Texas Licensed Clinical Claims Specialist
Job Summary
To improve and reduce the severity of complex claims, the full-time Texas Licensed Clinical Claims Specialist will provide cost-of-care estimates, consult on medical standards, and collaborate with stakeholders to implement claims savings solutions in a remote environment.
Key responsibilities
- Provide explanations of disease states and associated costs to stakeholders
- Consult with underwriting on medical care approaches and standards
- Review claims and clinical documents to identify opportunities for cost reduction and quality improvement
Required qualifications
- Licensure as a RN or Bachelor's in Healthcare Management or related field
- A minimum of 5 years of clinical/risk management experience
- Experience and/or knowledge of health insurance processes
- CCM, NANCM, or other relevant certification is a plus
- Strong organizational skills with proven time management experience
Complete Job Description
The complete job description is available to members. Premium membership includes:
Full access to 41,015 remote jobs from human-vetted companies, updated daily
Resume Builder - AI-powered tool to craft, enhance, and tailor your resume to a specific job
Twice-monthly live group coaching and the full Remote Career Center
20% member discount on Career Services
Backed by a 30-day money-back guarantee
Company Company Name
Headquarters Headquarters
Founded Founded
Website
Wikipedia Wikipedia URL
The company description is available to members. Go Premium for full access to every job and company profile in our remote jobs database, backed by a 30-day money-back guarantee.
