- 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
- AIG (Atlanta, GA)
- …and supporting documentation. + Ability to address queries, disputes, challenges through the claims audit cycle while maintaining the philosophies of the GQA ... Claims , QA Specialist - Worker's Compensation Join us as a Claims QA Specialist to make more of your specialist expertise and experience. Make your mark in … more
- Jacobs (Albany, NY)
- …Contract, determine validity. * Day-to-day tracking, review, and management of delay claims . * Audit contractor's claim costs, including certified payrolls and ... is where you belong. We are seeking a full-time claims analyst and cost estimator with at least 4...and cost estimator with at least 4 years of claims and estimating experience. Candidate must be highly proficient… more
- AIG (Atlanta, GA)
- …succeed + Proven claim adjudication or claim operations experience for multi-line commercial claims . Claim Audit or file review experience is desirable. + ... Claim Compliance Reviewer Join us as a Claims Compliance Reviewer to make more of your...+ Assist with the collection of data to support audit or regulatory reporting requirements. This includes industry and… more
- The Cigna Group (Seattle, WA)
- …and available tools including the CSP, Access, Excel, Teradata etc., identify pharmacies and claims representing audit risks and develop an audit plan to ... **Job Description Summary** Provides advanced professional input to complex Quality Assurance/ Audit assignments/projects to identify pharmacy audit risks. Works… more
- AIG (Atlanta, GA)
- …to IT as needed to resolve issues in a timely manner. + Partner with Compliance, Audit , Claims , and IT to provide direction and support for SOX and SOC1 testing ... Senior Lead Analyst Claims Operations At AIG, we are reimagining the...questions, etc. as well as the remediation of system-related audit findings and improvement opportunities. + Analyze/assess current business… more
- CRC Insurance Services, Inc. (Charlotte, NC)
- …5. Train claims staff on new policies or procedures. 6. Oversee and audit claims process ensuring proper documentation was created in the system and/or ... Responsible for overseeing, managing and supporting all activities of the commercial claims ' employees and operations of the department. The team that will handle… more
- Robert Half Accountemps (Plantation, FL)
- …billing, and claim administration, while utilizing various computer programs. Responsibilities: * Audit medical claims to ensure accuracy and compliance with ... a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation,...insurance industry, based in Plantation, Florida. As a Medical Claims Analyst, you will be tasked with handling various… more
- Sedgwick (Austin, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer General Liability Claims Team Lead | Remote + **6 years liability... Team Lead | Remote + **6 years liability claims experience to include 2 claims supervisor… more
- Sedgwick (Pasadena, CA)
- …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 Workers Compensation REMOTE (MUST RESIDE IN CA) **MUST HAVE CA… more
- Sedgwick (Roseville, CA)
- …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 | Roseville, CA (HYBRID)) Are you looking… more
- Sedgwick (Long Beach, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements and ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead, Professional Liability (Medical Malpractice) **PRIMARY PURPOSE** **:**… more
- HCA Healthcare (Nashville, TN)
- …with claim management on performance management recommendation. + Weekly review of high-dollar claims . + Review and analyze audit data, including trend results ... part of our team. **Job Summary and Qualifications** The Claims Auditor will serve as a Subject Matter Expert...support services personnel and conduct additional training, based on audit findings. What you will do: + Perform concurrent… more
- Martin's Point Health Care (Portland, ME)
- …to claims , claims audits or other matters directed to the Audit Department. + Planning and Reporting: The Auditor II will support, as directed, the Manager ... payments or payment policies. + Research, design, and development of audit formats to identify claims overpayment scenarios, from basic to complex. + Liaise with… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. + Maintains awareness of fraud, waste and ... protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed… more
- PRGX (Grand Rapids, MI)
- … audit and analyze the client's business operations. + Finds, supports, and documents audit and claims operations. + Produces claims using appropriate ... audit concepts for writing claims , updating claims management system, and billing claims to client. + Provides vendors with claim back-up information. May… more
- Molina Healthcare (NE)
- …purpose: * Claims Adjudication accuracy including configuration in QNXT (ie Claims Production, Audit , Production Vendor Oversight) for all lines of business. ... up operational workflows to efficiently review high volumes of claims and maintain compliance TAT requirements. * Partners with... Claims Shared Services for all lines of business (ie… more
- Molina Healthcare (Louisville, KY)
- …purpose: * Claims Adjudication accuracy including configuration in QNXT (ie Claims Production, Audit , Production Vendor Oversight) for all lines of business. ... design, and implementation of payment accuracy initiatives impacting core claims operations. * Determines strategy for outsourcing, technology enablement... Claims Shared Services for all lines of business, ie,… more
- Penn Medicine (Philadelphia, PA)
- …the auditing technician will support the managers during in person audits, proactively audit claims for accuracy and support needed regulatory requirements. The ... Pharmacies and in accordance with Federal, State, and Internal Audit standards + Proactive claims auditing to...State, and Internal Audit standards + Proactive claims auditing to ensure the appropriateness and accuracy of… more
- Axis (New York, NY)
- …and collaborating with other departments and stakeholders (eg, Legal & Compliance, Internal Audit , Finance, North America Claims and Claims Operations etc.) ... upon request for candidates taking part in the selection process. AXIS Capital Claims Compliance Specialist, Claims Shared Services- Job Description AXIS is… more