- Elevance Health (Boston, MA)
- ** Claims Auditor I, II and Senior**...and post payment and adjudication audits of high dollar claims for limited lines of business, claim ... an accommodation is granted as required by law._ The ** Claims Auditor I** is responsible for pre...an impact :** + Performs audits of high dollar claims . + Ensures claim payment accuracy by… more
- WTW (Houston, TX)
- **Description** As a Medical Claim Field Auditor , you will apply your medical claims audit, project management and claim processing and auditing ... environment + Claims processing knowledge/exposure to one or more administrator claim systems such as UNET, WGS, NASCO, ACAS, Proclaim, PowerMHS, Facets, ITS,… more
- WTW (Houston, TX)
- **Description** As a Medical Claim Lead Auditor , you will apply your audit, project management and client management skills to lead client audits. You will serve ... administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report. You will… more
- US Tech Solutions (Whittier, CA)
- …: Day** **Next Start date: Immediately** **Contract length: 3 months** **POSITION SUMMARY** The Claims Auditor assists in the Claims Department by analyzing ... status and pending claims reports ensuring authorized claims are paid in accordance with company ...authorized claims are paid in accordance with company guidelines 6.Investigate, process and track payment adjustments including… more
- Cedars-Sinai (Los Angeles, CA)
- …fuels innovation. **Req ID** : 13340 **Working Title** : Outpatient Surgical and Claims Edit Auditor **Department** : CSRC Coding Audit **Business Entity** : ... Los Angeles. We also were awarded the Advisory Board Company 's Workplace of the Year. This award recognizes hospitals...will I be doing in this role?** The Coding Auditor works under the general direction of the Coding… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure ... Follows established guidelines/procedures. **Where you Come In** The Medical Coding Auditor reviews medical claims submitted against medical records provided,… more
- UPMC (Pittsburgh, PA)
- …in person or virtual recipient restriction hearings. + Review Medical Pended Queue claims to understand and resolve claim referral issues through research and ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor /Analyst Intermediate! The Clinical Auditor /Analyst Intermediate is an integral part of the… more
- Elevance Health (Chicago, IL)
- …methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company , for all lines of ... **DRG Coding Auditor Principal** **_Virtual: _** _ _ This role...letter writing) on lower level auditors. + Identifies new claim types by identifying potential claims outside… more
- Elevance Health (Chicago, IL)
- …** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company , for all lines of ... **DRG CODING AUDITOR ** **_Virtual_** **_: _** _ _ __ This...and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside… more
- Humana (Columbus, OH)
- …evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle ... help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical...looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers… more
- AmeriHealth Caritas (Philadelphia, PA)
- …audit process and communicate the audit outcome to the appropriate persons. The auditor will validate production to ensure that the case is migrated appropriately. ... post-implementation review is completed as the policy outlines. The auditor will be expected to build/run complex queries to...will be expected to build/run complex queries to identify claims affected by the configuration change and analyze all… more
- MAPFRE Insurance (Webster, MA)
- Internal Auditor (Webster or Boston, MA) Date: Nov 22, 2025 Location: Webster or Boston, MA, US Company : MAPFRE **Who We Are** A dynamic, forward-thinking ... risk mitigation, and continuous process improvement. We are looking for an Auditor to optimize and streamline our audit processes while driving innovation and… more
- AutoZone, Inc. (Memphis, TN)
- **Job Description** The Associate Auditor , Audit Recovery, will be required to: + Utilize analytical and forensic email review skills to audit Merchandising ... funding/negotiations). 3rd Party vendors to recover less than 20% behind Associate Auditor .\ + Negotiate and communicate flawlessly with Merchandising and Vendors to… more
- Sedgwick (Charlotte, NC)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Attorney Auditor ** **This is a fully remote position, and candidates residing in any ... United States are encouraged to apply. As an Attorney Auditor at Sedgwick, you'll have the opportunity to take...Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. +… more
- Insight Global (South Jordan, UT)
- …valid claim identification and documentation (letter writing). Identifies potential claims outside of the concept where additional recoveries may be available. ... Job Description Insight Global is seeking a DRG Validation Auditor for one of our clients to sit 100%...for auditing inpatient medical records and generating high-quality recoverable claims for the benefit of our client and their… more
- Elevance Health (Chicago, IL)
- **Diagnosis Related Group Clinical Validation Auditor -RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time, ... granted as required by law. The **Diagnosis Related Group Clinical Validation Auditor -RN** is responsible for auditing inpatient medical records to ensure clinical… more
- Sedgwick (Indianapolis, IN)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Internal Auditor **PRIMARY PURPOSE OF THE ROLE:** To perform internal audit procedures under ... identifying risks. + Develops and modifies internal audit programs to include all company functions. + Communicates with company management as needed during… more
- Humana (Madison, WI)
- …of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation ... is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and… more
- Humana (Topeka, KS)
- …caring community and help us put health first** The Inpatient Medical Coding Auditor reviews a variety of medical records and to determine appropriate procedural ... terminology and medical codes (eg, ICD-10-CM, CPT.) The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the… more
- Cedars-Sinai (Los Angeles, CA)
- …Best Hospitals. **What you be doing in this role:** The Physician Compliance Auditor is responsible for reviewing and auditing claims , medical records, and ... medical care in Los Angeles. We also were awarded the Advisory Board Company 's Workplace of the Year. We provide an outstanding benefit package that includes… more