- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Senior Claims Research and Resolution Professional reports to the Claims Research ... strategy and operating objectives, including their applications to assignments. The Senior Claims Research and Resolution Professional follows general guidance… more
- Axis (Alpharetta, GA)
- …available upon request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims...practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the implementation of Management… more
- Elevance Health (Winston Salem, NC)
- ** Claims Auditor Senior ** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... considered for employment, unless an accommodation is granted as required by law._ The ** Claims Auditor Senior ** is responsible for auditing of high dollar … more
- Grant Thornton (Los Angeles, CA)
- As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare systems. This includes areas such as… more
- Point32Health (Canton, MA)
- …contract interpretation in accordance to claims processing guidelines, Point32Health Medical and Payment Policies and established audit protocols. He/she ... (minimum): 5-7 years of related professional healthcare experience including familiarity with medical claims processing. + Preferred: 8-10 years of related work… more
- Providence (MT)
- **Description** ** Senior Claims Manager - Employment Practice Liability \*Remote * Candidates residing in Alaska, Washington, Montana, Oregon, California, Texas ... or New Mexico are encouraged to apply.** The Senior Claims Manager- Employment Practice Liability ("EPL")...- they're invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused,… more
- CRC Insurance Services, Inc. (Raleigh, NC)
- …following job description:** Responsible for managing and resolving complex insurance claims involving litigation, coverage disputes, and high exposure. This role ... then hire attorney for coverage counsel for coverage analysis. 2. Settle claims within settlement authority, where applicable. 3. Work with adjusters, insureds,… more
- CHS (Clearwater, FL)
- … claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with… more
- WTW (Chicago, IL)
- …PPO, Indemnity and Managed Care + Must demonstrate a high level of claims administration knowledge, including experience with medical , dental, mental health and ... **Description** As a Lead Auditor you will apply your audit , project management and client management skills to lead client audits. You will serve as the team leader… more
- Cardinal Health (San Juan, PR)
- …with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, ... medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles… more
- American Water (Camden, NJ)
- …package including 401(k),Defined Contribution Plan, Employee Stock Purchase Plan, medical , prescription, dental and vision coverage, plus disability, paid time ... wastewater services to our communities. Effective, efficient, and intelligent insurance claims management, oversight, and forecasting are essential to this mission.… more
- Providence (WA)
- … Claims Managers, Claims Technicians and Claims Specialists. The Claims Manager can be distinguished from the senior manager by handling claims ... **Description** ** Claims Manager** **_Remote. Candidates residing in AK, WA,...- they're invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused,… more
- CRC Insurance Services, Inc. (NC)
- …5. Train claims staff on new policies or procedures. 6. Oversee and audit claims process ensuring proper documentation was created in the system and/or ... order to provide account loss ratios and claims history to senior management....of CRC Group offering the position. CRC Group offers medical , dental, vision, life insurance, disability, accidental death and… more
- Ascension Health (Austin, TX)
- …requirements established by Health and Human Services Commission. Perform routine and/or targeted audit of claims to ensure payment accuracy and adherence to ... that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine appeal outcomes....of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision… more
- AutoZone, Inc. (Little Rock, AR)
- …due AutoZone. **Responsibilities** ** Senior Focus - Data Responsibilities or 3rd Party Audit Support:** DATA + Assist the Senior Manager with the Annual ... **Job Description** As a **Sr. Audit Recovery Auditor** , you will Utilize analytical...3rd Party vendors to recover less than 10% behind Senior Auditor. Negotiate and communicate flawlessly with Merchandising and… more
- Movn Health (CA)
- Role Summary Movn Health is seeking a highly experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts ... receivable recovery. This is a hands-on, senior -level role focused on accelerating cash flow, reducing outstanding balances, and ensuring accurate, compliant billing… more
- Independent Health (Buffalo, NY)
- …knowledge and audit tips across the team. The Clinical & Coding Specialist- Senior will support the leadership in Hospital Audit in accomplishing all aspects ... statistics. + Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding… more
- Axis (Chicago, IL)
- …variety of loss scenarios as well as reporting and presenting about same to senior management + In-depth knowledge of claims , litigation, arbitration, and trial ... part in the selection process. **Job Description** AXIS is seeking a **_Senior Claims Specialist - Environmental Claims_** to join our North America Claims .… more
- The County of Los Angeles (Los Angeles, CA)
- SENIOR NURSING INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3309230) Apply SENIOR NURSING ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...the Quality Improvement program for these sections. + Reviews audit and monitoring tools on an on-going basis to… more
- AdventHealth (Maitland, FL)
- …as it relates to reimbursement methodologies + Applies significant understanding of medical coding systems affecting the adjudication of claims to include ... Location** : Maitland, FL **The role you will contribute:** The Senior Compliance Analyst applies technical, analytical, and problem-solving skills to identify,… more