- Providence (CA)
- …organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance program, management of projects and continual ... assists the Claims leaders in managing a quality assurance program to ensure compliance with...and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based… more
- Adecco US, Inc. (Los Angeles, CA)
- **Job Summary** We are seeking a ** Quality Assurance Specialist** to ensure our products and operations comply with all applicable US federal, state, and local ... quality and regulatory standards **Qualifications** + 5-10 years of experience in quality assurance , preferably in a US-based beauty or personal care platform… more
- Grant Thornton (San Jose, CA)
- …Grant Thornton LLP, a licensed, certified public accounting (CPA) firm that provides audit and assurance services ― and Grant Thornton Advisors LLC (not ... and the overall effectiveness and efficiency of processes. + Oversee internal audit outsourcing and co-sourcing engagements for clients. + Manage the risk… more
- Insight Global (Irvine, CA)
- … claims examiner or auditor preferred. Experience with claim investigation, quality assurance process, ad-hoc audits, claim reviews, claim auditing ... An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working...processes, including pre and post-billing activity. The Examiner will audit , conduct root cause analysis, identify issues and propose… more
- Prime Therapeutics (San Diego, CA)
- …or combined pharmacy and PBM experience to include: + 2 years of work experience in audit or quality assurance + 1 year of work experience in customer ... and professional knowledge to identify educational trends and select claims for audit in alignment to department...new ideas and work collaboratively to provide the highest quality of care and service to our members. If… more
- Banner Health (CA)
- …documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. ... different focuses (Facility vs Profee)._ In this **Inpatient Facility-based HIMS Coding Quality Associate** position, you bring your **5 years of acute care… more
- Elevance Health (Costa Mesa, CA)
- …in applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance , or clinical documentation improvement, and a ... Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes...to generate audit determinations and formulate detailed audit findings letters. + Maintains accuracy and quality… more
- Sharp HealthCare (San Diego, CA)
- …reasonableness checks). Providing efficient and cost-effective solutions as required.Oversees all claims testing and quality assurance activities and ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- Sharp HealthCare (San Diego, CA)
- …checks) provide efficient, cost-effective solutions as directed.Serve as the lead on claims testing and quality assurance activities and assisting ... investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or… more
- LA Care Health Plan (Los Angeles, CA)
- …Support and Control will report to Director, Production Support within the IT Quality Assurance and Process excellence organization and will be primarily ... services. Collaborate with Infrastructure team, hosted vendor teams, Release Management and Quality Assurance teams to address production incidents per the… more