- USAA (Phoenix, AZ)
- …special and impactful. **The Opportunity** As a dedicated ** Quality Assurance Advisor Senior ** for the Property Claims Team, you will be responsible for ... more years progressive operations or process experience in the P&C insurance industry, Property Claims . + 2 years of quality assurance/control, or quality … more
- The Cigna Group (Bloomfield, CT)
- The Quality Review & Audit Senior Analyst exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in ... Adjustment (RA) program and Risk Adjustment Data Validation (RADV) audits. The Senior Analyst is responsible for all aspects of auditing medical documentation for… more
- Molina Healthcare (AZ)
- …knowledge although they may have technical team members. **Expanded Scope:** The Senior Project Manager for Claims Operations drives complex, multi-workstream ... hypothesis, and measurable success criteria (eg, first-pass resolution, auto-adjudication rate, claims cycle time, audit findings, cost-to-serve). + Process… more
- Axis (Alpharetta, GA)
- …available upon request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims...Assurance - Comply with best practices measured by monthly Quality Assurance and Management Initiated Audit scores… more
- CHS (Clearwater, FL)
- …for Claims Department strategy, planning, staffing projection, budgeting and quality assurance and improvement. * Responsibility for final hiring decisions on ... **Overview** ** Claims Manager** **Servicing** **Health Insurance Policies or Benefits**...Quality to implement appropriate standards for accuracy and audit procedures intended to validate those standards are met.… more
- Johns Hopkins University (Baltimore, MD)
- **General Summary** We are seeking an **Internal Audit Manager,** who demonstrates subject matter expertise in operational internal auditing and the healthcare ... and/or higher education industry. Manages multiple complex internal audit projects. Manages and serves as a technical expert to internal audit staff. Partners… more
- Dignity Health (Bakersfield, CA)
- …for audit purposes. - Collaborate with internal departments, including claims processing, UM, compliance, and provider relations, to develop and implement ... relationships with provider representatives. - Prepare and present detailed reports on claims research activities, findings, and outcomes to senior management. -… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …transform healthcare? Bring your true colors to blue. As a valued member of the Audit and Risk Management (ARM) team, the Senior Internal Auditor will lead and ... role will be asked to use data analytics tools and techniques to enhance audit testing, identify emerging risks, and drive automation and efficiency in audit … more
- NJM Insurance (Trenton, NJ)
- …coordinating quality and compliance audits/reviews including pre-work such as audit program development and file selection, assuring the review process is proper ... Reporting to the Workers' Compensation (WC) Training and Quality Assurance Management Supervisor, the WC Quality...to present to management. + Collaborate with the BPU, claims management, law and regulation, and internal audit… more
- Saint-Gobain (Mankato, MN)
- "This Job Matters" **_What's the job?_** The Senior Quality & Process Control (Q&PC) Manager is a strategic and operational leader responsible for driving ... quality excellence and process control across multiple manufacturing facilities... Council to align with strategic goals. - Ensures audit readiness via structured reviews and root cause analysis.… more
- Molina Healthcare (Rio Rancho, NM)
- …care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue ... **Job Description** **Job Summary** The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and… more
- Independent Health (Buffalo, NY)
- …knowledge and audit tips across the team. The Clinical & Coding Specialist- Senior will support the leadership in Hospital Audit in accomplishing all aspects ... fosters growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist- Senior will be responsible for reviewing coding and clinical decisions on… more
- Metropolitan Council (St. Paul, MN)
- …Region: As anAccount Specialist ( audit accounts) you will be responsible to audit and process bills and claims ; post transactions; balance and reconcile ... future vacancies. What you would do in this job Accounts Payable Specialist + Audit bills, claims and related documents by recalculating and reviewing them to… more
- AON (St. Peter, MN)
- …reconciliation of claims bordereaux. + Responsibility for the year end audit . + Responsibility for all regulatory matters, corresponding with the GFSC and ... Senior Financial Account Manager - Captives (Guernsey) Aon,...claims bordereaux. + Responsibility for the year end audit . + Responsibility for all regulatory matters, corresponding with… more
- University of Southern California (Alhambra, CA)
- …Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related ' claims denials' and ' claims rejections,' specific to ICD-10-CM, ... the denial management process for coding-related denials, triage denied claims to distinguish coding-related denials versus clinical-related denials, evaluating … more
- Houston Methodist (Houston, TX)
- …risk and identify and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis, and medical record reviews of ... specific practices. Serves a subject matter expert. + Effectively communicates audit results to faculty and staff. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS**… more
- Humana (Springfield, IL)
- …systems. + Knowledge of relevant regulatory requirements and industry best practices in claims payment integrity. + Familiarity with audit processes and recovery ... caring community and help us put health first** The Senior Payment Integrity Professional uses technology and data mining,...anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Senior Revenue Accountant-(Revenue Cycle) Patient Financial Services- Corporate 42nd Street-Full-Time Days (Hybrid)** The Senior Revenue ... in revenue trends. This position will report to the Senior Director of Revenue. This role will ensure the...large academic healthcare setting. + Possess prior Big 4 audit background and/or experience in high-growth environments. + Build,… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- **Job Summary** As the Senior Manager of Process, Policy & Governance reporting to the Senior Director, Procurement Operations; your primary focus will be the ... issues. + Partner with Sourcing, Legal, Compliance, Information Security, Finance and Quality to embed regulatory risk and controls into the purchasing process. +… more
- Grant Thornton (Phoenix, AZ)
- …Examples of relevant consulting services may include: + Reverse audits (eg, refund claims ) + Audit defense and controversy support + Multi-state nexus analyses ... As the Global Indirect Tax Senior Associate, you'll deliver a full range of...succeed. From day one, you'll be empowered by high quality tools and resources to thrive in your role… more