- CenterLight Health System (NY)
- …effectiveness of the claims department by timely and accurate processing of claims appeals and performing claims audit , ensuring payment integrity and ... monies and proper application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical claims paid and denied accurately.… more
- Axis (New York, NY)
- …Reinsurance Senior Claim Specialist - Job Description Job Family Grouping: Reinsurance Claims Job Family: Claims Location: New York Hiring Manager: Marina ... office following in person orientation, provided performance is satisfactory. The Reinsurance Claims Specialist is a key contributor to the reinsurance team at AXIS.… more
- City of New York (New York, NY)
- …CIVIL SERVICE LIST ARE ELIGIBLE TO APPLY. Division/Program Summary: The Bureau of Audit Services plays a leading role in risk-based assessments of the Department's ... Innovation's policies. Position Summary: DOHMH is seeking an Assistant Audit Manager to join the Bureau of Audit...all testing schedule (PS, OTPS, Fringe, Admin, LOS, EI claims ) and draft reports and submit for Supervisors review… more
- CenterLight Health System (NY)
- …a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining processes, conducting comprehensive data analysis, ... guidelines. This position requires a working knowledge of Government Programs medical claims payment system and configuration with strong focus on data review and… more
- Gates Chili Central School District (Rochester, NY)
- …strives to dismantle exclusion, bias, racism, and prejudice of all forms. Deputy Internal Claims Auditor To audit and approve each claim (except contracted wages ... contractors. The individual appointed to the position should be independent, qualified to audit the claims , and should receive any necessary training. The … more
- Molina Healthcare (Yonkers, NY)
- **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
- Healthfirst (NY)
- …and results verification before sign-off and Production. + Assist in the on-going audit of configurations for new and existing claims business rules within ... terms, prepare fee schedules and accurately document file changes into the claims processing system + Research and identify published updates to payment… more
- Sedgwick (Rochester, NY)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Team Lead | New York Jurisdiction Job Description We are seeking a… more
- Axis (New York, NY)
- …request for candidates taking part in the selection process. **Job Description: Senior Claims Specialist** AXIS is seeking a Senior Claims Specialist to join ... Claims team reporting to the Manager of Casualty Claims . This position requires senior claims management...practices measured by monthly Quality Assurance and Management Initiated Audit scores as well as the implementation of Management… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure ... general supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any other regulatory… more
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