- Elevance Health (Overland Park, KS)
- ** Claims Auditor I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... employment, unless an accommodation is granted as required by law._ The ** Claims Auditor ** **I** is responsible for pre and post payment and adjudication audits… more
- Conduent (Dallas, TX)
- …be part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like ... pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety of pharmacy records against our… more
- UCLA Health (Los Angeles, CA)
- …to the next level. You can do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned ... to the auditor . You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical ... kneeling, stooping and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** PA123 **Job Locations**… more
- LA Care Health Plan (Los Angeles, CA)
- Specialty Health Plans Auditor III Claims Job Category: Customer Service Department: Financial Compliance Location: Los Angeles, CA, US, 90017 Position Type: ... required to achieve that purpose. Job Summary The Specialty Health Plans Auditor III Claims is responsible for all aspects of planning, execution, reporting and… 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 ... claims are processed in accordance with Federal, State and...supervision. PRIMARY RESPONSIBILITIES: + Conducts monthly audits of CPHL claims utilizing CPHL guidelines, policies and procedures or any… more
- NTT DATA North America (Decatur, IL)
- …Summary:** The Utilization Management Coordinator reports to the Director of Claims . This position is responsible for coordinating the appeal activities and ... including pre-determinations and retrospective reviews. + Review submissions by the Claims Department to determine appropriateness of services through established UM… more
- Centene Corporation (Sacramento, CA)
- …PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims ... a monthly, quarterly and annual basis to ensure regulatory compliance. + Perform claims compliance audits for either federal or state programs. + Evaluate processes… more
- Trinity Health (Columbus, OH)
- …at 3100 Easton Square Pl Suite 300, Columbus, OH 43219 **Position Purpose:** Delegated Claims Auditor executes, in an accurate and timely manner, in accordance ... You Will Do:** + Maintain current knowledge of the claims operating system + Sort and organize incoming mail...system + Sort and organize incoming mail for the Claims Department. + Log and enter incoming mail into… more
- CVS Health (Scottsdale, AZ)
- … submitted through the CVS Health claims processing systems. The Pharmacy Claims Auditor will identify and rectify claim inaccuracies that would result in ... to not only help people get well, but help them stay well in body, mind and spirit. The Pharmacy Claims Reviewer is responsible for reviewing pharmacy claims… more