- 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, ... role requires meticulous attention to detail and adherence to FEMA guidelines. Audit and Quality Control Claims Specialist will objectively review, investigate,… more
- 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,...at LogixHealth: We offer a comprehensive benefits package including health , dental and vision, 401(k), PTO, paid holidays, life… more
- DXC Technology (Richmond, VA)
- …quality control and assurance tasks, by reviewing Life and Annuity Death Claims payment and correspondence review, to ensure product compliance with regulatory and ... work experience in Life and Annuity** Proven experience in Life/Annuity Death Claims processing and Quality review** Proficiencies in quality assurance and risk… more
- LA Care Health Plan (Los Angeles, CA)
- …for planning audits and audit work programs that address appropriate claims and financial compliance criteria for specialty health plans. These audits ... Senior Health Care Audit Analyst Job Category:...also LA Care contractual agreements. The position handles DMHC claims data submissions for LA Care and its Plan… more
- LA Care Health Plan (Los Angeles, CA)
- …for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted with LA Care. ... findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted with LA Care. Timely audit reports… more
- Elevance Health (Houston, TX)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … 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
- Novant Health (NC)
- …of ICD-10- CM/PCS, CPT or HCPCS codes and the accuracy of assignment for Novant Health Facilities as assigned by Corporate Coding Audit Response Lead. + Audits ... audits, commercial payers, and CMS payers. Responses will be coordinated through the Audit Response Lead for all applicable Novant Health facilities. + The… more
- Novant Health (NC)
- …of ICD-10- CM/PCS, CPT or HCPCS codes and the accuracy of assignment for Novant Health Facilities as assigned by Corporate Coding Audit Response Lead. + Audits ... audits, commercial payers, and CMS payers. Responses will be coordinated through the Audit Response Lead for all applicable Novant Health facilities. + The… more
- WelbeHealth (Los Angeles, CA)
- …with the oversight, monitoring, and auditing of other functional areas within Health Plan Services, including Claims , Contracting, Credentialing and Provider ... **Plan Operation Audit Specialist** WelbeHealth is a value-based healthcare organization...validating various system configurations to ensure accurate processing of claims in accordance with provider agreements, regulatory guidelines, and… more
- CHS (Clearwater, FL)
- **Overview** ** Claims Manager** **Servicing** ** Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party ... Examiner queues waiting to be adjudicated, and in either audit or needing approval status. * Developing and implementing...results will be compared to goals in each period. ** Claims Manager** ** Health Insurance Policies or Benefits**… more
- Conduent (Warren, MI)
- …and be part of a culture where individuality is noticed and valued every day. ** Claims Auditor** **Position is onsite in Warren, MI** Training: Mon- Thur ( On the ... North America Supplier Claim Activity ("SCA") group is responsible for receipt, audit , processing, accrual and forecasting of supplier obsolescence and cancellation … more
- Henry Ford Health System (Detroit, MI)
- …and general liability, workers compensation and employers liability claims review, investigation, management and disposition, including financial mitigation ... and management of System reputation Will work under the guidance of Senior Claims Managers, Senior Claims Consultant, Director of Insurance, and Vice President,… more
- Providence (Renton, WA)
- …and retain the best people, we must empower them.** **Providence St Joseph Health operates a self-administered claims program for General and Healthcare ... organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending… more
- CenterLight Health System (NY)
- …a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining processes, conducting comprehensive data analysis, ... guidelines. This position requires a working knowledge of Government Programs medical claims payment system and configuration with strong focus on data review and… more
- Prime Healthcare (Ontario, CA)
- …and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the ... position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible...TheVice President of Health Plan Operations and Claims is responsible for the development and execution of… more
- University of Utah (Salt Lake City, UT)
- …current knowledge, and interprets state and federal regulations regarding payments in health care to audit claims correctly. **Minimum Qualifications** ... **Work Schedule Summary** Hybrid weekday schedule. **VP Area** U of U Health - Academics **Department** 01663 - COMPLIANCE SERVICES **Location** Campus **City** Salt… more
- City of New York (New York, NY)
- …CIVIL SERVICE LIST ARE ELIGIBLE TO APPLY. Division/Program Summary: The Bureau of Audit Services plays a leading role in risk-based assessments of the Department's ... Innovation's policies. Position Summary: DOHMH is seeking an Assistant Audit Manager to join the Bureau of Audit...all testing schedule (PS, OTPS, Fringe, Admin, LOS, EI claims ) and draft reports and submit for Supervisors review… more
- CVS Health (Tallahassee, FL)
- …travel on the company's site in a cost effective manner - Knowledge of CVS Health (or other PBM) claims processing - Knowledge of retail pharmacy operations ... At CVS Health , we're building a world of health ...you will be an essential part to the Pharmacy Audit Department at CVS/Caremark. In this role, you will be… 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