- Insight Global (Irvine, CA)
- …medical terminology. Previous experience as a medical claims examiner or auditor preferred . Experience with claim investigation, quality assurance ... An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working...will assist management with implementation of measures to ensure claim processing and payment accuracy. They will also help… more
- Centene Corporation (Sacramento, CA)
- …related field such as Business, Accounting, Finance, Healthcare or equivalent experience preferred . + 2+ years claims compliance experience, preferably with ... PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims… more
- Prime Therapeutics (San Diego, CA)
- …passion and drives every decision we make. **Job Posting Title** Onsite Pharmacy Auditor (based in California) **Job Description** The Onsite Pharmacy Auditor ... pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III, $5,000 SIGN ON BONUS Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Specialty Health Plans Auditor III is offering a $5,000 Sign On Bonus....and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors.… more
- Elevance Health (Walnut Creek, CA)
- **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, ... required by law. The **Diagnosis Related Group Clinical Validation Auditor ** is responsible for auditing inpatient medical records to...Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes… more
- Highmark Health (Sacramento, CA)
- …communication skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and strong education/training background ... and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting… more
- Humana (Sacramento, CA)
- …cycle management (related to billing, coding, collections for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must ... and regulations governed by the Department of Insurance and CMS ** Preferred Qualifications** + Compliance regulations knowledge and compliance auditing experience +… more
- Warner Bros. Discovery (Burbank, CA)
- …production incentive claim from either 3rd party CPA or government auditor . + Retrieves all required support (from digital and physical filing systems) required ... to compile the claim /application and to defend the production incentive from audit/review....in production accounting. + Working knowledge of production incentives preferred . + Working knowledge of the production or postproduction… more
- Marriott (Santa Barbara, CA)
- **Additional Information** Pay: $16.50/hour, full time, experience preferred **Job Number** 25137682 **Job Category** Rooms & Guest Services Operations **Location** ... guests. Complete nightly audit of parked vehicles with vehicle claim tickets, resolve discrepancies, and submit list for charges...submit list for charges to be posted by Night Auditor . Maintain security of vehicles and vehicle keys. Follow… more
- LA Care Health Plan (Los Angeles, CA)
- …data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements. Manages complex ... lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree Experience Required: At least 6 years of experience in… more