial lending and post-sales claims functions. This role plays a key part in reducing the credit-to-cash and days-to-claim cycles while ensuring accurate financial analysis, documentation, and reporting across Construction Machinery sales operations.
<br><br>
If you enjoy working in a fast-paced environment, collaborating with sales teams and lenders, and applying financial expertise to support equipment sales, this is a great opportunity to grow your career.
<br><br>
<b>What You’ll Do as a Finance Analyst:</b><br>
Finance & Sales Support
<br><ul>
<li>Coordinate finance and post-sales claims activities to support increased sales and rental unit conversions.</li>
<li>Prepare accurate payoff calculations, finance option quotes, and conversion contract details.</li>
<li>Review sales contracts for accuracy and compliance with lending and claim requirements.</li>
<li>Serve as a key liaison between customers, sales teams, lenders, and internal credit teams.</li>
</ul>
Financial Analysis & Lending
<br><ul>
<li>Submit complete financial packages to lenders for credit decisions.</li>
<li>Track deal packages from submission through funding completion.</li>
<li>Support pending-funding reporting and help reduce the credit-to-cash cycle.</li>
<li>Assist with payment collections on open prime product receivables.</li>
</ul>
Post-Sales Claims
<br><ul>
<li>Submit and manage post-sales and OTO claims through GCSS and PSCS systems.</li>
<li>Select the most advantageous claim programs based on contract review.</li>
<li>Monitor claim status to ensure requested amounts are met or exceeded.</li>
</ul>
Reporting & Performance
<br><ul>
<li>Compile and analyze monthly departmental reports.</li>
<li>Meet performance expectations, including timely funding and claim submission targets.</li>
</ul>
<b>What You’ll Need to Succeed as a Finance Analyst:</b><br>
Required Qualifications
<br><ul>
<li>Strong sense of urgency, organization, and attention to detail.</li>
<li>Professional communication skills with the ability to interact across all levels of the organization.</li>
<li>Ability to work effectively in a high-pressure, deadline-driven environment.</li>
<li>Strong math and analytical skills, including financial modeling and forecasting.</li>
<li>Knowledge of finance and leasing products, policies, and procedures.</li>
<li>Proficiency in Microsoft Office and database systems (CFCS & CFCA).</li>
</ul>
Preferred Qualifications
<br><ul>
<li>Bachelor’s degree in Finance, Accounting, Business Administration, Business Management, or Statistics.</li>
<li>Coursework or pursuit of Moody’s Commercial Credit certification.</li>
<li>Experience supporting equipment finance, lending, or sales operations.</li>
</ul>
<b>Top Benefits for Mustang Cat Team Members:</b><br>
<ul>
<li>Competitive Pay</li>
<li>Full-Time Benefits: Medical, Dental, Vision</li>
<li>Paid Time Off & Holidays</li>
<li>401(k) with Employer Matching</li>
<li>Company-paid life insurance and long-term disability coverage</li>
<li>On-Site Medical Clinic</li>
<li>Tuition Reimbursement and Professional Development Opportunities</li>
<li>Employee Assistance Program</li>
</ul>
Ready to Apply?
<br>Apply today and become part of a company that invests in your growth and values your contributions.
<br><br>
Check out the Mustang Cat Anthem to see our mission in action!
<br><br>
Having trouble logging in? Create an account through the link on the "Sign In" pop-up window, and apply today!
<br><br>
Mustang Cat is an Equal Opportunity Employer.

Finance Analyst

Baylor College of Medicine

<div><div><div><div><h2 class="jobSectionHeader"><b>Summary</b></h2></div><div><p>
Patient Business Services is seeking a Coordinator, Patient Accounts Receivable to expedite and maximize payment of insurance medical claims by contacting insurance payers and patients by telephone or website.</p></div></div><div><div><h2 class="jobSectionHeader"><b>
Job Duties</b></h2></div><div><ul><li>
Expedites and maximizes payment of insurance medical claims by contacting insurance payers and patients by telephone or website.</li><li>
Works on complex and/or specialized cases.</li><li>
Provides assistance with inquiries from outside parties regarding account status and possible resolutions.</li><li>
Utilizes specialized knowledge of regulatory or contractual billing guidelines to determine an account&rsquo;s ability to pay after initial rejection from payer.</li><li>
Resolves all denials, and requests for information, including appeals.</li><li>
Identifies trends in payer non-compliance and informs management accordingly.</li><li>
Follows up on outstanding accounts and makes proper notations in EPIC system and logs.</li><li>
May provide guidance and technical work direction to less experienced staff.</li><li>
Performs other job-related duties as assigned.</li></ul></div></div><div><div><h2 class="jobSectionHeader"><b>
Minimum Qualifications</b></h2></div><div><ul><li>
High School Diploma or GED.</li><li>
Minimum of two years of experience working in a medical setting, to include medical insurance and/or accounts receivable follow-up.</li></ul></div></div><div><div><h2 class="jobSectionHeader"><b>
Preferred Qualifications</b></h2></div><div><ul><li>
A/R follow up experience.</li><li>
Experience speaking with insurance company reps for claim status.</li><li>
Experience accessing payer websites for claim information.</li><li>
Experience submitting appeals for reimbursement.</li></ul></div></div></div><p></p><p><b><br>
Work Authorization Requirement:</b></p><p><b>
This position is not eligible for visa sponsorship.</b> Candidates must be legally authorized to work in the United States at the time of application and throughout the duration of employment.</p><p></p><p><br>
Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.</p></div>

