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Claims assistant • dallas tx

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Claims Adjudicator

Claims Adjudicator

Parkland Health and Hospital System (PHHS)Dallas, TX, United States
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Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.PCHP is a Medicaid Manage...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Claims Adjuster- TPA Claims

Claims Adjuster- TPA Claims

AIGDallas, TX
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At AIG, we are reimagining the way we help customers to manage risk.Join us as a Claims Analyst TTPO Claims to play your part in that transformation. It’s an opportunity to grow your skills and expe...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Claims Business Analyst

Claims Business Analyst

RIT SolutionsDallas, TX, US
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Location : Hybrid 3 Days (Charlotte, NC; Chicago, IL; Colorado Springs, CO; Conshohocken, PA; Dallas, TX; Fargo, ND; Garden City, NY. Houston, TX; Jacksonville, IL; Lenexa, KS; Los Angeles, CA; Lub...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Casualty Claims Representative

Casualty Claims Representative

W.R. BerkleyIrving, TX, US
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Casualty Claims Representative.Berkley Southwest offers commercial property and casualty products and services through independent agents in Arizona, Arkansas, New Mexico, Oklahoma and Texas.We mai...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Claims Examiner

Claims Examiner

Arthur LawrenceIrving, TX, US
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Schedule : Monday to Friday, 8 : 00 AM – 4 : 00 PM.Work Setup : Hybrid (1–2 days on-site per week).Review and process standard or less complex insurance claims (electronic and written).Respond to custome...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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VSC Claims Adjuster

VSC Claims Adjuster

FortegraDallas, TX, US
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The VSC Mechanical Claims Adjuster is responsible for handling incoming claims calls, evaluating mechanical failures, and determining coverage under Vehicle Service Contracts (VSC).This role is par...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Claims Adjudicator

Claims Adjudicator

Parkland HealthDallas, TX, US
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Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.PCHP is a Medicaid Manage...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Assistant Claims Examiner

Assistant Claims Examiner

SSi PeopleIrving / Texas
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Job Title : Assistant Claims Examiner.Location : Irving, Texas (Hybrid).Input insurance claims received via electronic or written formats. Handle customer inquiries about claim processing.Record claim...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Claims Representative

Claims Representative

VirtualVocationsDallas, Texas, United States
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A company is looking for a Claims Representative.Key Responsibilities Provide expertise in claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Claims Adjudicator - Managed Care Medicaid Claims

Claims Adjudicator - Managed Care Medicaid Claims

Parkland Health & Hospital SystemDallas, TX, US
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Claims Adjudicator - Managed Care Medicaid Claims.Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of th...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Insurance Claims Specialist

Insurance Claims Specialist

DPR ConstructionDallas, TX, US
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The Claims Specialist will be responsible for assisting with the management of the Fleet Vehicle Safety & Operations Policy for DPR (and DPR related entities) across the US, as well as first and th...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
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Claims Team Lead Assistant - Liability - Irving or Plano, TX

Claims Team Lead Assistant - Liability - Irving or Plano, TX

SedgwickIrving, TX, US
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Claims Team Lead Assistant - Liability.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Claims Representative

Claims Representative

UnitedHealth GroupDallas, TX, US
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This position is National Remote.You'll enjoy the flexibility to telecommute • from anywhere within the U.Optum is a global organization that delivers care, aided by technology to help millions of p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Claims Trainer

Claims Trainer

KemperDallas, Texas
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Birmingham, Alabama, Dallas, Texas.Kemper is one of the nation’s leading specialized insurers.Our success is a direct reflection of the talented and diverse people who make a positive difference in...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Manager, Claims (Portal Response)

Manager, Claims (Portal Response)

Molina HealthcareDallas, TX, United States
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Responsible for administering claims payments, provider claims inquiries, reconsiderations, claims adjudication, and maintaining claim records for the Portal Response Team.Provides counsel to claim...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Indemnity Claims Specialist

Indemnity Claims Specialist

CorVel CorporationDallas, TX, USA
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The Indemnity Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible o...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Claims Manager, Construction

Claims Manager, Construction

Starr Insurance CompaniesDallas, TX, United States
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Starr Insurance Companies is a leading insurance and investment organization, providing commercial property and casualty insurance, including travel and accident coverage, to almost every imaginabl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Claims Adjudicator

