Current jobs related to Claims Analyst - Houston - Apex Health Solutions

  • Claims Processing Analyst

    3 weeks ago

    Houston, Texas, United States Elementia USA Full time

    DIVISION/LOCATION: Elementia USAPOSITION TITLE: Claims Processing AnalystREPORTS TO TITLE: Claims SupervisorGeneral FunctionThe main duty of the Claims Processing Analyst is to evaluate information pertaining to warranty claims, including the assessment of processes and payments. This role involves analyzing warranty claims to identify patterns that can help...

  • Shipping Claims Analyst

    3 weeks ago

    Houston, Texas, United States Primary Services Full time

    --Become a key player in a vibrant team where your analytical expertise will enhance the precision and effectiveness of maritime operations, all within a nurturing and cooperative work atmosphere.--Primary Services is pleased to introduce the position of Demurrage Analyst for our client in the energy and logistics sector. This role is pivotal for the...

  • Bodily Injury Claims Quality Analyst

    3 weeks ago

    Houston, Texas, United States Aston Carter Full time

    Company Overview:Aston Carter is a leading provider of corporate talent solutions, specializing in various sectors including accounting, finance, human resources, and procurement. We are dedicated to delivering exceptional service to our clients and fostering a diverse and inclusive workplace.Position Summary:We are seeking a skilled Claims Analyst to join...

  • Guidewire Business Analyst

    4 days ago

    Houston, Minnesota, United States CAPGEMINI ENGINEERING Full time

    Job Title: Guidewire Business AnalystCapgemini Engineering is seeking an experienced Guidewire Business Analyst with a strong background in Claim Center to join our team.Key Responsibilities:Lead the migration of claims data from legacy systems to Guidewire, ensuring seamless integration and minimal disruption to business operations.Collaborate with...

  • Claims Analyst

    2 months ago

    Houston, United States CEVA Logistics Full time

    YOUR ROLEThe Claims Adjuster is responsible for the administration of the claims management process related to all cargo claims, domestic international and contract logistics and assist with other related duties as needed. Models and acts in accordance with our guiding principles and core values.WHAT ARE YOU GOING TO DO?Utilize knowledge of Excel/database...

  • Claims Analyst

    2 months ago

    Houston, United States CEVA Logistics Full time

    YOUR ROLEThe Claims Adjuster is responsible for the administration of the claims management process related to all cargo claims, domestic international and contract logistics and assist with other related duties as needed. Models and acts in accordance with our guiding principles and core values.WHAT ARE YOU GOING TO DO?Utilize knowledge of Excel/database...

  • Medical Claims Specialist

    4 weeks ago

    Houston, United States Kelly Full time

    Finding a job that fits your lifestyle isn’t always easy. That’s where Kelly® comes in. We’re seeking a Medical Claims Analyst to work at a premier healthcare organization in Houston, TX 77092. Sound good? Take a closer look below. We’re here to help you find something great that works for you—so you won’t miss a moment of what really...

  • Automotive Claims Analyst II

    3 weeks ago

    Houston, Texas, United States Cox Communications Full time

    Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator II Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $26.06/hour. The hourly base rate may vary within the anticipated range based on factors...

  • Insurance Risk Analyst

    3 weeks ago

    Houston, Texas, United States BIC Recruiting Full time

    Job OverviewCOMPANY BACKGROUND: BIC Recruiting is a prominent firm specializing in industrial services, focusing on sectors such as petrochemicals, refining, and power generation.POSITION TITLE: Insurance Risk AnalystCOMPENSATION: Competitive salary based on experienceBENEFITS: Comprehensive benefits packageLOCATION: Houston, TXROLE SUMMARY: The Insurance...

  • Risk Management Analyst

    3 weeks ago

    Houston, United States BIC Recruiting Full time

    Job DescriptionJob DescriptionCOMPANY OVERVIEW: A leading industrial services company targeting the petrochemical, refining, and power generation industriesPOSITION TITLE: Risk Management AnalystCOMPENSATION: Competitive salary DOE BENEFITS: Standard packageLOCATION: Houston, TXSUMMARY: The Risk Management Claims Analyst is responsible for analyzing the...

  • Healthcare Statistics Data Analyst II

    4 weeks ago

    Houston, United States WCC Full time

    Job DescriptionJob DescriptionHealthcare Data Analyst II Seeking a full-time Medicare Data Analyst to perform waste and abuse detection, deterrence and prevention activities for Medicare claims. The Data Analyst II will use data and tools to perform comprehensive research, data analysis, and trending activities to support the identification of potential...

  • Guidewire Business Analyst

    3 weeks ago

    Houston, United States Atlas Cloud Foundry LLC Full time

    Job Title: Guidewire Business Analyst Location: Remote Visa: USC OR GC OR GC_EAD ONLY Contract Description Skill set Business Analyst experienced with personal, auto, or home insurance They prefer Guidewire PolicyCenter, if we cannot find those resources with BA backgrounds, they are open to strong Claims or Billing BA Prefer Jira...

  • Population Health Analyst

    4 days ago

    Houston, Texas, United States Privia Health LLC Full time

    Job Title: Population Health AnalystAt Privia Health LLC, we are seeking a highly skilled Population Health Analyst to join our team. As a Population Health Analyst, you will play a critical role in developing and implementing data-driven strategies to improve patient outcomes and reduce healthcare costs.Key Responsibilities:Champion understanding of...

