- Toyota Boshoku (Hopkinsville, KY)
- …customer expectations. G. Oversee and support service part quality issues and warranty claims as necessary. H. Assist in developing quality management system (eg, TS ... multicultural office environment preferred.Personal/Technical Skills: * Working knowledge of quality audit techniques. * Must be trusted with confidential data. *… more
- WelbeHealth (Los Angeles, CA)
- …Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate ... pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or...and claim . Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing… more
- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...and respond to carrier and/or arbitrator inquires + Submit claims through state arbitration portals Qualifications : To perform… more
- Magellan Health Services (Maryland Heights, MO)
- …and priorities. Strong verbal and written communication skills. Minimum 1 year health claims audit experience. General Job Information Title Claims Auditor ... This position supports management in the design, implementation, and maintenance of claims auditing programs. Responsible for auditing claims for accuracy.… more
- Axis (Red Bank, NJ)
- …including preparation and presenting audit reports and findings. May be part of a Claims Audit Team or travel to assess claims + Conducts monthly desk ... taking part in the selection process. Position Summary: AXIS is seeking a Senior Claims Specialist to join our North America Accident & Health Claims team… more
- Elevance Health (Denver, CO)
- …which would provide an equivalent background. **Preferred Qualifications:** + Pharmacy Claims Audit Strongly preferred + PBM (Pharmacy Benefit Management) ... for handling high level pharmaceutical claim audits and reviewing claims issues from junior team to ensure claims... claims issues from junior team to ensure claims are being resolved and reported in a timely… more
- Providence (Anaheim, CA)
- **Description** Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process ... for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative… more
- CRC Insurance Services, Inc. (Richmond, VA)
- …losses. 5. Train claims staff on policies or procedures. 6. Oversee and audit claims ensuring proper documentation was created in the system and/or files. 7. ... for overseeing, managing and supporting all activities of the construction defect claims team and claim files under your supervision within your respective… more
- CVS Health (Cumberland, RI)
- …team environment* Experience negotiating with vendors and landlords to settle audit claims * Experience preforming Contract Compliance Audits EducationBachelor's ... Cumberland, RI office three days per week.** The Internal Audit Recovery Analyst will be a key member of...of opportunity for recovery dollars, documenting and creating recovery claims , and corresponding with business partners as needed for… more
- Sedgwick (Columbus, OH)
- …management reports and takes appropriate action. * Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead - Consumer **PRIMARY PURPOSE:** To supervise the operation of… more
- Sedgwick (San Diego, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Workers' Compensation Claims Team Lead | Roseville, CA or San Diego, CA **PRIMARY PURPOSE:**… more
- Sedgwick (Annapolis, MD)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead - Workers Compensation **PRIMARY PURPOSE:** To supervise the… more
- MyFlorida (Tallahassee, FL)
- …on pending claims , initiating management and security review as deemed necessary. + Audit paid claims to ensure prizes were paid in compliance with the ... CLAIMS PROCESSING SPECIALIST - 36000116 Date: Jun 19,...Requisition No: 822431 Agency: Department of Lottery Working Title: CLAIMS PROCESSING SPECIALIST - 36000116 Pay Plan: Lottery Exempt… more
- Prime Therapeutics (Columbus, OH)
- … audit analytics and professional knowledge to identify educational trends and select claims for audit in alignment to department procedures and objectives + ... of audit tools and processes to effectively identify erroneous claims , non-compliant pharmacy practices or potential pharmacy reimbursements + Track audit… more
- Independent Health (Buffalo, NY)
- …of Microsoft Office with experience in Word and Excel required, knowledge of claims audit software preferred. + Demonstrated ability to prepare medical record ... fraud system and make determination to pay or deny claims . **Qualifications** + Bachelor's degree in criminal justice or... audit reports. + Strong organizational skills, verbal and written… more
- TEKsystems (Dallas, TX)
- …and brokers as well as internal business partners Skills: Connect, Workflow, Audit , Claim, Insurance, claims analysis, regulations and case law, litigation ... Description: Sr. Complex Claims Analyst: Proactively investigate, evaluate and negotiate resolution of assigned primary and excess Insurance Agents and Brokers… more
- WTW (Los Angeles, CA)
- …leadership to the overall development of the Disability, Leave and Life Claims Audit practice. The Requirements: + First-hand experience managing disability ... Strong intellectual curiosity and desire to keep abreast of latest developments in Claims Audit and contribute to the development of new tools and approaches +… more
- Nestle (Eden Prairie, MN)
- …Finance leader with trade deduction analysis and reconciliation. + Management of Customer post- audit claims + Collaborate with Account Managers and Sales Finance ... Solon, OH, and Loveland, OH. **Responsibilities:** **Trade Auditing/Analysis (Deductions, Fines, Claims , Post- Audit Work)** + Support the Account Management Team… more
- Robert Half Accountemps (Westerville, OH)
- …working as a Medical Accounts Receivable Specialist or similar role * Proficiency in Insurance Claims , Medical Claims , and Audit Functions * Experience with ... employment opportunity. Responsibilities: * Reviewing and following up on outstanding claims from insurance carriers for specified physicians. * Conducting regular… more
- AIG (Concord, CA)
- …point for colleagues. + You will also contribute to continuous improvement in Claims by supporting Quality Assurance / Regional Audit processes, ensuring ... Senior Claims Analyst Join us as a Senior Claims Analyst to take on key responsibilities within a world-class claims function. Make your mark in Claims … more