Claims Adjudicator

Parkland Health and Hospital SystemDallas, TX, US
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Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.PCHP is a Medicaid Manage...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Claims Technical Specialist

Claims Technical Specialist

Core SpecialtyDallas, TX, United States
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A key member of the Property Claim team, responsible for direct handling of first party Property claims of high severity and complexity. Responsibilities may also include oversight of first party Pr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Claims Technical Specialist

Claims Technical Specialist

Core Specialty InsuranceDallas, TX, US
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A key member of the Property Claim team, responsible for direct handling of first party Property claims of high severity and complexity. Responsibilities may also include oversight of first party Pr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Claims Adjudicator

Claims Adjudicator

Parkland Health and Hospital System (PHHS)Dallas, TX, United States
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Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose

Parkland Community Health Plan's (PCHP's) Claims Adjudicator is responsible for reviewing, adjudicating, and resolving Medicaid healthcare claims within the QNXT system. This role supports efficient claims operations, maintaining high accuracy while meeting production targets and ensuring compliance with TMHP and Medicaid guidelines. This is a Hybrid role with some in-office meetings required.

Minimum Specifications

Education

  • High school diploma or equivalent required.

Experience

  • Two (2) years of experience in healthcare claims adjudication required.
  • Expertise in the QNXT platform preferred.
  • Experience working with Texas Medicaid claims and Medicaid regulatory requirements is preferred.
  • Knowledge of NetworX Pricer for claims pricing and reimbursement is a plus.
  • Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
  • Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
  • Excellent analytical and problem-solving skills.
  • Proficient in adjudicating claims using QNXT, including resolution of pended or denied claims.
  • Strong understanding of claims adjudication processes, benefit structures, and provider contracts.
  • Familiarity with the claim's life cycle, including submission, processing, adjudication, and payment processes.
  • Ability to identify and resolve claim discrepancies effectively and efficiently.
  • Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
  • Ability to write clearly and succinctly with a high level of attention to detail.
  • Proficient computer and Microsoft Office skills. Ability to learn new software programs.
  • Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.

    • Responsibilities

    Operations

  • Review and process healthcare claims within the QNXT system, ensuring compliance with benefit policies, pricing, and regulatory guidelines.
  • Adjudicate claims accurately by analyzing supporting documentation, provider contracts, and fee schedules.
  • Investigate and resolve pended or denied claims by applying appropriate corrections in QNXT.
  • Collaborate with internal teams to identify, address, and resolve systemic claims issues.
  • Meet or exceed established productivity targets for claims adjudication in a high-volume environment.
  • Effectively prioritize and manage workload to meet deadlines and organizational objectives.
  • Document claim outcomes, adjustments, and resolutions accurately within the QNXT system.
  • Provide updates and insights on claims performance metrics to supervisors as needed

    • Quality

  • Integrate health literacy principles into all communication including Members and Providers.
  • Support strategies that meet clinical, quality and network improvement goals.
  • Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
  • For staff in clinical roles, foster collaborative relationships with members and / or providers to promote and support evidence-based practices and care coordination.
  • Ensures high accuracy in claims adjudication to meet quality standards and maintain compliance with policies and regulations.

    • Regulatory

  • Ensures work is carried out in compliance with regulatory and / or accreditation standards as well as contractual requirements.
  • Ensure all claims are adjudicated in alignment with TMHP guidelines, Medicaid regulations, and internal policies.

    • Professional Accountability

  • Promotes and supports a culturally welcoming and inclusive work environment.
  • Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
  • Adheres to organizational policies, procedures, and guidelines.
  • Completes assigned training, self-appraisal, and annual health requirements timely.
  • Adheres to hybrid work schedule requirements.
  • Attends required meetings and town halls.
  • Recognizes and communicates ethical and legal concerns through the established channels of communication.
  • Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
  • Maintains confidentiality at all times.
  • Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

    • Job Accountabilities

    1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.

    2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars / workshops, reading professional journals, actively participating in professional organizations, and / or maintaining certification or licensure. Integrates knowledge gained into current work practices.

    3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

    Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.