- Insight Global (Irvine, CA)
- …with strong understanding of medical terminology. Previous experience as a medical claims examiner or auditor preferred. Experience with claim ... with excel In the job experience of EHR systems and medical insurance claims management softwares Knowledge of state, federal, and applicable regulations… more
- CHS (Clearwater, FL)
- …(Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance claims and customer service calls to ... Responsibilities:** + In accordance with company guidelines, performs random medical audits, target audits, re-audits, etc and audits for...and lifting up to thirty (30) pounds. ** ** ** Claims and Call Auditor (Call Center QC)… more
- NTT DATA North America (Decatur, IL)
- …when executed as part of an overall sourcing strategy. NTT DATA currently seeks a Claims Auditor to join our team for a remote position. 100% Remote, Client ... of Direct Hire Pay Rate $21-$22/hr **Position Summary:** The Claims Auditor position reports to the Chief...nature of the role offered. Company benefits may include medical , dental, and vision insurance, flexible spending or health… more
- 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 ... an accommodation is granted as required by law._ The ** Claims Auditor ** **I** is responsible for pre...claim including eligibility, system coding and pricing, pre-authorization, and medical necessity. + Contacts others to obtain any necessary… more
- UCLA Health (Los Angeles, CA)
- …with: + High school diploma, GED or equivalent + Four or more years of medical claims payment experience in an HMO environment + Experience with CPT-4, ICD-9CM, ... do all this and more at UCLA Health. The Claims Quality Auditor will be responsible for...medical terminology + Experience in benefit determination and claims adjudication + Ability to accurately key 6,000-8,000 keystrokes… 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 ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a...sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service… more
- WTW (Chicago, IL)
- …PPO, Indemnity and Managed Care + Must demonstrate a high level of claims administration knowledge, including experience with medical , dental, mental health and ... **Description** As a Lead Auditor you will apply your audit, project management...will review discrepancy issues identified by field auditors, re-adjudicate claims , resolve open issues, and draft the final report.… more
- Centene Corporation (Sacramento, CA)
- … claims adjudication concepts, claims inventory management and general claims department processes required. + Knowledge of Medical Terminology, Current ... PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims… 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 ... process which includes initiating Case Management, requesting Pre-Certification, submitting Medical Reviews, and Independent Dispute Resolution. The successful candidate(s)… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Medicaid Inspector General, NYS Office of the Title Auditor 1/ Auditor Trainee 1/ Auditor Trainee 2 (NY HELPS) Occupational Category ... Albany State NY Zip Code 12204 Duties Description An Auditor 1 performs research on the functions of the...and recommends audit schedule; conducts rate audits of various medical facilities that receive cost based rates by performing… more