- 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
- 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 (Alexandria, VA)
- …where individuality is noticed and valued every day. **Pharmacist - Claims Auditor /Reviewer (Part-Time)** **Conduent Payment Integrity Solutions** **Are you ... behalf of major healthcare payers. As a **Pharmacist - Claims Auditor /Reviewer** , you'll apply your clinical...sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service… more
- Conduent (Los Angeles, CA)
- …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
- Insight Global (Los Angeles, CA)
- …systems in the country. This person will be responsible for for conducting audits of claims processed by medical groups and health plans contracted with LA Care, ... quarterly reporting (eg, MTR, OMT). Conduct oversight of delegates and subcontracted claims processors. We are a company committed to creating inclusive environments… 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
- Henry Ford Health System (Troy, MI)
- …ability to design complex spread sheet based and database applications. + Knowledge of medical claims data and managed care membership data. + Knowledge of ... to resolve identified issues on a case-by-case basis. The auditor will request medical records from providers...for fraud and abuse prevention and control. + Performs medical record audits including audit of claims ,… more
- Planned Parenthood of Central and Western NY (Rochester, NY)
- …and experience + Certified Professional/ Medical Coder or Certified Professional Medical Auditor desired Experience- + Minimum three years of experience ... Billing Auditor for Shared Services Fully Remote * Rochester,...medical billing and collections including follow-up on unpaid claims , researching insurance claims issues, and appealing… more
- ManpowerGroup (Vienna, VA)
- …and compliance with company policies and industry regulations. + Analyze claims documentation, including medical records, death certificates, policy terms, ... Our client, is seeking a Bank and Corporate Owned Life Insurance (BOLI/COLI) Auditor to join their team. As a Bank and Corporate Owned Life Insurance (BOLI/COLI) … more