- The Career Sphere (Denmark, SC)
- …Pediatrician to join our mission-driven team. The Pediatrician will provide high- quality , comprehensive medical care to children and adolescents in a community ... FHC features excellent physicians, nurses, and premier technology to ensure the highest quality experience. Our goal is to improve the health of the people of… more
- WellSense (Boston, MA)
- Claims Quality Assurance Inspector WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through ... works for our members, no matter their circumstances. **Job Summary:** The Claims Quality Inspector is responsible for the thorough and accurate review of… more
- AIG (Atlanta, GA)
- Claims , Quality Assurance Specialist - Worker's Compensation Join us as a Claims QA Specialist to make more of your specialist expertise and experience. Make ... your mark in Claims . Our Claims teams are the proven...efficiency. How you will create an impact + Complete quality reviews on all files within program guidelines while… 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
- UCLA Health (Los Angeles, CA)
- …random and focus audits of all claim processing activities to identify inaccurate claims adjudication. This will involve reviewing UB04 and CMS 1500 healthcare ... claims and adjustments for accuracy, and appropriate application ...maintain statistical data and ensure compliance with production and quality standards in accordance with department policy. Salary Range:… more
- Quad (Sussex, WI)
- …improvement in paper quality and performance. Key Responsibilities + Credit and Claims Management + File claims related to quality issues across ... outcomes + Operational Documentation + Co-author and maintain templates for production claims and quality tracking. + Contribute to technical specification… more
- Brighton Health Plan Solutions, LLC (NC)
- …reports. The expectations include providing coaching, mentoring, and training while promoting quality and superior customer service. The Claims Supervisor is ... claims requiring adjudication. + Review and process High Dollar claims and conduct quality reviews of claims and logic changes/updates. + Assist Customer… more
- Commonwealth Care Alliance (Boston, MA)
- …will not be considered at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst ... Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the end-to-end review,… more
- HCA Healthcare (Nashville, TN)
- …ability to independently problem solve and proactively manage and resolve claims . Job Responsibilities: Quality + Handle professional medical malpractice ... an organization that invests in you as a Senior Claims Supervisor? At HCA Healthcare, you come first. HCA... and trends in order to support collaboration and quality of care. + Build and maintain strategic alliances… more
- AIG (Boston, MA)
- …on the portfolio. + You will also contribute to continuous improvement in Claims by supporting Quality Assurance / Regional Audit processes, ensuring mitigation ... Job Description Join us as a Claims Analyst IV to take on key responsibilities within a world-class claims function. Make your mark in Claims As a Claim… more
- Cognizant (Lincoln, NE)
- …coverage guidelines and regulations + Experience in the analysis and processing of claims , utilization review/ quality assurance procedures + Must be able to work ... business operations. We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical**... Processors to join our growing team. The **Medical** ** Claims Processor** is responsible for the timely and accurate… more
- Honeywell (Phoenix, AZ)
- …and motivated Supplier Quality Lead to spearhead our initiative in managing supplier quality and overseeing monetary claims related to the cost of poor ... monetary claims from suppliers for costs associated with poor quality and additional inspections. + Develop and implement processes for documenting, tracking,… more
- APTIM (Santa Fe, NM)
- …requirements. This role serves as the primary point of escalation and quality assurance for assigned claims , supporting continuous training, technical accuracy, ... procedures to ensure compliance + Monitor the accuracy and quality of claims reviews, flag inconsistencies, and enforce corrective actions where necessary +… more
- Apex Health Solutions (Houston, TX)
- …consistent standards, practices, and processes focused on timely and accurate adjudication of claims to review, evaluate and/or quality control review and final ... issues and appropriately checking with management when necessary, to provide excellent quality in claims adjudication Promotes individual professional growth and… more
- Cedars-Sinai (CA)
- …to all CMS and DMHC guidelines. Investigate and complete open or pended claims . Meet production and quality standards. Job Duties and Responsibilities: + ... **Job Description** The Claims Examiner is responsible for accurately and consistently...preferred. **About Us** Cedars-Sinai is a leader in providing high- quality healthcare encompassing primary care, specialized medicine and research.… more
- Cognizant (Pierre, SD)
- About the role As a ** Quality Analyst with Healthcare - Claims & Membership experience** . You will make an impact by designing and executing end-to-end test ... strategies that ensure the quality and reliability of healthcare claims and membership applications. You will be a valued member of the Quality Engineering… more
- Kemin Industries (Des Moines, IA)
- …+ Support Kemin Health customer needs and/or create collateral related to regulatory, claims , and quality compliance as it related to Kemin Health ingredients. ... for final review and approval of all product formulas, and product claims ,, quality questions, and claim-language freedom to operate decisions for business unit… more
- Zurich NA (Springfield, IL)
- … Specialist, your primary accountabilities will include: + Work the most complex claims , involving multiple causes of loss, multiple quality issues, subrogation ... or area + Completes Crop Hail re-inspections when requested for quality assurance purposes + Works claims of 508H (Risk Management Agency pilot) crops + Assist… more
- Sedgwick (Orange, CA)
- …Compiles reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Liability Are you looking for...contract requirements, and quality standards. + Acts as second level of appeal… more
- Sedgwick (Madison, WI)
- …Compiles reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service ... Fortune Best Workplaces in Financial Services & Insurance Auto Claims Team Lead **PRIMARY PURPOSE** : To supervise the...contract requirements, and quality standards. + Acts as second level of appeal… more
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