- Sedgwick (West Hills, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Best Workplaces in Financial Services & Insurance Workers Compensation Claims Team Lead | West Hills, CA Are you...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more
- Sedgwick (Harrisburg, PA)
- …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, General Liability **PRIMARY PURPOSE** : To supervise a team of… more
- Sedgwick (San Antonio, TX)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance General Liability Claims Team Lead | Remote TX | Dedicated Client **_Are you looking for… more
- Ascension Health (Austin, TX)
- …requirements established by Health and Human Services Commission. Perform routine and/or targeted audit of claims to ensure payment accuracy and adherence to ... agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals using support systems to determine appeal outcomes. + Composes all… more
- Commonwealth Care Alliance (Boston, MA)
- …Experience (must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and ... 011250 CCA- Claims **_This position is available to remote employees...identify areas of risk or non-compliance. * Track internal audit findings and facilitate resolution through Corrective Action Plans… more
- United Rentals (Stamford, CT)
- …using company data, financial analysis, and contract interpretation to validate or dispute claims . + Audit Defense Execution + Develop clear, data-backed dispute ... of defense in contractual compliance audits initiated by customers or third-party audit firms for customer and national account pricing contracts. This role manages… more
- Prime Therapeutics (San Diego, CA)
- … audit analytics and professional knowledge to identify educational trends and select claims for audit in alignment to department procedures and objectives + ... of audit tools and processes to effectively identify erroneous claims , non-compliant pharmacy practices or potential pharmacy reimbursements + Track audit… 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
- AIG (Atlanta, GA)
- …succeed + Proven claim adjudication or claim operations experience for multi-line commercial claims . Claim Audit or file review experience is desirable. + ... valued member of the team. Make your mark in Claims . Our Claims teams are the proven...include: + Gathering of data for compliance with claim audit requests or for regulatory reporting. + Completion of… more
- TEKsystems (Los Angeles, CA)
- …analyzing benefits, and supporting compliance and auto-adjudication processes. Key Responsibilities + Audit denied provider claims (13/hour) and member claims ... Job Title: Claims Examiner - Contract Role Location: Northridge, CA...Pay: $25/hour Position Overview We are seeking a detail-oriented Claims Examiner for a short-term contract role. This position… more
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