- 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...Assurance - Comply with best practices measured by monthly Quality Assurance and Management Initiated Audit scores… more
- Grant Thornton (Atlanta, GA)
- 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 ... include but are not limited to co-sourced and outsourced internal audit , internal control assessments, enterprise risk management program assessments, tests of… more
- CHS (Clearwater, FL)
- …for Claims Department strategy, planning, staffing projection, budgeting and quality assurance and improvement. * Responsibility for final hiring decisions on ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...Quality to implement appropriate standards for accuracy and audit procedures intended to validate those standards are met.… more
- American Water (Camden, NJ)
- …wastewater services to our communities. Effective, efficient, and intelligent insurance claims management, oversight, and forecasting are essential to this mission. ... As the Claims & Insurance Manager, you will be instrumental in...are not limited to: o Compliance with applicable Internal Audit , Sarbanes-Oxley mandates and other internal policies. o Monopolistic… more
- NTT DATA North America (Ontario, CA)
- ** Senior Claims Examiner (Xcelys System)** **NTT DATA Services currently seeks a Senior Claims Examiner to join our team working 100% Remote and work on ... training on camera.** **Job Description** To serve as a senior -level adjudicator and SME for medical claims ...Claims processed per day / throughput -Accuracy / audit scores -Rework / error rate -Turnaround time for… more
- NTT DATA North America (Ontario, CA)
- NTT DATA is currently seeking ** Senior Medical Claims Examiners (3+ years of Xcelys required)** to join our US based team. This is a 100% remote role. **Must be ... pm Pacific time zone** **Purpose** To serve as a senior -level adjudicator and SME for medical claims ...contract exceptions + Author overpayment/underpayment determinations and coordinate appeals Quality & Compliance + Engage in quality … more
- Johns Hopkins University (Baltimore, MD)
- **General Summary** We are seeking an **_Internal Audit Manager,_** who demonstrates subject matter expertise in operational internal auditing and the healthcare ... and/or higher education industry. Manages multiple complex internal audit projects. Manages and serves as a technical expert to internal audit staff. Partners… more
- Healthfirst (NY)
- …management, including provider contracting, provider data management, directory data quality , credentialing, and other areas that impact the Healthfirst delivery ... Evaluates, develops, and recommends strategic plans to ensure modern and efficient claims management and provider payment + Analyzes, evaluates, develops, and leads… more
- Healthfirst (NY)
- …Services, etc.). + Experience with database reporting and automation, budgeting or internal audit processes. + Experience monitoring quality in a reporting and ... and consumable information to department leaders. + Define and implement metrics, quality benchmarks and related analysis on performance and service levels to inform… more
- CareFirst (Baltimore, MD)
- …Auditing experience. **Knowledge, Skills and Abilities (KSAs)** + BlueCard + Proficient in quality audit processes and reporting requirements. + Strong PC skills ... FUNCTIONS:** + Serves as the subject matter expert for Quality Assurance area. Perform quality assurance audits...skills conducting problem-solving discussions to negotiate effective solutions to audit issues. + Knowledge of all claims ,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions is seeking a Senior Quality Analyst, who will oversee contract and benefit configuration to ensure accurate ... claims processing and network compliance. This is a remote...compliance. This is a remote role. Primary Responsibilities + Audit system configuration against contract requirements. + Identify fee… more
- Saint-Gobain (Social Circle, GA)
- "This Job Matters" **_What's the job?_** The Senior Quality & Process Control (Q&PC) Manager is a strategic and operational leader responsible for driving ... quality excellence and process control across multiple manufacturing facilities... Council to align with strategic goals. - Ensures audit readiness via structured reviews and root cause analysis.… 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 ... fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist- Senior will be responsible for reviewing coding and clinical decisions on… more
- Capital One (Richmond, VA)
- …Retail Bank: Customer Protection to include Fraud Strategy and Prevention, Fraud Investigations, Claims and Disputes. **The Senior Manager supports the line of ... Senior Manager, Compliance Advisor - Retail Bank The...the Retail Bank Compliance Advisor is responsible for delivering quality results, providing compliance advice to lines of business… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- **Job Summary** As the Senior Manager of Process, Policy & Governance reporting to the Senior Director, Procurement Operations; your primary focus will be the ... issues. + Partner with Sourcing, Legal, Compliance, Information Security, Finance and Quality to embed regulatory risk and controls into the purchasing process. +… more
- Fair Haven Community Health Care (New Haven, CT)
- …clean, and reconcile data across EHR, population health tools, 340B program, and payer/ claims . + Define and implement data quality checks, lineage, and ... choices. As we grow and are able to bring high- quality health care to more areas that need access,...care, regardless of ability to pay. Job purpose The Senior Data Analyst turns clinical, operational, and financial data… more
- Grant Thornton (Phoenix, AZ)
- …Examples of relevant consulting services may include: + Reverse audits (eg, refund claims ) + Audit defense and controversy support + Multi-state nexus analyses ... As the Global Indirect Tax Senior Associate, you'll deliver a full range of...succeed. From day one, you'll be empowered by high quality tools and resources to thrive in your role… more
- Transdev (Lombard, IL)
- …solutions. Our mission is to improve public transportation, to enhance quality of life and combat global warming. https://www.transdevna.com Overview of Position: ... Senior staff position within North American headquarters responsible to...support for key internal topic of insurance and insured claims estimates + Work with actuary and risk department… more
- The Cigna Group (Plano, TX)
- …and data informatics and data exchange using healthcare and clinical data such as Claims , Membership, Audit , Client Structure, and Benefits. If you will be ... job profile for this position is Data Management Strategy Senior Advisor, which is a Band 4 Senior...system analysis, and data retention processes to assure data quality standards. + Collaborate with other departments to ensure… more
- Trinity Health (Pontiac, MI)
- …Ability to develop methodologies for collecting and analyzing relevant data; to audit program processes; monitor quality ; identify, problems and their root ... Services (FANS) Department in a large or sizeable multi-hospital setting. The Senior Manager of Food & Nutrition Services is responsible for successfully… more