- AIG (Atlanta, GA)
- Claims , Quality Assurance Specialist - Worker's Compensation Join us as a Claims QA Specialist to make more of your specialist expertise and ... efficiency. How you will create an impact + Complete quality reviews on all files within program guidelines while...skill enhancement. What you'll need to succeed + Proven claims experience handling and auditing Workers Compensation… more
- Axis (New York, NY)
- …upon request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist ** AXIS is seeking a Senior Claims Specialist ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims management...plus. **What will you do in this role?** + Auditing of Third-Party Administrators to ensure reserve adequacy. +… more
- MyFlorida (Fort Lauderdale, FL)
- SENIOR TAX SPECIALIST - 79011439 Date: Jan 7, 2026 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 867792 Agency: Business and Professional Regulations Working Title: SENIOR TAX SPECIALIST - 79011439 Pay Plan: Career Service Position Number: 79011439 Salary:… more
- Genesis Healthcare (PA)
- …plans related to such issues. 5. Participates in provider monitoring and auditing activities and investigations, and implementing quality assurance and ... We are seeking a full time Certified Professional Coding Specialist to join our Advanced Care Organization (ACO) team.... will work as a compliance team member by auditing documentation of credentialed providers for proper code assignment… more
- Fairview Health Services (St. Paul, MN)
- …Qualifications** + 5 years hospital inpatient coding-related experience such as coding, auditing , abstracting, DRG assignment, Data Quality in coding denials + ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...of hospital inpatient coding related experience such as coding, auditing , abstracting, DRG assignment, Data Quality in… more
- BrightSpring Health Services (Englewood, CO)
- …Inc. is a leading provider in home Infusion therapy. We are looking for a Billing Specialist to join our Revenue Cycle Management team as we grow to be one of the ... top home infusion providers in the country. The Billing Specialist will report to the Billing Manager and work...an industry shift from hospital delivery settings to lower-cost, high- quality alternative providers such as Amerita. As a core… more
- Veterans Affairs, Veterans Health Administration (Bronx, NY)
- …is recruiting for (1) full-time Registered Nurse Risk Manager reporting to the Quality and Patient Safety service at the James J. Peters facility. Responsibilities ... or regulatory noncompliance. This is accomplished by demonstrating continuous quality improvement (CQI) techniques related to performance and improvement, clinical… more
- Baylor Scott & White Health (Temple, TX)
- …reviews, and reports on quality control activities for all Pharmacy Services Specialist 1 staff. Including review and auditing reports as determined by ... **JOB SUMMARY** The Pharmacy Services Specialist 2 communicates with members, providers, and clients...assist with understanding the prior authorization process, and resolve claims processing and eligibility issues while adhering to department… more
- Southern Glazer's Wine and Spirits (Lakeland, FL)
- …(Depots). This position will complement these teams with technical, data management, compliance, auditing , and tactical support. The EHS Specialist will serve as ... that truly cares about its people. **Overview** The EHS Specialist reports to the Director of EHS and supports...national programs, and corrective actions associated with our compliance auditing program. This role supports SGWS in achieving our… more
- Zurich NA (Springfield, IL)
- …workstreams + Experience in a transactional, operational or customer service environment + Quality auditing experience + Knowledge of the insurance industry and ... Sr Supplier Medical Process Specialist 128416 Zurich North America is seeking am...continuous process and system enhancements to improve operational efficiencies, quality and/or timeliness. At Zurich North America Claims… more
- MyFlorida (Gainesville, FL)
- INVESTIGATION SPECIALIST II - 79001410 Date: Jan 7, 2026 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 867813 Agency: Business and Professional Regulations Working Title: INVESTIGATION SPECIALIST II - 79001410 Pay Plan: Career Service Position Number: 79001410… more
- CareFirst (Baltimore, MD)
- …knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in ... claims submissions. Utilizes extensive coding knowledge, combined with medical...expected methodologies for billing and code submissions to maximize quality for FWA prevention. **ESSENTIAL FUNCTIONS:** + Consults on… more
- Cedars-Sinai (CA)
- **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program ... rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing… more
- MyFlorida (St. Petersburg, FL)
- …action, equal employment opportunity, regulatory work as a paraprofessional or higher, claims adjusting, auditing , financial examining, land appraisal work, land ... INVESTIGATION SPECIALIST II - 64007449 1 1 Date: Jan...Estimator Tool (https://compcalculator.myflorida.com/) Department of Health Division of Medical Quality Assurance Bureau of Enforcement Investigative Services Unit -… more
- C&W Services (New York, NY)
- **Job Title** HSSE Regional Specialist **Job Description Summary** The Environmental Health & Safety (EH&S) Manager is responsible for providing direction and ... report and manage the corrective actions + Support Workers Compensation (WC) claims tracking, investigation, and management process + Liaise with WC Program Manager… more
- Henry Ford Health System (Jackson, MI)
- …of their quality rewards program. o Maintains accurate record of specialist referral information, provider panel status by product line, and Network's criteria ... obligations. The role performs further credentialing functions including resolving claims issues, assisting with onboarding new practices, and conducting audits… more
- MyFlorida (Tallahassee, FL)
- …action, equal employment opportunity, regulatory work as a paraprofessional or higher, claims adjusting, auditing , financial examining, land appraisal work, land ... INVESTIGATION SPECIALIST II - 64000179 Date: Jan 8, 2026...Estimator Tool (https://compcalculator.myflorida.com/) Department of Health Division of Medical Quality Assurance Bureau of Enforcement Investigative Services Unit -… more
- McLaren Health Care (Shelby Township, MI)
- **Position Summary** : The Underpayment Specialist is responsible for performing audits of patient accounts to identify inaccurately under adjudicated accounts by ... staff to identify process improvements that will allow payers to adjudicate claims per their associated contract. Underpayment Specialists will work with minimal… more
- Health Care Service Corporation (Tulsa, OK)
- …*High School Diploma or GED. *2 years experience in claim administration, claims auditing , customer service or membership. *1 year experience giving ... field. They also share a similar role with our Community Outreach Specialist , by coordinating, organizing, planning and implementation of the HCSC's community based… more
- Wabtec Corporation (Alliance, NE)
- …on various days as required, including having a flexible work schedule to perform auditing and training on various shifts. + The ability to maintain reliable and ... the forecasting of material needs for inbound and in-shop locomotives, ensuring quality control processes for inbound and outbound shipments, and arranging LTL and… more