- Sutherland Global Services (Columbus, OH)
- …regulatory guidelines + Follow up on claims needing additional information + Refer problem claims to a Lead and/or auditor for additional review + Make ... performance. Delivering measurable results._ This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much… more
- LA Care Health Plan (Los Angeles, CA)
- …health plans contracted with LA Care. This role works closely with the Supervisor and/or Lead Auditor on identification and resolution of issues in a timely and ... Financial Compliance Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type:… more
- Elevance Health (Richmond, VA)
- …service written and verbal inquiries. **How you will make an impact:** + Assists higher level auditor / lead on field work as assigned and acts as auditor in ... **Pharmacy Internal Auditor ** **Location:** This position will work a hybrid...in pre and post implementation audits ofpharmacy operational processes, claims processing and payment, member and provider inquiries, enrollment… more
- Elevance Health (Indianapolis, IN)
- **DRG Coding Auditor (DIAGNOSTIC RELATED GROUP)** _This position will work virtually._ _Alternate locations may be considered._ _The Ideal candidate must live within ... recover, eliminate and prevent unnecessary medical-expense spending. The **DRG Coding Auditor ** is responsible for auditing inpatient medical records and generating… more
- Elevance Health (Latham, NY)
- The **Performance** **Quality Auditor ** is responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. ... Included are processes related to enrollment and billing and claims processing, as well as customer service written and...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (Columbus, GA)
- **Diagnosis Related Group Clinical Validation Auditor -RN** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... one of our PulsePoint locations. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to ensure clinical… more
- Elevance Health (Columbus, OH)
- **Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location:_ Alternate locations may be considered. This position will work in a ... recover, eliminate and prevent unnecessary medical-expense spending. The **Clinical Provider Auditor II** is responsible for identifying issues and/or entities that… more
- Fallon Health (Worcester, MA)
- …identified, recommendations and management action plans by working under the direction of the Lead Auditor or Audit Manager. + Prepare detailed work papers for ... all aspects of audits following departmental standards and procedures. **The Internal Auditor will perform or assist in the following:** + Supports the internal… more
- Army National Guard Units (Montgomery, AL)
- …GUARD TITLE 5 EXCEPTED SERVICE POSITION. This National Guard position is for a AUDITOR (T5), Position Description Number T5148P02/ T5147P01 and is part of the AL ... answers questions. Performs survey work to identify potential operating problems. Prepares lead sheets to identify any potential weaknesses in internal controls that… more
- Lockheed Martin (Bethesda, MD)
- **Description:** Join Lockheed Martin's Corporate Internal Audit \(LMCIA\) team as a Financial Auditor and play a key role in evaluating and improving the company's ... a company culture that empowers employees to think big, lead with a growth mindset, and make the impossible...government finance including CAS, FAR, DFARS, GAGAS, incurred cost claims , and contract and indirect rate closure processes\. Understands… more
- Trinity Health (Columbus, OH)
- …effective working relationship with providers and their billing staff + Performs responsibilities of Claims Auditor as time and work load permit and dictate + ... **Employment Type:** Full time **Shift:** **Description:** Remote position - Seeking Claims processing with Medical Insurance Minimum of 5 years experience in … more
- Ventura County (Ventura, CA)
- …CA Job Type Full-Time Regular Job Number 0921AUD-24AE (EO) Department Auditor -Controller Opening Date 12/10/2024 Closing Date Continuous + Description + Benefits ... - 12 paid days per year which includes a scheduled floating holiday. THE AUDITOR -CONTROLLER'S OFFICE By State Law, the Auditor -Controller is charged with the… more
- The Cigna Group (Seattle, WA)
- …changes in processing procedures. **Job Description** The Quality Review and Audit Lead Hybrid Auditor is primarily responsible for using analytical skills ... requirements. **ESSENTIAL FUNCTIONS** + Perform efficient and effective network pharmacy claims audits to produce results consistent with departmental policies and… more
- 3M (Maplewood, MN)
- Job Description: Software Systems Lead Collaborate with Innovative 3Mers Around the World Choosing where to start and grow your career has a major impact on your ... You'll Make in this Role As a Software Systems Lead , you will have the opportunity to tap into...such as migrating legacy systems, regional deployments of the Claims module and implementing process improvements for CMP +… more
- Ventura County (Ventura, CA)
- …and financial analysis/reporting duties. At the Senior level, may provide lead supervision to lower level professional, technical or clerical staff. DISTINGUISHING ... financial analysis/reporting requirements; positions may also be assigned direct or lead supervisory duties over lower level staff when such assignments are… more
- The County of Los Angeles (Los Angeles, CA)
- …system. + Assist in the reconciling of accounts with the Auditor 's abstract. + Compile prescribed financial-statistical data. + Prepare highly standardized ... depreciation and accrued expenses and revenues. + Prepare complex claims for reimbursement. + Perform work which required the...so may result in an incomplete application and may lead to disqualification We will send notifications to the… more
- BD (Becton, Dickinson and Company) (San Diego, CA)
- …and participate in internal and external audits, addressing findings promptly. + Lead investigations into deviations, non-conformances, and customer claims . + ... a **maker of possible** with us. **Key Responsibilities:** + Lead the evaluation and disposition of held or nonconforming...a focus on minimizing Escape incidents. + Oversee intracompany claims and drive the resolution process. + Conduct and… more
- Eaton Corporation (Wilsonville, OR)
- …Certified Auditor for ISO 9001. Responsible for resolving warranty claims and issues for assigned product lines. Detailed job responsibilities are: Provide ... System practices. Analyze quality problems and assist in solutions. Internally lead process improvement teams utilizing corrective actions, A3 and 8D methodology.… more
- Danfoss (Van Wert, OH)
- …a Quality role in industrial manufacturing operations **Preferred Qualifications** + Certified lead internal auditor (ISO9001 / IATF16949) + 8D structured team ... the claim handling, and associated root cause problem-solving for internal and customer claims . It ensures the qualification of the directly purchased parts at site… more
- Somatus (Mclean, VA)
- …sound monthly reserving process for Total Medical Expense (TME) estimation. + Lead continuous evaluation of TME performance compared to plan expectations. + ... relevant actuarial estimates. Leads the development/compilation of the risk premium, claims and shared savings forecasting models used in the corporate… more