- FM (Johnston, RI)
- …in a variety of challenging roles. **Summary:** This position heads up the critical IT audit group and is relied upon as the subject matter expert on all IT ... audit related issues by the chief internal auditor. The...of core insurance business processes including underwriting, premiums, reinsurance, claims , as well as, the following general business processes:… more
- CVS Health (Tallahassee, FL)
- …travel on the company's site in a cost effective manner - Knowledge of CVS Health (or other PBM) claims processing - Knowledge of retail pharmacy operations ... At CVS Health , we're building a world of health ...you will be an essential part to the Pharmacy Audit Department at CVS/Caremark. In this role, you will be… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance ... and compliance with appropriate policies, procedures, and regulations + ** Health , Dental, Vision, and Life Insurance as well as...medical audits, target audits, re-audits, etc and audits for claims which are in excess of payment authority limits… 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
- Commonwealth Care Alliance (Boston, MA)
- …in claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of MassHealth transmittals, ... 011250 CCA- Claims Job Description **Position Summary:** Reporting to the...Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit , compliance, and provider engagement initiatives. This role also… more
- NJ Transit (Newark, NJ)
- Chief of Risk Management & Claims Finance Job Description: Move forward with us! At NJ TRANSIT, you'll join us in transforming the third-largest transportation ... service providers. + Direct all aspects of loss control, claims investigation, evaluation, and negotiation, and activities of defense...Management and Claim items involved in the annual external audit or any other external or internal audit… more
- Guidehouse (El Segundo, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- UCLA Health (Los Angeles, CA)
- …Take your career 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 ... + Knowledge of claims adjudication systems + Flexibility and adaptability UCLA Health is a world-renowned health system with four award-winning hospitals and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …in your career and be what you want to be. We provide: * Comprehensive health benefits that start day 1 * Student Loan Repayment Assistance & Reimbursement Programs ... Location:** Atlanta, GA **Description** + Reporting to the Director, Compliance Audit and Analysis, oversees audits, monitoring, and education for hospital and… more
- Houston Methodist (Houston, TX)
- …and capture potential revenue opportunities. This position performs quality assurance, detailed claims analysis and medical record reviews of complex claims and ... FUNCTIONS** + Conducts risk-based and baseline reviews of complex and escalated claims or records in a timely manner, evaluates corrective actions and processes… more
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