- Sedgwick (Fayetteville, NC)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Compliance Auditor | Dedicated Client | Liability & Auto experience ... preferred | Remote **Experience** **Five (5) years claims management experience or equivalent combination of education and experience required. Two (2) years of… 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 ... Through our dedicated associates, Conduent delivers mission-critical services and solutions...compliance to policies/processes for GM cancellation and obsolescence claims . + Support claim process improvements and implementation on… more
- Conduent (Alexandria, VA)
- …where individuality is noticed and valued every day. **Pharmacist - Claims Auditor /Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you ... Through our dedicated associates, Conduent delivers mission-critical services and solutions...behalf of major healthcare payers. As a **Pharmacist - Claims Auditor /Reviewer** , you'll apply your clinical… more
- UPMC (Pittsburgh, PA)
- …can make a significant impact? **UPMC Corporate Compliance ** is seeking a dedicated and detail-oriented **Intermediate Compliance Auditor ** to join our ... **Join UPMC Corporate Compliance as an Intermediate Compliance Auditor !** Are you passionate about ensuring...and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting. . **Regulatory… more
- UPMC (Pittsburgh, PA)
- …ensuring compliance in healthcare? **UPMC Corporate Finance** is looking for a dedicated and meticulous ** Compliance Auditor , Associate** to join our ... **Join UPMC Corporate Finance as a Compliance Auditor , Associate!** Are you detail-oriented...DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting. + **Post-Audit… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …or in conjunction with other third party vendors to detect and trend potential claims and billing compliance issues relative to revenue cycle risk areas + ... At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety...clinical and operational excellence. **Summary** Works collaboratively with the Compliance Manager on creating auditing protocols which align with… more
- Humana (Jefferson City, MO)
- …Coding Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper ... this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Revenue Integrity Auditor Full Time, 80 Hours Per Pay Period, Day Shift In person training with work from home option, at Manager's discretion, after ... employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million… more
- Elevance Health (Hanover, MD)
- …associated with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies ... **Clinical Provider Auditor II** **Supports the Payment Integrity line of...prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses… more
- Humana (Denver, CO)
- …about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and ... validate the mitigation of compliance risk across the organization. This team ensures that...(related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare… more
- Zurich NA (New York, NY)
- Chief Auditor - Zurich Cover-More 123124 **About Us** **Zurich Group Audit** Zurich Group Audit is a diverse international team of over 250 colleagues from 33 ... as Zurich Cover-More integrates the newly acquired Travel Guard business. The Chief Auditor Zurich Cover-More has a global remit and will be responsible for… more
- McLaren Health Care (Indianapolis, IN)
- …and knowledge of HMO, or PPO (eg accounting/finance, reinsurance, regulatory compliance , claims processing, membership/eligibility, and actuarial precepts). + ... We are looking for a Special Investigative Unit Auditor to join us in leading our organization...members. McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each… more
- The County of Los Angeles (Los Angeles, CA)
- …health protection, water conservation, cultural activities and many more. We are dedicated professionals committed to preserving the dignity and integrity of the ... easements, licenses, joint developments, and property management, all in compliance with applicable laws (eg, California Environmental Quality Act), rules… more
- Banco Popular Puerto Rico (San Juan, PR)
- …unit, which is tasked with conducting continuous audits, investigating customer claims , allegations, and internal irregularities where there is a possibility that ... Audits: Design and oversee the execution of continuous audits to ensure compliance with internal controls, policies, and procedures. Identify and assess potential… more
- R1 RCM (Detroit, MI)
- …help review and interpret medical records to draft appeals of denied and underpaid claims . Every day you will review medical records to ensure appropriate coding of ... and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and knowledge for DRG...a Clinical Validation Review by an insurer or third-party auditor . + Draft appeal letters that are well-written, logically… more
- Danfoss (Searcy, AR)
- …+ Responsible for driving customer return investigations including warranty and processing claims . + Internal auditor for ISO 9001 and internal quality ... appraisals, coaching, coordinating daily work, etc.). + Responsible for gage compliance and requirements for new and existing gaging. Understand and source… more
- State of Massachusetts (Boston, MA)
- …of the Commonwealth, who is appointed by the Governor, Attorney General and Auditor " solely on the basis of integrity and demonstrated ability in accounting, ... is organized into three bureaus: Specialty & General Government, Legal & Compliance , and Operations, Training & Publications. Each bureau contains divisions that… more