- Robert Half Accountemps (Boston, MA)
- Description Job Title: Medical Claims Auditor - RN Auditor Location: Massachusetts - 90% Remote Job Type: 1 Year Contract - Potential for Perm Hire ... 1, 2025 Job Description We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities...perform onsite audits (1-4 times per month) + Evaluate claims and provider documentation for compliance and accuracy +… more
- Elevance Health (Boston, MA)
- ** Claims Auditor I, II and Senior** **Location...interprets Medical Policy and Clinical Guidelines. + ** Claims Auditor Senior** - all the above, plus ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...various aspects of the claim including eligibility, pre-authorization, and medical necessity. + Contacts others to obtain any necessary… more
- GE Aerospace (Boston, MA)
- …team at ERAC, a corporate holding of GE Aerospace, as a Reinsurance Auditor and lead audits that drive transparency, innovation, and integrity across reinsurance ... In this high-impact role, you'll deliver sharp insights, adjudicate complex claims , and collaborate across teams using advanced analytics and emerging technology.… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will ... (CPC) + Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to...Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for… more
- CVS Health (Woonsocket, RI)
- …adjudication principles, such as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review and respond to ... all the auditor questions in a short window of time. This...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …member of the Audit and Risk Management (ARM) team, the Senior Internal Auditor will lead and execute a variety of financial, operational, and risk-based audits ... reporting and risk-based audits of these areas (eg Enrollment, Premiums, Claims Operations, Provider Enrollment and Pricing, Accounting, and Information Technology… more