- MetroPlusHealth (New York, NY)
- …members and providers.Position OverviewClaims Quality Auditor is responsible for reviewing claims to determine if payments have been made correctly. This position ... analyzes data used in settling claims to determine the validity of payment of ...and procedures. The incumbent will research, review, and suggest process improvements, training opportunities and is a resource of… more
- Grant Thornton (New York, NY)
- As a Process Risk & Claims Audit Manager, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand ... and help you achieve more, confidently. Your day-to-day may include: + Leverage claims operations experience and claim audit experience to review and analyze… more
- Grant Thornton (Atlanta, GA)
- …of enterprise or operational risk management programs, and/or entity-level and business process controls for Internal Audit , or other risk management, ... As a Healthcare Process Risk Senior Associate, you will...but are not limited to co-sourced and outsourced internal audit , internal control assessments, enterprise risk management… more
- Amazon (Nashville, TN)
- Description Amazon shipping is seeking a strategic and results driven leader to join as a Sr. Claims Risk Manager to lead the Claims charter for our org. We ... skills, and be an effective communicator. As a Sr. Claims Risk Manager, you will own the...shipping solutions. Basic Qualifications - 6+ years of compliance, audit or risk management experience - Knowledge… more
- American Water (Camden, NJ)
- …opportunity for a detail-oriented and solutions-focused individual with experience in claims management, insurance program oversight, contractual risk transfer, ... role is responsible for the management of American Water's overall loss control, risk control, and analytics-focused claims programs, including but not limited… more
- CHS (Clearwater, FL)
- …approval status. * Developing and implementing strategies for greater automation in the claims process , including electronic receipt of claims and ... clients. * Management of relationships with essential vendors involved with the Claims Adjudication process , including clearinghouses, claims cost control… more
- DoorDash (Tempe, AZ)
- …the company's bottom line. The team is divided into three separate subgroups: Actuarial, Claims Operations, and Risk Management & Mitigation. We are looking for ... About the Team The Risk & Insurance team at DoorDash is responsible...DoorDash. About the Role We are seeking an experienced claims specialist who will be a member of DoorDash's… more
- UNUM (Columbia, SC)
- …significant claims processing counts with ownership over overall payment risk and processing of significant payments. VP oversees direct reporting leaders and ... performance to expectations for service standards for timeliness, accuracy, and risk management of claims including accountability for accurate administration… more
- Axis (Short Hills, NJ)
- …part in the selection process . About the Team AXIS is hiring a Claims Specialist - Primary Casualty for its North America Claim Team. This role involves managing ... We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns...primary claims for AXIS US Primary Casualty policies. How does… more
- Johns Hopkins University (Baltimore, MD)
- …internal audit plan in assigned areas, including performing effective risk assessments and meeting with institutional management to support the development of ... claims processing, premium billing, encounter data, utilization management, risk adjustment, provider contracting, quality metrics, and related operations. +… more
- Aflac (Columbia, SC)
- …and Fraud to gather, analyze and implement process flow changes related to all claims risk activities; serves as a claims subject matter expert for ... Claims Compliance Coord I The Company: Aflac Columbus...operations, products, and services + Fundamental knowledge of auditing process and quantitative and qualitative risk assessment… more
- Axis (Alpharetta, GA)
- …Accommodation is available upon request for candidates taking part in the selection process . **Job Description: Senior Claims Specialist** AXIS is seeking a ... We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns...of signal reserves as well as the sensitivity projection process , to drive optimal claims resolutions for… more
- Sedgwick (Orange, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Sedgwick (Bismarck, ND)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Sedgwick (Troy, MI)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Axis (Red Bank, NJ)
- …third party administrator threshold + Assists in the documentation of system processes + Process claims that are not administered by third party administrators + ... We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns...upon request for candidates taking part in the selection process . Job Title: Accident and Health Claims … more
- Robert Half Office Team (Ontario, CA)
- … claims according to market, priority, appeal status, scanning need, and health plan risk . + Ensure all claims received are complete and ready for processing. ... the appropriate health plan for handling. + Run the Claims Fallout process and distribute Fallout Worksheets...and prepare mailing. + Reconcile processed batches within the audit database. + Create denial trailers and mail denial… more
- M&T Bank (Getzville, NY)
- …Security Claims , Loss Mitigation Claims , and Deed in Lieu Claims . + Process /file claims according to investor/insurer/statutory & regulatory ... the loan to the next phase of the Claim process . + Review claims completed by processors...investor or prior servicer. + Adhere to applicable compliance/operational risk controls in accordance with Company or regulatory standards… more
- Cardinal Health (San Juan, PR)
- …planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory ... evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. + Conducts risk assessments to define audit… more
- Levi, Ray & Shoup, Inc. (Chicago, IL)
- …business goals and regulatory requirements. + Collaborate with compliance teams to audit processes and develop risk mitigation strategies. + Facilitate Agile ... Filters Careers Added Jul 21, 2025 Business Analyst - Claims Systems (26971) Chicago, IL | Contract Apply (https://evoportalus.tracker-rms.com/LRS/apply?jobcode=26971&shownonlrs=True)… more
