- Marshfield Clinic (Marshfield, WI)
- …come together to support the most exciting missions in the world!** **Job Title:** Claims Auditor (Remote - WI or MN) **Cost Center:** 682891379 SHP- Claims ... day shifts (United States of America) **Job Description:** **JOB SUMMARY** The Claims Auditor is responsible for performing payment, procedural accuracy,… more
- 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 Hours: 40 ... 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
- Conduent (Los Angeles, CA)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against our… 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
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... kneeling, stooping and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** PA123 **Job Locations**… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... required to achieve that purpose. Job Summary The Specialty Health Plans Auditor III Claims is responsible for all aspects of planning, execution, reporting and… more
- WTW (Chicago, IL)
- **Description** As a Lead Auditor you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader ... administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report. You will… more
- Molina Healthcare (Iowa City, IA)
- …accurate and timely implementation and maintenance of critical information on all claims and provider databases, validate data housed on databases and ensure ... that the contracts are configured correctly in QNXT. The claims are reviewed to ensure that the configured services...to detect any gaps in the correct payment of claims Make recommendations for potential revision and updates *… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... claims are processed in accordance with Federal, State and...supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any… more
- Amergis (Los Angeles, CA)
- …+ Level I Trauma & Teaching at Large Hospital REQUIRED + Prefer someone from a big time University Medical Center + Recent experience auditing and educating coders ... Salary: $50 / Hour Position Overview: + Primary Responsibility: OP Claim Edits - Must have extensive experience in this area + Audit HB SDS / Observation cases (may see some ED cases) + Will see a wide range of HB surgical specialties + Potentially lots of… 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 ...claims and adjustments for accuracy, and appropriate application claims adjudication, including CMS regulations, Department of Financial Responsibility… more
- CVS Health (Phoenix, AZ)
- …part of CVS Caremark's extensive Pharmacy Audit division. The Medicare Pharmacy Claims Auditor will administer assigned Medicare Part-D Compliance Audit ... Programs, review pharmacy submitted Medicare claims , make independent decisions, and call network pharmacies to audit submitted information and communicate business… more
- New York State Civil Service (Syracuse, NY)
- NY HELP Yes Agency Taxation & Finance, State Title Auditor 1 (Tax)/ Auditor Trainee 1 (Tax)/ Auditor Trainee 2 (Tax) (NY HELPS) Occupational Category ... City Syracuse State NY Zip Code 13202 Duties Description Auditor 1 (Tax) performs on-site field audits and examinations...and advocate disputed cases at BCMS conferences and Small Claims Hearings. May participate at hearings as a witness… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Civil Service, Department of Title Internal Auditor 1, or Trainee 1 / Trainee 2 Occupational Category Other Professional Careers Salary Grade NS ... into NYSHIP's databases. Under the direction of an Internal Auditor 2 the Internal Auditor 1, or...Experience and competence in medical fields, medical research, medical claims , Access, Pandas, Anaconda, SQL, and/or Python is preferred.… more
- Humana (Boise, ID)
- …Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider ... caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns… more
- Sedgwick (Des Moines, IA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Independent Adjuster Auditor As an Independent Adjuster Auditor at Sedgwick, you'll have the ... professional needs. **PRIMARY PURPOSE** **OF THE ROLE** The Independent Adjuster Auditor reviews Independent Adjuster and other Non-Legal Vendor invoices on behalf… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …transform healthcare? Bring your true colors to blue. About the Role: The Professional Auditor is responsible for post-pay review to verify the accuracy of claims ... the Plans' provider agreements and the National Healthcare guidelines. The Professional Auditor helps improve clinical outcomes and quality of care, to reduce… more
- MAPFRE Insurance (Webster, MA)
- Internal Auditor (Webster or Boston, MA) Date: Sep 22, 2025 Location: Webster or Boston, MA, US Company: MAPFRE **Who We Are** A dynamic, forward-thinking ... risk mitigation, and continuous process improvement. We are looking for an Auditor to optimize and streamline our audit processes while driving innovation and… more
- The County of Los Angeles (Los Angeles, CA)
- LAW ENFORCEMENT AUDITOR Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4668332) Apply LAW ENFORCEMENT AUDITOR Salary $109,807.68 - ... No 10 In the execution of the Law Enforcement Auditor duties, you will have to make site visits...to view correspondence. Los Angeles County will not consider claims of not viewing or receiving notifications to be… more
- City of New York (New York, NY)
- Job Description Only permanent Administrative Management Auditor and Incumbent employees are eligible to apply. DCAS's mission is to make city government work for ... to ACS' Senior leadership, auditees and stakeholders. Responsibilities for the Lead Auditor /Supervisor will include but may not be limited to: - Plan, coordinate… more