• Quality Assurance (BlueCard) LOS- Auditor…

    CareFirst (Baltimore, MD)
    …of BlueCard-related transactions in a specific area of operations (ie, claims , customer service) within the organization. Incumbent conducts a variety of ... audit activities which may include, but not be limited to, process audits where there is a technology component, and operational audits involving internal and/or external process and procedures. In addition, the incumbent is responsible for ensuring QA testing… more
    CareFirst (07/17/25)
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  • Internal Auditor

    City of New York (New York, NY)
    …reports. - Participates in and reviews the processing of fiscal documents, claims , financial statements, and the accounting for the receipt, deposit and disbursement ... of large sums of money. - Performs work using information available in various phases of the accounting systems, account relationships and established techniques for computing and verifying accounting data. - Examines, analyzes, reconciles, adjusts and… more
    City of New York (07/05/25)
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  • Internal Auditor II- Hybrid (Bala Cynwyd,…

    Philadelphia Insurance Companies (Bala Cynwyd, PA)
    …the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an ... Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life… more
    Philadelphia Insurance Companies (06/27/25)
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  • Coding Auditor Professional - Remote…

    McLaren Health Care (Shelby Township, MI)
    …and efficiency in physician documentation, code assignment, data collection, and claims processing. 3. Performs retrospective, random, and focused audits of coding ... cases to ensure correct coding, legal compliance, and complete charge capture. 4. Evaluates the proper assignment of procedure, modifier, and diagnosis codes to professional services to validate accuracy and compliance. 5. Reports quality results, tracking and… more
    McLaren Health Care (06/04/25)
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  • Administrative Claims Preparer

    City of New York (New York, NY)
    …relating to cost allocation. The Finance Office is recruiting for one (1) Management Auditor II to function as an Administrative Claims Preparer who will: - ... Job Description APPLICANTS MUST BE PERMANENT IN THE MANAGEMENT AUDITOR CIVIL SERVICE TITLE, OR BE PERMANENT IN A...COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE CHANGE Bureau of Claims and Reimbursement (BCR) is responsible for the daily… more
    City of New York (06/03/25)
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  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    011250 CCA- Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr....+ Certified Inpatient Coder (CIC) + Certified Professional Medical Auditor (CPMA) **Desired Education (nice to have):** + Masters… more
    Commonwealth Care Alliance (05/28/25)
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  • PBM Compliance Manager ( Claims Audit)

    Elevance Health (Norfolk, VA)
    **PBM Compliance Manager ( Claims Audit)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... is granted as required by law. The **PBM Compliance Manager ( Claims Audit)** is responsible for coordinating pharmacy compliance activities and initiatives… more
    Elevance Health (07/29/25)
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  • Deputy Director - Office of Contract Agency Audits

    City of New York (New York, NY)
    …PERMANENT EMPLOYEES IN THE TITLE AND THOSE THAT ARE REACHABLE ON THE MANAGEMENT AUDITOR CIVIL SERVICE LIST ARE ELIGIBLE TO APPLY. CANDIDATES MUST STATE THE TITLE ... - Reviewing CBO's independently audited financial statements. - Conducting reviews of monthly claims for reimbursement submitted by CBOs, as part of the NYC Health… more
    City of New York (07/10/25)
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  • Principal Accounting Systems Technician

    The County of Los Angeles (Los Angeles, CA)
    …systems. + Supervises the review of audit findings prepared by the County Auditor and outside agencies and supervises the preparation of reports to support requests ... professional auditing or accounting experience** at the level of Senior Accountant- Auditor , Senior Accounting Systems Technician , Senior Accounting Systems Analyst… more
    The County of Los Angeles (05/14/25)
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  • Specialist, Configuration Oversight

    Molina Healthcare (NY)
    …conducting various audits including, but not limited to; vendor, focal, audit the auditor . Confirm that documentation is clear and concise to ensure accuracy in ... auditing of critical information on claims ensuring adherence to business and system requirements of...& ABILIITIES:** + Minimum 2 years as an operational auditor for at least one core operations function +… more
    Molina Healthcare (07/18/25)
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