- CRC Insurance Services, Inc. (Flower Mound, TX)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- Philadelphia Insurance Companies (Melville, NY)
- …of Ward's Top 50 and rated A++ by AM Best. We are looking for a Sr. Claims Examiner - PIP to join our team! Summary: Analyze insurance claims to determine extent ... or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and… 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
- PennyMac (Fort Worth, TX)
- …of homeownership through the complete mortgage journey. A Typical Day The Claims Supervisor is responsible for providing structure and oversight to the post-sale ... for the claim process including, filing all MI, investor, and insurer claims timely and accurately, providing all back-up as requested, and the reconciliation… more
- Grant Thornton (Atlanta, GA)
- …exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare systems. This includes areas such as ... include but are not limited to co-sourced and outsourced internal audit , internal control assessments, enterprise risk management program assessments, tests of… more
- CVS Health (Harrisburg, PA)
- …a Regional Pharmacy Onsite Auditor, you will be an essential part to the Pharmacy Audit Department at CVS/Caremark. In this role, you will be based from your home ... and travel onsite to conduct claims audits at pharmacies throughout multiple states by reviewing...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- CVS Health (Augusta, ME)
- …all with heart, each and every day. **Position Summary** The Quality Specialist will audit pre and post payment claims for accuracy and eligibility transactions. ... identifying errors, necessary corrective measures, and may participate in special audit assignments. **Required Qualifications** + 1+ years of experience working in… more
- The Cigna Group (Bloomfield, CT)
- …be detail oriented, self-motivated, and have excellent organization skills * Understanding of medical claims submissions is preferred * Ability to meet timeline, ... The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical … more
- Public Consulting Group (Chula Vista, CA)
- …Assessments and Feasibility Studies PCG is seeking highly motivated and dependable Claims Specialist payment processing clerk with an interest in public service who ... Create and maintain adequate budget files for clients for audit purposes. + Monitor accuracy/timeliness of payment processing. +...provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave,… more
- Molina Healthcare (NE)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment is ... claim audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and...to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of… more