- Mass General Brigham (Somerville, MA)
- …to be part of Mass General Brigham. Job Summary Perform DRG validation and quality audit on claims , providing coding expertise in the application of medical and ... to DRG-based reimbursement. Qualifications Responsibilities Perform DRG validation and quality audit on claims , providing coding expertise in the application… more
- Solugenix (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including the audit of claims processed by medical groups and health plans contracted ... requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted… more
- NYC Health Hospitals (New York, NY)
- …of projects. a. Conducts and reviews the following audits: Monthly TPA captured claims audit Monthly additional financial opportunity audit Bimonthly ... wholesaler invoice reviews Quarterly PSA reviews Quarterly CE self- audit collection and review b. Assists the external, independent audit team in collection and… more
- Prime Therapeutics LLC (Albuquerque, NM)
- …audit analytics and professional knowledge to identify educational trends and select claims for audit in alignment to department procedures and objectives ... of audit tools and processes to effectively identify erroneous claims , non-compliant pharmacy practices or potential pharmacy reimbursements Track audit … more
- Ross Stores (Dublin, CA)
- …to remain well informed on industry trends, court decisions impacting lease audit claims , opportunities in technology, and the capabilities of third-party ... all occupancy expenses payable to landlords. Accountable for the entire lease audit function from claim identification to dispute resolution. Manage third party… more
- PIIAC (Grand Junction, CO)
- …needs to present to client. Negotiate insurance premiums with carriers on basis of claims audit . 5. Attend and coordinate meeting with client and Account ... and P&C staff with service questions related to administration, billing, claims issues and problem-solving, upon request. 3. Continually seek cross-sell… more
- Marriott International (Bethesda, MD)
- …Investigations, Legal and Internal Audit , in the resolution of EPLI and Fidelity claims . Advise the Director of Specialty Claims of any high exposure ... Job Description JOB SUMMARY The Senior Manager, Specialty Claims is primarily responsible for overseeing and managing claims covered under Marriott… more
- Aquent (Los Angeles, CA)
- …in ensuring the financial integrity and regulatory compliance of healthcare claims , directly contributing to the organization's mission of providing accessible and ... services. This is an exceptional opportunity to leverage your expertise in claims auditing and financial compliance within a dynamic and purpose-driven environment.… more
- Servpro (Kennewick, WA)
- …situations? Then don't miss your chance to join our Franchise as a new Restoration Claims Manager / Case Manager. In this position, you will be making a difference ... Employee recognition programs Responsibilities: Monitor job file status and job file audit status Maintain job file WIPs Monitor and ensure client requirements are… more
- Stanley Black & Decker (Towson, MD)
- …and detail-oriented individual to join our Legal Team as a Supervising Claims Coordinator. In this position, you will provide administrative support to Product ... including quarterly reporting to Medicare's claim systemCMS. Preparing quarterly Mass Tort audit and summary for EII Board Meetings. Receiving M&S Mass Tort… more
- American International Group, Inc. (Dallas, TX)
- …that best meets clients' needs. Working collaboratively with home office, distribution, actuary, claims , loss control, premium audit , credit and legal to develop ... and maintain a profitable portfolio of primary accounts business. Adhering to underwriting rules and guidelines. Ability to collaborate with other product lines to provide full product support to the client. Strong relationships with brokers to ensure a… more
- Monarch Healthcare Management (St. Paul, MN)
- …monthly billing (including Medical Assistance), and handles collections, refunds, insurance claims , and reporting. Financial and Audit Preparation: Balances ... accounts receivable monthly, prepares aged trial balances, compiles audit documentation, and processes Certificates of Rent Paid (CRPs) by year-end deadlines. Tenant… more
- Walgreens (Canton, MI)
- …into the data processing system for new patient/new referrals. Participates in the review/ audit of test claims for new patient/new referral. Handles processing ... of reorders and emails distribution as needed. Responsible for image indexing, AE report filing, Provides primary support and expertise for specialized programs such as ETT or Pharma. Performs the job responsibilities listed for programs that require special… more
- AssuredPartners (Reading, MA)
- …management plans for clients as assigned an directed by Agency management. Own all audit , review and claims processes for assigned book of business. Analyze data ... to draft client service plans, stewardship reports, and other meaningful reports tailored to the needs of the client and circumstances of the presentation. Insurance Expertise Develop and maintain strong personal relationships with appropriate insurance… more
- GT Independence (Sturgis, MI)
- The GT Self Determination Claims Specialist maintains a core understanding of the company and of Operations. The GT Self Determination Claims Specialist is ... work is completed accurately and efficiently. The GT Self Determination Claims Specialist maintains knowledge, skills, and abilities that contribute to various… more
- City of South Gate, CA (South Gate, CA)
- …Budget Manager on fund forecasting and grant activity. Oversee the preparation, audit , and disbursement of claims , accounts payable, payroll, and collections; ... process and ensure timely delivery of required documentation. Oversee the preparation, audit , and disbursement of claims , accounts payable, and payroll… more
- TEKsystems (Phoenix, AZ)
- …of the servicer and/or client *Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits *Reviews MI claim ... and research curtailment reasons for potential rebuttal *Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI… more
- MINTO PUBLIC SCHOOL (Minto, ND)
- …negotiations) and disseminate minutes to newspaper if applicable Comply with internal audit procedures, schedule external audit , and respond to audit ... Risk Management: Determine insurable values of buildings and contents File loss claims and accident reports Maintain inventory of district equipment; update as… more
- The Travelers Indemnity Company (Glendale, CA)
- …this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim ... resolution for personal or business claims of moderate severity and complexity. Handles ...business other than property (ie auto, workers compensation, premium audit , underwriting) may be required. Provides quality claim handling… more
- City of New York (New York, NY)
- …of Homeless Services (DHS). AO maintains the operation of the Office of Audit Services (OAS) and Office of Quality Assurance (OQA), Special Investigations Division ... Trusts is responsible for the settlement of liens and claims for recoupment of money expended in Medicaid and...the Estates Unit represents DSS and asserts liens and claims against recipients' assets for the recovery of benefits… more
