Complex Claims Resolution & Auto-Adjudication Specialist
Community First Health Plans
A healthcare services provider in San Antonio is seeking a Claims Consultant to analyze complex problems related to claim payments and eligibility. The ideal candidate will have at least five years of experience in HMO/PPO claims, be knowledgeable of benefit programs, and preferably have experience with the Amisys claims processing system. This role requires strong analytical skills and the ability to work cooperatively across departments. #J-18808-Ljbffr Community First Health Plans
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Complex Claims Resolution & Auto-Adjudication Specialist in San Antonio, TX vacancy
- ...looking for an experienced Claims Analyst for our Claims department... ...RESPONSIBILITIES Analyze complex problems pertaining to claim... ...in complex claim issue resolution. Work cooperatively with... ...operations and reporting to assure auto adjudication. Perform in accordance with...CarClaims
University Health
San Antonio, TXmore than 2 months ago - WEB-TPA, Inc. in San Antonio is looking for a Client Resolution Specialist to enhance customer service by resolving complex client issues. Responsibilities include managing customer inquiries, providing expert assistance, and supporting the customer service team. Ideal...ClaimsFlexible hours
- ...tissue bodily injury claims. This role is responsible... ...settlements, and adjudicating claims in compliance with... ...expectations, and timely claim resolution. This role... ...varying levels of claim complexity. Key Responsibilities... ..., including related auto physical damage exposures...CarClaimsWork at officeLocal areaRelocation packageMonday to FridayAfternoon shift3 days per week
AlphaStaffHCM
San Antonio, TX2 days ago $57.97k - $97.82k
...soft tissue bodily injury or auto PIP/MP medical claims to include confirming... ...evaluating, negotiating, and adjudicating claims in compliance with... ...Adjusts soft tissue, moderately complex and complex 1st party... ...facilitate timely claims resolution. Delivers a best-in-...CarClaimsContract workH1bWork at officeRemote workRelocation packageMonday to FridayAfternoon shift3 days per weekUSAA
San Antonio, TX2 days ago- ...Description The Revenue Cycle Specialist II is responsible for... ...accurate and timely submission of claims, works to resolve... ...effectively. Work on denial resolutions, including claims denied for... ...payers or guarantors Review adjudicated claims from Medicare, Medicaid...Claims
$63.59k - $121.53k
...attorney-involved, moderately complex UM/UIM claims or moderately complex to... ...evaluating, negotiating, and adjudicating claims in compliance with... ...UIM claims, as well as some auto physical damage associated... ...to facilitate timely claims resolution. Delivers a best-in-class...CarClaimsFull timeContract workH1bWork at officeRemote workRelocation packageAfternoon shift3 days per week- Auto Adjuster - San Antonio, TX Kforce has a client in San Antonio... ...on adjusting non-injury auto claims. You will work under... ...evaluate, negotiate, and adjust low complexity auto insurance claims... ...external partners to facilitate resolution Support members using various...CarClaimsHourly payContract work
- ...Vice President, Auto Insurance & Risk Management Solutions About the Company Prestigious provider of risk & claims management services Industry Insurance Type Privately... ..., and the ability to manage large, complex programs are essential. The role requires...CarClaims
- ...appropriate records, reports, claims and correspondences necessary... ...clinic staff. Assists in the resolution of complaints, requests and... ...analyze, and interpret the most complex documents. Ability to respond... ...maintain valid drivers license and auto liability insurance....CarClaimsPermanent employmentMonday to FridayFlexible hoursWeekend workAfternoon shift
Methodist Healthcare Ministries of South Texas
San Antonio, TX4 days ago - ...A leading risk and claims administration partner is seeking a skilled professional to... ...end cases involving serious injuries and complex coverage scenarios. The ideal candidate... ...role, you will develop strategies for case resolution, engage with legal counsel, and...Claims
Sedgwick
San Antonio, TX1 day ago $63.59k - $114.45k
A leading insurance provider is seeking a Senior Property Adjuster in San Antonio, TX to handle complex property insurance claims. The role involves investigating, negotiating settlements, and requires a strong understanding of claims processes. Ideal candidates should...ClaimsWork from home3 days per week$75k - $100k
...Job Description Complex Bodily Injury Adjuster - Commercial Trucking/Transportation... ...Bodily Injury Adjusters to join a dynamic claims team. This role involves managing... ...evaluate coverage, and determine appropriate resolutions, including settlement or denial of coverage...ClaimsThe Jonus Group
San Antonio, TX3 days ago- ...Black Belt Process Improvement Specialist who will support the Bureau... ...Lean Six Sigma. An active, adjudicated SECRET security clearance documented... ...Experience supporting large, complex healthcare or military... ...including pet insurance, home and auto insurance, additional life...CarContract workWork at officeLocal areaFlexible hours2 days per week
- GuideWell is seeking a Client Resolution Specialist in San Antonio, TX. This role focuses on resolving client-related issues and providing support for complex customer service inquiries. The ideal candidate will have over a year of customer service experience, knowledge...ClaimsFlexible hours
$107.6k - $161.4k
