- LA Care Health Plan (Los Angeles, CA)
- Senior Health Care Audit Analyst Job...Plans Auditor III is responsible for planning audits and audit work programs that address appropriate claims ... also LA Care contractual agreements. The position handles DMHC claims data submissions for LA Care and its Plan...Care's Specialty Health Plans. Plans specialty audits and develops audit work programs which address state or federal mandates… more
- Providence (Renton, WA)
- …Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims . The Senior Quality Analyst assists the Claims ... claims environment, and respond positively to change.** **The Senior Quality Analyst performs all duties in a manner...and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based… more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
- Axis (New York, NY)
- …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...practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the implementation of Management… 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 ... order to provide account loss ratios and claims history to senior management....of CRC Group offering the position. CRC Group offers medical , dental, vision, life insurance, disability, accidental death and… more
- CVS Health (Tallahassee, FL)
- …a Regional Pharmacy Onsite Auditor, you will be an essential part to the Pharmacy Audit Department at CVS/Caremark. In this role, you will be based from your home ... and travel onsite to conduct claims audits at pharmacies throughout multiple states by reviewing...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- WelbeHealth (Los Angeles, CA)
- **Plan Operation Audit Specialist** WelbeHealth is a value-based healthcare organization that's transforming the future of senior care by providing an ... all-inclusive care option to our most vulnerable senior population. We step in as the care provider...and social services needed to thrive. The Plan Operations Audit Specialist will be accountable for validating various system… more
- CHS (Clearwater, FL)
- … claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with… more
- Henry Ford Health System (Detroit, MI)
- …claim defense costs and management of System reputation Will work under the guidance of Senior Claims Managers, Senior Claims Consultant, Director of ... professional and general liability, workers compensation and employers liability claims review, investigation, management and disposition, including financial mitigation… more
- Amazon (New York, NY)
- Description Amazon's Global Risk Management & Claims team is seeking a highly skilled and detail-oriented Senior Risk Analyst with a background in logistics, ... The ideal candidate will possess an in-depth understanding of insurance claims processes, global cargo regulations, and risk management in transportation. As… more
- Amazon (Tempe, AZ)
- …The Program, Project, Product, and Vendor Management Team within Amazon's Logistics Claims Management and Operations group is seeking a motivated and experienced ... Senior Risk Manager. The ideal candidate will be familiar with insurance and claims programs, and insurance policies, have a history of success in procurement,… 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 ... statistics. + Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding… more
- Ventura County (Ventura, CA)
- …analyze (Accountant I) or calculates and analyzes (Accountant II) Incurred but not Reported medical claims based on system generated claim lag reports to provide ... Accountant I/II/ Senior Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4690309) Apply Accountant I/II/ Senior...up to $23,530 annually to offset the purchase of medical , dental, and/or vision insurance for you and your… more
- Tucson Electric Power (Tucson, AZ)
- …Manages Short-Term and Long-Term Disability (STD/LTD) programs and vendor relationships; ensures STD claims are coordinated with FMLA or general medical cases. o ... **Benefits Analyst - I, II, Senior or Lead** Company **Tucson Electric Power** Location..., including: o Manages all administrative aspects of leave claims to include tracking hours used/taken and working closely… more
- The County of Los Angeles (Los Angeles, CA)
- SENIOR NURSING INSTRUCTOR (EMERGENCY MEDICAL SERVICES) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3309230) Apply SENIOR NURSING ... hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty...the Quality Improvement program for these sections. + Reviews audit and monitoring tools on an on-going basis to… more
- Ventura County (Ventura, CA)
- Senior /Principal Accountant-MB Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4946844) Apply Senior /Principal Accountant-MB Salary ... contribution will be made to the 401(k) plan. + Health Insurance Plans: Medical , dental, and vision plans for you and your dependents. A maximum flexible… more
- LA Care Health Plan (Los Angeles, CA)
- Senior Health Plan Auditor Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... net required to achieve that purpose. Job Summary The Senior Health Plan Auditor is a hybrid role and...and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors.… more
- Otsuka America Pharmaceutical Inc. (Hartford, CT)
- **Position Summary** The Senior Manager, Fleet & Samples Operations oversees the execution of field fleet logistics and pharmaceutical sample distribution. The role ... day to day operations and issue resolution. Escalate issues as appropriate to senior management. + Proactively source and develop ideas to improve fleet program,… more
- Elevance Health (Indianapolis, IN)
- …for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related ... **Clinical Fraud Investigator Senior ** **Location:** _Hybrid1:_ This role requires associates be...regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on… more
- The Cigna Group (Trenton, NJ)
- **Pharmacy Account Manager (Non-IC) Senior Advisor - NY/NJ Market** **Work from Home: Preferably in NY or NJ** As part of Cigna Pharmacy Management, the Senior ... assigned geographical market(s) and client size band. The Pharmacy Account Senior Advisor position will be responsible for developing and maintaining relationships… more
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