San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$19.80 - $31.25/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
San Antonio, TX · On-site
$20.30 - $33/hr
Work cooperatively with Configuration in testing of contracts used in business operations and ... Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred.
The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving ... This role works in conjunction with Business Configuration, Network Management, Provider Data ...
The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving ... This role works in conjunction with Business Configuration, Network Management, Provider Data ...
This role works in conjunction with Business Configuration, Network Management, Provider Data ... Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities ...
This role works in conjunction with Business Configuration, Network Management, Provider Data ... Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities ...
Bellaire, TX · On-site
... configuration setup issues when trending appeals to determine if modifications must be made to ... Process all claims for providers flagged by the Office of Inspector General for prepayment review ...
Bellaire, TX · On-site
... configuration setup issues when trending appeals to determine if modifications must be made to ... Process all claims for providers flagged by the Office of Inspector General for prepayment review ...
Must be confident navigating the configuration tools and understanding the downstream impact of changes. * Be an Escalation Point: Serve as a go-to resource for complex or unresolved EVV and claims ...
New
Must be confident navigating the configuration tools and understanding the downstream impact of changes. * Be an Escalation Point: Serve as a go-to resource for complex or unresolved EVV and claims ...
New
Must be confident navigating the configuration tools and understanding the downstream impact of changes. * Be an Escalation Point: Serve as a go-to resource for complex or unresolved EVV and claims ...
New
Must be confident navigating the configuration tools and understanding the downstream impact of changes. * Be an Escalation Point: Serve as a go-to resource for complex or unresolved EVV and claims ...
New
Fort Worth, TX · On-site
The Claim Auditor I ensures that claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audit ...
Fort Worth, TX · On-site
The Claim Auditor I ensures that claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audit ...
Direct all aspects of claims intake, adjudication, configuration, and operational support functions across Commercial, Individual/Marketplace, Medicare Advantage, FEP, and self-funded/ASO lines of ...
Direct all aspects of claims intake, adjudication, configuration, and operational support functions across Commercial, Individual/Marketplace, Medicare Advantage, FEP, and self-funded/ASO lines of ...
Galveston, TX · Remote
This position is responsible for the design, configuration, implementation, optimization ... The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims ...
Galveston, TX · Remote
This position is responsible for the design, configuration, implementation, optimization ... The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims ...
Galveston, TX · Remote
This position is responsible for the design, configuration, implementation, optimization ... The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims ...
Galveston, TX · Remote
This position is responsible for the design, configuration, implementation, optimization ... The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims ...
Galveston, TX · On-site +1
This position is responsible for the design, configuration, implementation, optimization ... The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims ...
Galveston, TX · On-site +1
This position is responsible for the design, configuration, implementation, optimization ... The Lead HB Epic Claims Analyst serves as the primary expert for Epic Hospital Billing (HB) claims ...
| Aspect | Claims Configuration | Claims Processing Specialist |
|---|---|---|
| Primary Role | Setting up and customizing claims systems and workflows | Reviewing, adjudicating, and processing individual insurance claims |
| Required Skills | Technical knowledge of claims systems, data management | Attention to detail, knowledge of claims policies, customer service |
| Work Environment | Typically in IT or claims system teams within insurance companies | In claims departments, interacting directly with claimants and providers |
| Certifications | Claims system certifications, insurance knowledge | Insurance claims processing certifications, customer service training |
Claims Configuration involves setting up and maintaining claims systems to ensure efficient processing, while Claims Processing Specialists handle the day-to-day review and adjudication of claims. Both roles are essential in the insurance industry but focus on different aspects of claims management.
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$20.30 - $33/hr
Full-time
Re-posted 7 days ago
8.5
Based on 18 frontline employees who took The Breakroom Quiz
80th of 618 rated colleges and universities
POSITION SUMMARY/RESPONSIBILITIES
Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision.
EDUCATION/EXPERIENCE
High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.
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