  • Senior Insurance Analyst

    5 days ago

    Houston, Texas, United States Petroplan Full time

    Senior Insurance Analyst PositionPetroplan is seeking a highly skilled Senior Insurance Analyst to join our team in the Insurance Department, part of the Treasury/CFO organization. The successful candidate will support the Director of Corporate Insurance in overseeing the client's global insurance, claims, and captive functions for an international oil and...

  • Data Business Analyst

    5 days ago

    Houston, Texas, United States Della Infotech Full time

    About the RoleWe are seeking a skilled Data/Sys Business Analyst to join our team at Della Infotech. As a key member of our organization, you will play a crucial role in analyzing healthcare data to drive business decisions.Key ResponsibilitiesConduct in-depth analysis of healthcare data, including claims, member enrollment, and carrier information.Identify...

  • Lead Business Analyst

    3 weeks ago

    Houston, Texas, United States American National Full time

    American National is in search of a Senior Business Analyst to enhance our P&C Underwriting Division. This role is ideal for individuals with substantial experience in business analysis who are eager to engage in large-scale initiatives while guiding fellow analysts.Key Responsibilities:• Gather, identify, and document comprehensive business requirements...

  • Lead Business Analyst

    3 weeks ago

    Houston, Texas, United States American National Full time

    American National is in search of a Senior Business Analyst to enhance our P&C Underwriting Division. This role is ideal for individuals with substantial experience in business analysis who are eager to engage in significant projects while guiding fellow analysts.Key Responsibilities:• Gather, define, and document comprehensive business requirements along...

  • Lead Business Analyst

    3 weeks ago

    Houston, Texas, United States American National Full time

    American National is in search of a Senior Business Analyst to enhance our P&C Underwriting Division. This role is ideal for individuals with substantial experience in business analysis who are prepared to engage in large-scale initiatives while guiding fellow analysts within the team.Key Responsibilities:• Gather, define, and document comprehensive...

  • Lead Business Analyst

    3 weeks ago

    Houston, Texas, United States American National Full time

    American National is in search of a Senior Business Analyst to enhance our P&C Underwriting Division. This role is ideal for individuals with substantial experience in business analysis who are eager to engage in significant projects while guiding fellow analysts.Key Responsibilities:• Gather, define, and document comprehensive business requirements along...

  • Lead Business Analyst

    3 weeks ago

    Houston, Texas, United States American National Full time

    American National is looking for a Senior Business Analyst to enhance our P&C Underwriting Division. This role is ideal for individuals with substantial experience in business analysis who are prepared to engage in large-scale initiatives while guiding fellow analysts.Key Responsibilities:• Gather, identify, and document comprehensive business requirements...

Claims Analyst

4 months ago

Houston, United States Apex Health Solutions Full time
Job DescriptionJob DescriptionSummary
Claims Analyst is responsible for accurate and timely research of all providers claim inquiries according to policies, process instructions and system requirements, regulatory reporting, and acts as a liaison between internal stakeholders for associated claims processes. Candidate will respond to all incoming inquiries and coordinate with other internal and external stakeholders to resolve the issue, determine the underlying cause and make recommendations regarding system changes that may be relevant.

Essential Duties and Responsibilities include the following. Other duties may be assigned.
  • Responsible for data collection and analysis regarding provider inquiries and/or disputes or other trending payment integrity activities
  • Acts as point of contact for submission and/or resolution of denial determinations and provider disputes. Interfaces with internal stakeholders regarding reconsiderations, disputes and/or appeals as appropriate
  • Research and documents denial determinations at all levels of provider disputes in a thorough, professional, and expedient manner
  • Coordinates workflow between departments and interfaces with internal and external resources
  • Composes all correspondence and dispute information concisely and accurately, in accordance with regulatory requirements
  • Supports the development and standardization of business rules documents including appropriate trend reporting
  • Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all provider disputes
  • Monitors each dispute to ensure all internal and regulatory timelines are met
  • Provides re-enforcement training for new and existing associates as needed
  • Work with contracting, provider relations and configuration teams when inconsistencies are found
  • Collaborate with internal and external stakeholders to ensure prompt and appropriate action is taken regarding cost avoidance/cost containment activities
  • Conducts regulatory research to determine revisions/updates to various federal and state payment requirements for hospital, ambulatory surgery, and physician providers
  • Consults and coordinates with various internal departments, external resources, business partners, and government agencies as appropriate
  • Works closely with clinical personnel to ensure alignment with clinical and benefit policies
  • Reviews technical documents and specifications for compliance with operational procedures
  • Ensures safe care to patients, staff, and visitors; adheres to all Apex policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

Minimum Qualifications
Education: High School diploma; Bachelor’s in business or health care field preferred
Licenses/Certifications: (None)

Experience / Knowledge / Skills:
  • Three (3) years of experience working in a healthcare data or regulatory environment; payment integrity and claims experience preferred.
  • Effective oral and written communication skills.
  • Knows how to obtain and use data and is comfortable with statistical concepts.
  • Strong interpersonal skills to work with all levels across all functional areas to include internal business partners.
  • Strong understanding of regulatory requirements and reporting related to claims processing including Texas Department of Insurance and CMS.
  • Expert understanding health care claims data, pricing and claims editing concepts, including UB04 and HCFA 1500 claim content for varying business lines including Medicare Advantage, Commercial Fully Insured, Medicaid, etc.
  • Experience with Microsoft Word, Excel, PowerPoint, Visio.
  • Preferred systems knowledge – Facets, NetworX Pricer, CES, Tableau.
  • Ability to solve practical problems and deal with a variety of variables in situations where information may be limited.