Coordinator, Patient Accounts Receivable - Appeals/Denials

Metropolitan Transit Authority of Harris County, Texas

<b>Requisition Number:</b><br>
7886
<br><br>
<b>Pay Rate:</b><br>
PGR11
<br><br>
<b>Location:</b><br>
Houston, TX, US
<br><br>
<b>Category:</b><br>
Public Safety
<br><br>
<b>Description:</b><br>
Basic Function
<br>Responsible for investigating and administering assigned Liability claims and when warranted pursue litigation and subrogation against third parties. Performs duties in a safe, efficient manner and in compliance with applicable rules and safety procedures. Responsibilities and Specific Duties
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Investigates and administers liability claims of varying complexity including, bodily injury, first party auto, third party auto, first party property, and general liability.
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Sets appropriate financial reserves and maintains adequate funding.
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Sets appropriate diary date schedule according to claim milestones.
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Takes recorded statements from involved parties and explains the Texas Tort Claims Act and procedures as needed.
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Requests indexing of all injured parties through Insurance Services Office (ISO) and confirms eligibility for benefits through Centers for Medicaid & Medicare Services (CMS).
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Requests damage appraisals, police reports, medical bills, medical reports and wage information.
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Reviews facts, establishes liability, evaluates damages and negotiates appropriate settlements within the authority granted based upon all known facts.
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Reports suspected fraudulent claim activities to the appropriate law enforcement agency, NICB or counsel for METRO.
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Maintains contact with all parties regarding claims (i.e., repair vendors, appraisal vendors, doctors, claimants, and attorneys).
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Coordinates investigation with Workers’ Compensation adjusters to avoid duplication of processes and subrogation pursuit.
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May be required to represent METRO at mediations, depositions, pretrial hearings and other legal proceedings as deemed appropriate.
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Provides any additional information requested by supervisors or lawyers relating to claims.
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Reviews claim files on a daily diary basis and pursues subrogation.
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Provides excellent customer service to METRO internal and external customers.
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Applies Safety Management System (SMS) methods and principles in daily routine and supports all aspects of the agency’s Public Transportation Agency Safety Plan (PTASP).
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Promotes safety awareness and follows safety procedures to reduce or eliminate accidents.
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Performs other job-related duties as assigned.
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<b>Pay Range:</b> $70,700 - $92,800 Education Requirement
<br>High school diploma or GED is required. Bachelor’s degree in Risk Management, Finance or Business Administration is preferred. Years & Experience Required
<br>Minimum five (5) years of progressively responsible liability claims and litigation claims management experience. Knowledge & Skills Required
<br>Excellent analytical skills in researching and reviewing negligence laws, traffic codes, accident reports, statements or interrogatories, medical bills, indexes and medical narratives. Good communications (written and verbal) skills. Must have an understanding of legal insurance defense, medical terminology, and functional knowledge of Texas Tort Claims Act and/or Texas Workers’ Compensation Act. Texas Insurance Adjusters license in one of these types: Texas Property and Casualty or a Texas All Lines license is required. Bilingual preferred. Additional Information
<br>The Metropolitan Transit Authority of Harris County, Texas has a zero-tolerance drug and alcohol policy for all employees. All internal and external applicants will be required to undergo drug testing before employment and will be subject to further drug and/or alcohol testing throughout their employment.
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Further, employees who perform safety-sensitive functions will submit to drug and/or alcohol testing in accordance to the Department of Transportation (DOT) and the Federal Transit Administration (FTA) regulatory requirements.
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We provide equal opportunity to all qualified individuals regardless of race, color, religion, age, sex, national origin, veteran status, genetic information or disability.
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<b>Nearest Major Market:</b> Houston

Senior Claims Adjuster (Liability)

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