- Sedgwick (Cincinnati, OH)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Auto Liability **PURPOSE:** To supervise the operation of a… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation. + Maintains awareness of fraud, waste and ... protocols which align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to hospital revenue cycle services performed… more
- Highmark Health (Columbus, OH)
- …the consistent, accurate, efficient, and appropriate processing of adjustments and/or duplicate claims through an audit sampling review process. 2. Develop ... data relevant to the handling of all types of complex adjusted claims ; conducting reviews of all organizational or functional activities related to fraud/abuse… more
- Sedgwick (Columbus, OH)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- Elevance Health (Mason, OH)
- …claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. + Prepares correspondence to providers ... Alternate locations may be considered. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing… more
- Elevance Health (Mason, OH)
- …Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an...you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding… more
- Elevance Health (Independence, OH)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more
- Elevance Health (Mason, OH)
- …unit/brand as appropriate regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Trains ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Trustmark (Columbus, OH)
- …communities. **About the role** This role is a dedicated training position for Claims that resides in the Knowledge Management & Customer Experience group. The ... primary function of this role is to train and audit new and existing staff in all products including...claim handling process and procedures and experience in handling claims appropriately in accordance with the corporate claim philosophy,… more