- Elevance Health (St. Louis, MO)
- ** Claims Auditor II** **Location :** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... for employment, unless an accommodation is granted as required by law._ The ** Claims Auditor II** is responsible for audits of high dollar claims across… more
- Conduent (Los Angeles, CA)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against our… more
- UCLA Health (Los Angeles, CA)
- …to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned ... to the auditor . You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... kneeling, stooping and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** PA123 **Job Locations**… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... required to achieve that purpose. Job Summary The Specialty Health Plans Auditor III Claims is responsible for all aspects of planning, execution, reporting and… more
- WTW (Chicago, IL)
- **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 ... administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report. You will… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... claims are processed in accordance with Federal, State and...supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any… more
- Trinity Health (Columbus, OH)
- …at 3100 Easton Square Pl Suite 300, Columbus, OH 43219 **Position Purpose:** Delegated Claims Auditor executes, in an accurate and timely manner, in accordance ... You Will Do:** + Maintain current knowledge of the claims operating system + Sort and organize incoming mail...system + Sort and organize incoming mail for the Claims Department. + Log and enter incoming mail into… more
- CVS Health (Scottsdale, AZ)
- … submitted through the CVS Health claims processing systems. The Pharmacy Claims Auditor will identify and rectify claim inaccuracies that would result in ... to not only help people get well, but help them stay well in body, mind and spirit. The Pharmacy Claims Reviewer is responsible for reviewing pharmacy claims… more
- TEKsystems (Los Angeles, CA)
- …with a passion for healthcare claims and compliance? Join our team as a Claims Compliance Auditor , where you'll play a pivotal role in ensuring accuracy, ... efficiency, and regulatory alignment across our claims operations. In this role, you'll: + Lead audits...Lead audits and compliance reviews for HMO and Medicare claims + Analyze benefit structures and system configurations (EZCap… more
- Actalent (West Des Moines, IA)
- …understanding of standard medical coding, including CPT, ICD-10, and HCPCS. The Nurse Auditor is responsible for adjudicating claims to comply with client ... Nurse Auditor Job Description This role requires a thorough...documentation. This includes determining accurate payment criteria for pending claims , auditing and pricing a wide variety of claim… more
- CVS Health (Phoenix, AZ)
- …part of CVS Caremark's extensive Pharmacy Audit division. The Medicare Pharmacy Claims Auditor will administer assigned Medicare Part-D Compliance Audit ... Programs, review pharmacy submitted Medicare claims , make independent decisions, and call network pharmacies to audit submitted information and communicate business… more
- United Rentals (Stamford, CT)
- …charges, and other negotiated terms. + Apply these terms when assessing auditor claims to identify potential misinterpretations or overreach. + Findings ... internal and external stakeholders - with the goal of minimizing unwarranted financial claims and protecting company revenue. **What you'll do:** + Audit Intake &… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Agriculture & Markets, Department of Title Auditor 1 or Trainee (NY HELPS) Occupational Category Other Professional Careers Salary Grade 18 ... State Department of Agriculture and Markets is seeking an Auditor 1 or Trainee to work in Albany. The...integrity of the tax credit mid-year advance and year-end claims . Specific duties and responsibilities include but are not… more
- CGI Technologies and Solutions, Inc. (Knoxville, TN)
- **OP Coding Auditor ** **Category:** Analytics and Emerging Digital Technologies **Main location:** United States, Tennessee, Knoxville **Alternate Location(s):** ... ID:** J0925-0302 **Employment Type:** Full Time **Position Description:** The OP Coding Auditor is a member of the CGI Healthcare Compliance, Outpatient Coding Team,… more
- The County of Los Angeles (Los Angeles, CA)
- INTERNAL AUDITOR / ACCOUNTANT- AUDITOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4103628) Apply INTERNAL AUDITOR / ACCOUNTANT- ... CA Job Type Full time Job Number S0675I Department AUDITOR -CONTROLLER Opening Date 09/02/2025 Closing Date 9/19/2025 5:00 PM...steps to view correspondence, and we will not consider claims of missing notices to be a valid reason… more
- New York State Civil Service (Brooklyn, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Occupational Category ... City Brooklyn State NY Zip Code 11201 Duties Description Auditor 1 (Tax) performs on-site field audits and examinations...and advocate disputed cases at BCMS conferences and Small Claims Hearings. May participate at hearings as a witness… more
- ManpowerGroup (Vienna, VA)
- Our client, is seeking a Bank and Corporate Owned Life Insurance (BOLI/COLI) Auditor to join their team. As a Bank and Corporate Owned Life Insurance (BOLI/COLI) ... Auditor , you will be part of the Audit Services...policies. + Conduct thorough audits of life and death claims to verify accuracy, completeness, and compliance with company… more
- MAPFRE Insurance (Webster, MA)
- Internal Auditor (Webster or Boston, MA) Date: Aug 24, 2025 Location: Webster or Boston, MA, US Company: MAPFRE **Who We Are** A dynamic, forward-thinking ... risk mitigation, and continuous process improvement. We are looking for an Auditor to optimize and streamline our audit processes while driving innovation and… more
- The County of Los Angeles (Los Angeles, CA)
- LAW ENFORCEMENT AUDITOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4668332) Apply LAW ENFORCEMENT AUDITOR Salary $109,807.68 - ... No 10 In the execution of the Law Enforcement Auditor duties, you will have to make site visits...to view correspondence. Los Angeles County will not consider claims of not viewing or receiving notifications to be… more
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