- Grant Thornton (Los Angeles, CA)
- …risk management programs, and/or entity-level and business process controls for Internal Audit , or other risk management, compliance, and assurance activities + ... Grant Thornton LLP, a licensed, certified public accounting (CPA) firm that provides audit and assurance services ― and Grant Thornton Advisors LLC (not… more
- TEKsystems (Los Angeles, CA)
- …and support departmental improvement projects. + Perform audits and contribute to quality assurance efforts. Qualifications: + Prior experience in healthcare ... Medical Claims Examiner Location: Remote (must be located in...for assigned claim types. + Analyze Manual Review and audit reports across all Health programs. + Identify and… more
- Grant Thornton (Newport Beach, 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
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …Summary** We are seeking an experienced and dynamic Executive Director of R&D Global Quality to join our team. This pivotal role will be responsible for leading a ... global team focused on R&D Quality . This global role includes direct reports in the...oversee clinical trial and submission support, lead the R&D audit program, engage with regulatory authorities, and maintain clinical… 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
- Elevance Health (Walnut Creek, 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
- City and County of San Francisco (San Francisco, CA)
- …compliance with federal requirements. + Reviews targeted tasks, phone calls, and supervisor quality assurance forms to ensure quality of customer service. ... is sustained by our City's commitment to heighten the quality of life for the diverse population of San...general duties above: + Detects, investigates, and prevents fraudulent claims for public assistance to avoid welfare fraud and… more