- Harbor Health Services, Inc. (Mattapan, MA)
- …through communication of practice standards, PACE, and through an internal quality assurance program that measures vendor performance. Assists managers ... We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent, comprehensive benefits package including… more
- AIG (New York, NY)
- …You will also contribute to continuous improvement in Claims by supporting Quality Assurance / Regional Audit processes, ensuring mitigation of indemnity ... Job Description Join us as a Claims Analyst III to take on key responsibilities within a world-class claims function. Make your mark in Claims As a Claim… more
- AIG (Atlanta, GA)
- Claims , Quality Assurance Specialist - Worker's Compensation Join us as a Claims QA Specialist to make more of your specialist expertise and experience. ... skills with ability to create consistently factual, correct, high quality audit reports and supporting documentation. +...+ Ability to address queries, disputes, challenges through the claims audit cycle while maintaining the philosophies… more
- City of New York (New York, NY)
- …conformity to State and Federal regulations and to the mandated deadlines - Perform an audit / quality control review of completed claims for accuracy and for ... revenues, expenditures and staffing for all HRA's programs. The Quality Assurance & Data Analysis Unit is...compliance with State and Federal regulations and to reconcile claims to expense data - Oversee the audit… more
- CHS (Clearwater, FL)
- …for Claims Department strategy, planning, staffing projection, budgeting and quality assurance and improvement. * Responsibility for final hiring decisions ... **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
- Commonwealth Care Alliance (Boston, MA)
- …states will not be considered at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance , the Claims Sr. ... Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance ,...claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of… more
- Prime Therapeutics (Richmond, VA)
- …Benefit Management experience to include 1 year of work experience in an operations, audit or quality assurance environment + National Pharmacy Technician ... our clients. **Responsibilities** + Conduct in-depth analysis of large datasets and audit findings to detect high-risk pharmacy claims , identify billing… more
- AIG (Charlotte, NC)
- …SCUP, Claims , Japan Transformation, Data Engineering, and myAIG, ensuring quality assurance at every phase. + Drive GenAI-based transformation initiatives ... (QE&A) organization. This pivotal role combines deep domain expertise in Quality Assurance , cutting-edge automation practices, and Generative AI (GenAI)… more
- Axis (Alpharetta, GA)
- …& Quality Assurance - Comply with best practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the ... taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims... Claims Specialist** AXIS is seeking a Senior Claims Specialist to join our North America Claims… more
- Textron (Saginaw, MI)
- ** Quality Assurance Engineer \- AeroMotion** Textron Aviation has been inspiring the journey of flight for nine decades through the iconic and beloved Cessna and ... the future, beginning day one\. Your success is our success\. **Description** The Quality Assurance Engineer is responsible for developing and implementing … more
- Grant Thornton (Newport Beach, CA)
- …risk management programs, and/or entity-level and business process controls for Internal Audit , or other risk management, compliance, and assurance activities + ... Grant Thornton LLP, a licensed, certified public accounting (CPA) firm that provides audit and assurance services ― and Grant Thornton Advisors LLC (not… more
- City of New York (New York, NY)
- …and Department of Homeless Services (DHS). DSS-AO maintains the operation of the Office of Audit and Quality Assurance (OAQA), Office of Compliance & Support ... to function as a(n) Executive Director, Financial Review & Claims Processing who will: - Manage, plan and develop...of DFRP, ICP and SNAP-CR. - Establish criteria and high- quality standards, policies and procedures that comply with current… more
- NJM Insurance (Trenton, NJ)
- Reporting to the Workers' Compensation (WC) Training and Quality Assurance Management Supervisor, the WC Quality Assurance /Compliance Analyst is ... to present to management. + Collaborate with the BPU, claims management, law and regulation, and internal audit...develop resources and training material to support regulatory and Quality Assurance compliance + Attend internal and… more
- Elevance Health (Roanoke, VA)
- …at least one of the following: AA/AS or minimum of 15 years of experience in claims auditing, quality assurance , or recovery auditing. + Requires at least ... including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit...Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad, deep… more
- CGI Technologies and Solutions, Inc. (Indianapolis, IN)
- ** Quality Analyst** **Category:** Testing/ Quality Assurance **Main location:** United States, Indiana, Indianapolis **Position ID:** J0825-0830 **Employment ... such as Great Expectations, Soda, or custom Python/SQL test harnesses to automate quality assurance processes. * Validate data migration efforts from legacy… more
- Otsuka America Pharmaceutical Inc. (Boise, ID)
- …applicable cGMP/GDP quality standards. This role will direct Biologics Quality Assurance support, including oversight of upstream and downstream biologics ... Sciences. + Ten years of combined and/or pharmaceutical manufacturing, QA or QC assurance roles managing and directing quality oversight of commercial product… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …management (RHIA or RHIT) or a Nursing Degree. . Three (3) years' experience in claims auditing, quality assurance , or recovery auditing, of (MS/APR) DRG ... claims processing platform. . Manages case volumes and review/ audit schedules, prioritizing case load as assigned by Management....Level I Qualifications) . Five (5) years' experience in claims auditing, quality assurance , or… more
- Permobil (Lebanon, TN)
- …European Union. Experience Required: + Preferable 5+ years of experience in supplier quality engineering, quality assurance , or related roles within ... audit planning, and supplier re-evaluations, to support robust quality management across the supply base. Supplier Audits, Qualification, and Re-evaluation… more
- Elevance Health (Norfolk, VA)
- …at least one of the following: AA/AS or minimum of 5 years of experience in claims auditing, quality assurance , or recovery auditing. + Requires at least one ... responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of...Validation Audit setting or hospital coding or quality assurance environment preferred. + Broad knowledge… more
- Boar's Head Brand/Frank Brunckhorst Co., LLC (Sarasota, FL)
- …+ Provide advanced super user support to functional groups (R&D, Procurement, Engineering, Quality Assurance , and Manufacturing) on QMS related issues. + Provide ... Audit Team with performing Food Safety & Product Quality audits at different venues to include but not...COAs, Allergen forms, Weight & Tare, any other product claims , etc.), as applicable. + Perform Food Safety &… more
