- Robert Half Accountemps (Plantation, FL)
- …billing, and claim administration, while utilizing various computer programs. Responsibilities: * Audit medical claims to ensure accuracy and compliance ... We are offering a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation, Florida. As a… more
- USAA (Plano, TX)
- …what makes us so special! **The Opportunity** As a dedicated **Senior** ** Audit Manager,** you'll manage Bank Fraud Management, Dispute Operations, and general ... banking engagements involving fraud driving the quality of audit work. You may lead engagements as Auditor-In-Charge (AIC). Continuously enhances knowledge of fraud,… more
- USAA (Phoenix, AZ)
- …be a part of what makes us so special! **The Opportunity** As a dedicated ** Audit Manager,** you'll lead and execute complex audit engagements throughout the ... crimes, and related consumer regulations and applies that knowledge to audit assignments. Creates and independently performs complex work assignments and problem… more
- 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,...two years related experience + Healthcare industry knowledge + Medical billing experience Benefits at LogixHealth: We offer a… more
- Martin's Point Health Care (Portland, ME)
- …of education and relevant experience. + 5 or more years of related medical claims auditing experience or equivalent experience. + Detailed knowledge of ... claims audits or other matters directed to the Audit Department. + Planning and Reporting: The Auditor II...or payment policies. + Research, design, and development of audit formats to identify claims overpayment scenarios,… 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
- Sedgwick (Long Beach, CA)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Team Lead, Professional Liability ( Medical Malpractice) **PRIMARY PURPOSE** ... and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- Metropolitan Council (St. Paul, MN)
- …to our organization and the Twin Cities region: TheWorkers' Compensation Claims Representativewill administer Minnesota lost time and medical -only Workers' ... and pursue subrogation, as appropriate. + Participate in bi-annual claims meetings with internal departments. + Review medical...or management job; is in the Finance, Information Services, Audit , or Human Resources departments; or has access to… more
- Flynn Restaurant Group (Independence, OH)
- … claims . + Evaluating more complex injuries and corelating medical records, diagnostic imaging, and bills, identifying pre-existing conditions, confirming ... **Position Description** The Liability Claims Analyst / Bodily Injury Analyst is responsible...lien notices are received, handle as appropriate with Medicare, Medical provider or court appointed liens and incorporate in… more
- Healthfirst (FL)
- …Assist in the setup of code sets and defining pre-authorization guidelines used in claims configuration to drive application of medical policy and accurate ... of claims configuration change requests using production validation and audit strategies. + Provide project and informational updates to management as available… 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 (Brea, 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 Workers Compensation - (Dedicated Account) **WORK LOCATION:** Hybrid… 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
- Axis (Chicago, IL)
- …AXIS is seeking a _Senior Claim Specialist -_ _Construction_ _Claims_ to join our North America Claims team and will report to the Head of Property Claims . As a ... direct report to the Head of Property Claims , the candidate should possess the ability to handle...claim trends + Leading and participating in claim audits, audit wrap up meetings, and formal result reporting +… 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 ... care environment, required + Hands-on knowledge and functional understanding of medical claims billing, processing, terminology, diagnosis and procedures. +… more
- The Cigna Group (Denver, CO)
- The Medical Claims FP&A Senior Manager will manage projection and results analysis for core Medicare Advantage Part C medical claims expense processed ... governance (primarily in Excel/SQL). Familiarity with R/Python a plus. + Experience with medical claims , clinical, and financial data + An actuarial background… 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
- 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)
- … Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the VP will identify financial ... our corporate team! Responsibilities TheVice President of Health Plan Operations and Claims is responsible for the development and execution of Claim Operations… more
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