Specialist Claims - CH07DE Specialist Claims CA - CH07DN We’re determined... ...liability claims including excess auto liability, products... ...Specialist will handle a caseload of complex, high-exposure claims under... ...) from inception to final resolution. This team works closely...CarClaimsTemporary workWork at officeRemote work3 days per week$57.97k - $103.87k
...negotiating, defending, and settling claims in compliance with state laws... ...claims, as well as all auto physical damage associated... ...to facilitate timely claims resolution. Supports workload surges... ...experience to include highly complex vehicle physical damage, such...CarClaimsContract workH1bWork at officeRemote workRelocation package3 days per weekUSAA
San Antonio, TX3 days ago$48.34k - $50.34k
...learning and growing. Our Associate Auto Adjuster role may be a new... ...on adjusting non-injury auto claims and you'll work under... ...evaluate, negotiate, and adjust low complexity auto insurance claims... ...partners to facilitate claims resolution. Support members, business partners...CarClaimsFull timeWork at officeRemote workRelocation packageAfternoon shift2 days per week- GuideWell Mutual Holding Corporation is looking for a Client Resolution Specialist in San Antonio, TX. This entry-level position involves handling inbound customer calls and resolving complex client-related issues. Candidates should have at least 1 year of experience in...ClaimsFlexible hours
- Liability Claims Manager Location: San Antonio, TX (Branch Office... ..., and timely, accurate claim resolution. The role is hands‑on and highly... ...Liability Commercial Auto Commercial Property / Inland... ...exposure Strong capability in complex coverage evaluation and direction...CarClaimsWork at officeLocal areaFlexible hoursNight shift
- ...seeking an Injury Adjuster to manage soft tissue bodily injury claims in San Antonio, TX. This hybrid position requires 3 days in... ...and collaborating with various stakeholders to ensure timely resolutions. This position also requires participation in CAT response operations...CarClaimsWork at office
$48.34k - $50.34k
...simple liability, evaluates, and settles high volume and low complexity auto claims with repairable vehicles. Resolves claims through proactive... ...and internal business partners to facilitate claims resolution. Supports members, business partners, and claimants, through...CarClaimsFull timeSummer workH1bRemote workAfternoon shift- ...when criteria are/are not met. Evaluates claims for conflict of interest and criteria... ...Provides clinical oversight to cases that are complex and need additional review prior to... ...regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party...CarClaimsExtra incomeFreelanceWork at officeRemote work
Dane Street, LLC
San Antonio, TX24 days ago - First Chicago Insurance Company (FCIC) is looking for an experienced Litigation Specialist to manage complex injury claims related to Personal and Commercial Auto Liability policies. Responsibilities include handling litigation claims, conducting investigations, managing...CarClaims
- ...reporting, coordinating with third‑party administrators (TPAs) on claims, and supporting the preparation and distribution of... ...the Legal Department and insurance carriers through claim resolution, and managing auto claims with third‑party carriers and repair vendors....CarClaimsFor contractorsWork at office
$107.6k - $161.4k
Specialist Claims - CH07DE We’re determined to make a difference and are proud to be an... ...responsible for handling a caseload of complex, high exposure, auto and general liability claims... ...levels; Developing and implementing resolution strategies to achieve high quality...CarClaimsFull timeTemporary workWork at officeRemote work3 days per week- ...Job Description Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established...ClaimsRemote jobWork at office
$45.36k - $62.37k
...Order Management Specialist (Solventum) At Solventum, we enable better, smarter, safer... ...ability to prioritize and problem solve complex cases Highly disciplined, self-motivated... ...and recruitment schemes that falsely claim to represent Solventum and seek to exploit...ClaimsH1bRemote workRelocation packageFlexible hoursSolventum
San Antonio, TX3 days ago- ...and completes work log tasks in the system by working through claim edits, denials, and aging tasks; turns in daily productivity reports... ...to payer requests for information/medical records for claim adjudication. Communicates with patients about billing inquiries and...Claims
- ...Antonio!*****Additionally, the Credit Balance Specialist will:*** Research and resolve patient credit... ...(refund, overpayment, underpayment, accounts resolution, etc.)* Working knowledge of the following: health insurance claims, medical billing, medical coding, credit finance...ClaimsTemporary workWork at officeRemote workRelocationFlexible hoursShift work
- ...Client Resolution Specialist WebTPA, a GuideWell Company, is a healthcare third-party administrator... ...providing expert-level resolution to complex cases. This may include partnering... ...support: Primary client contact for claims and customer service issues and...ClaimsTemporary workPart timeWork experience placementMonday to FridayFlexible hours
Blue Cross Blue Shield of Florida
San Antonio, TX15 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Complex Claims Resolution & Auto-Adjudication Specialist. Be the first to apply!
Related searches
- claims analyst San Antonio, TX
- claim representative (remote) San Antonio, TX
- claims assistant San Antonio, TX
- senior claims specialist San Antonio, TX
- medical insurance claims specialist San Antonio, TX
- claims processor San Antonio, TX
- claims assistant workers compensation San Antonio, TX
- claims consultant San Antonio, TX
- medical claims analyst San Antonio, TX
- claim specialist San Antonio, TX