- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...and respond to carrier and/or arbitrator inquires + Submit claims through state arbitration portals Qualifications : To perform… more
- CenterLight Health System (NY)
- …effectiveness of the claims department by timely and accurate processing of claims appeals and performing claims audit , ensuring payment integrity and ... monies and proper application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical claims paid and denied accurately.… more
- Champlain Valley Educational Services BOCES (Plattsburgh, NY)
- …This position is an annual appointment of the CVES Board to fulfill their claims audit function. Audits are done weekly and typically on Wednesday each ... the Deputy Claims Auditor. The ideal time for our weekly Wednesday claims audit is during the workday between 8am and 4pm. Location: CVES Learning Hub Campus… more
- Old Dominion Freight Line (Thomasville, NC)
- …pay as needed + Review financial information and determining settlement of downtime claims + Audit and process independent adjuster invoices + Write settlement, ... keep OD the premier transportation solutions provider. Effectively handle property damage claims due to OD vehicle accidents and incidents. Perform other duties… more
- LA Care Health Plan (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including 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
- AIG (Atlanta, GA)
- …Professional Services Partners, while monitoring SLA's and quality. + Partner with Compliance, Audit , Claims , and IT providing direction and support for SOX and ... customers to manage risk. Join us as a Senior Claims Business Analyst to play your part in that...questions, etc. as well as the remediation of system-related audit findings and improvement opportunities. What you'll need to… more
- Gates Chili Central School District (Rochester, NY)
- …strives to dismantle exclusion, bias, racism, and prejudice of all forms. Deputy Internal Claims Auditor To audit and approve each claim (except contracted wages ... The individual appointed to the position should be independent, qualified to audit the claims , and should receive any necessary training. The claims auditor… more
- Wittenberg Weiner Consulting LLC (Santa Fe, NM)
- Copperhead is seeking multiple Audit and Quality Control Claims Specialist for a potential contract to support disaster relief. This position involves receiving, ... meticulous attention to detail and adherence to FEMA guidelines. Audit and Quality Control Claims Specialist will...to FEMA guidelines. Audit and Quality Control Claims Specialist will objectively review, investigate, process, and evaluate… more
- CRC Insurance Services, Inc. (TN)
- …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 ... Responsible for overseeing, managing and supporting all activities of the claims employees and operations of the department. **ESSENTIAL DUTIES AND… more
- Robert Half Accountemps (Minneapolis, MN)
- …Process appeals and adjustments in alignment with established procedures and guidelines. * Audit claims for accuracy and adherence to organizational standards. * ... Description We are looking for a highly skilled MCO Claims Analyst to join our team on a long-term...In this role, you will analyze and process healthcare claims while ensuring strict compliance with industry standards, organizational… more
- Providence (Renton, WA)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... to department leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and training observations +… more
- Conduent (Orlando, FL)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Sedgwick (Baltimore, MD)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Team Lead | Dedicated Client | Remote **5-7 years Workers Compensation… more
- Sedgwick (Long Beach, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Best Workplaces in Financial Services & Insurance Workers Compensation Claims Supervisor | Long Beach, CA (Hybrid) | SIP...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more
- Sedgwick (Seven Hills, OH)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Team Lead | OH Jurisdictions (potential for MI, KY & IN) +… more
- Sedgwick (Rochester, NY)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Team Lead | New York Jurisdiction Job Description We are seeking a… more
- Access Dubuque (Dubuque, IA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Workforce Absence Team Lead - Claims Assistant Team **Sedgwick** 1 Positions ID: R61333...Financial Services & Insurance Workforce Absence Team Lead - Claims Assistant Team All eligible candidates must live near… more
- Sedgwick (Dubuque, IA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Best Workplaces in Financial Services & Insurance Workforce Absence Team Lead - Claims Assistant Team All eligible candidates must live near our center of excellence… more
- Commonwealth Care Alliance (Boston, MA)
- …Experience (must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and ... 011250 CCA- Claims Position Summary: Reporting to the Director, ...identify areas of risk or non-compliance. * Track internal audit findings and facilitate resolution through Corrective Action Plans… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. + Maintains awareness of fraud, waste and ... protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed… more
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