- 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,...at LogixHealth: We offer a comprehensive benefits package including health , dental and vision, 401(k), PTO, paid holidays, life… more
- Martin's Point Health Care (Portland, ME)
- …Summary Job Description Position Summary: Under the supervision of the Director of Health Plan Operations, the Claims Auditor II will perform the following ... Join Martin's Point Health Care - an innovative, not-for-profit health...claims audits or other matters directed to the Audit Department. + Planning and Reporting: The Auditor II… more
- Scripps Health (San Diego, CA)
- …been with Scripps Health for over 10 years. The Director of HMO Payment ( Claims ) Services for Scripps Health Plan, leads claims payment team and ensures ... claims . Candidate will manage successful Plan and DMHC Audit performance, staff education and training, and manages PDR...of which in leadership. * Expertise is California DMHC claims regulations, NCQA regulations and health Plan… more
- Elevance Health (Columbus, OH)
- **Staff VP Claims Operations (Original Claims )** **Location:** Successful candidate must reside within 50 miles of an Elevance office, and able to work a hybrid ... **Summary** Responsible for the strategic and operational business needs of original claims , or first-time claims , for the Government Business and Commercial… more
- Prime Healthcare (Ontario, CA)
- …and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the ... to join our corporate team! Responsibilities TheVice President of Health Plan Operations and Claims is responsible for the development and execution of Claim… 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
- AIG (Atlanta, GA)
- …reimagining the way we help customers to manage risk. Join us as a Claims TPA Regulatory Governance and Performance Manager to play your part in that transformation. ... valued member of the team. Make your mark in Claims Our Claims teams are the proven...ensure necessary changes to controls are made based upon audit feedback (self-audits, state agency/Workers' compensation board audits, PwC… 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...spent at work to offer benefits focused on your health , wellbeing and financial security-as well as your professional… 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
- Guidehouse (Lewisville, TX)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- Centene Corporation (Austin, TX)
- …Bulletins for changes and updates and submit change requests (CRs) to update payment system + Audit check run and send claims to the claims department for ... for our 28 million members. Centene is transforming the health of our communities, one person at a time....perspective on workplace flexibility. **Position Purpose:** Serve as the claims payment expert for the Plan and as a… more
- Sedgwick (Brea, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than… more
- Sedgwick (Pasadena, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than… more
- Sedgwick (Roseville, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than… 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 ... regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than… more
- HCA Healthcare (Nashville, TN)
- …The Claims Auditor will serve as a Subject Matter Expert (SME) in medical claims processing at health plan payor, MSO, HMO, and IPA organizations with the ... HCA, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...on performance management recommendation. + Weekly review of high-dollar claims . + Review and analyze audit data,… more
- Axis (Kansas City, MO)
- …is available upon request for candidates taking part in the selection process. ** Claims Team Manager - Media/E&O/Cyber** **New York New Jersey Metro or Kansas City ... will report to the Head of North American Cyber Claims . The Claim Team Manager will lead and develop...drive brand + Leading and participating in claim audits, audit wrap up meetings, and formal result reporting +… more
- AIG (Atlanta, GA)
- Head of North America Claims Operations At AIG, we are reimagining the way we help customers to manage risk. Join us as Head of North America Claims Operations ... of the industry's top talent. Make your mark in Claims Our Claims teams are the proven...management and process improvement. + Strong Compliance, Governance and/or audit , regulatory background. Comprehensive awareness of the Business and… more
- Healthfirst (FL)
- …of claims configuration change requests using production validation and audit strategies. + Provide project and informational updates to management as available ... the on-going evaluation of configuration for new and existing claims business rules including member benefits, claims ...or GED from an accredited institution. + Previous managed care/ health plan experience in an operations department where you… more
- AIG (Atlanta, GA)
- Make your mark in Legacy Solutions Claims Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and ... showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by… more