- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million ... business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems… more
- Festival Foods (WI)
- …tasks and plans to meet department objectives. Provides direct leadership to the Senior Claims Specialist and Workplace Safety Specialist. Prepares and delivers ... safety and care across our organization. Reporting to the Senior Director of Asset Protection, you'll lead strategic initiatives...and conferences. + Oversee and review vocational reports and medical record reports related to various claims … more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …collaborates with practice, providers, and other departmental leaders to provide education on medical coding and documentation based on audit findings and as ... Party Payors) + Collaborate with appropriate teams to ensure claims data is transferred through the clearinghouse appropriately +...on a year-for-year basis + Minimum 2 years ofrelevant audit experience in physician or facility medical … more
- Ford Motor Company (Albany, NY)
- …for the balance of the book . Proactively monitor key underwriting and claims metrics to identity emerging risks and opportunities . Collaborate with underwriting ... strategic decisions, or adoption of best practices . Manage internal and external audit procedures **UW Audit Process:** . Manage overall underwriting audit… more
- CVS Health (Franklin, TN)
- …(Agent Configuration, Commissions Configuration, Product Configuration, Premium Configuration, Claims Configuration, Document Configuration). + Determine impact of ... business impact, sample data), enter service request ticket, respond to and update SR ticket as information changes. Assist with evaluating priorities across all SSI… more
- Sedgwick (Indianapolis, IN)
- …perform internal audit procedures under the general direction of the Internal Audit Senior ; to conduct walk-throughs for processes; to assist in preparation ... of internal audit reports and audit programs. **ESSENTIAL RESPONSIBILITIES...opportunities + A diverse and comprehensive benefits offering including medical , dental vision, 401K, PTO and more The statements… more
- Beth Israel Lahey Health (Charlestown, MA)
- …Prepare appeal requests as appropriate. * Responsible for appealing and defending claims denials, adverse audit results, and sanctions. * Analysis, tracking, ... appeals relevant to the audits in order to prove medical necessity and level of care were warranted in...fraud or abuse, as necessary. * Appeal and defend claims denials, adverse audit results, and sanctions.… more
- Ford Motor Company (Dearborn, MI)
- …investigation and litigation issues. + Supports handling the workers' compensation claims from initial report to resolution and investigates accidents involving ... provided to the claim adjusters. + Determines the need to report claims and maintains regular communication/review with claim adjusters to ensure excellent… more
- Option Care Health (Bannockburn, IL)
- …to summarize and communicate complex findings effectively. Reporting to the Senior Manager, Compliance Auditing, Monitoring and Analytics, this individual assists in ... actions. Partners with other functional areas and field teams to coordinate audit and monitoring activities from initiation through completion of corrective action.… more
- Sunrise Senior Living (Pueblo, CO)
- **When you join Sunrise Senior Living, you will be able to use your unique skills to empower residents to live longer, healthier, and happier lives. Not only will ... meaningful ways to serve, grow, and shine together.** **Sunrise Senior Living was again certified as a Great Place...completed for each business area. + Assist in providing audit materials and information as requested. + Meet business… more