- Elevance Health (Norfolk, VA)
- **PBM Compliance Manager ( Claims Audit )** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... is granted as required by law. The **PBM Compliance Manager ( Claims Audit )** is responsible for coordinating pharmacy compliance activities and initiatives… more
- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...and respond to carrier and/or arbitrator inquires + Submit claims through state arbitration portals Qualifications : To perform… more
- The Cigna Group (Bloomfield, CT)
- …tools including the Enterprise Data Warehouse (EDW), Access, Excel, etc., identify pharmacies and claims representing audit risks and develop an audit plan, ... to 50% of the time. **POSITION SUMMARY:** The Quality Review and Pharmacy Technician Audit Lead Analyst is responsible to identify pharmacy audit risks using… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …of the audit analysis to ensure the accuracy and appropriateness of claims payments. + Translate audit insights into actionable recommendations and partner ... (ICD-10, CPT, HCPC) and reimbursement methodologies. + Deep understanding of claims systems and audit platforms such as NASCO, Cognos, and CXT. + Proven… more
- Wittenberg Weiner Consulting LLC (Santa Fe, NM)
- Copperhead is seeking multiple Audit and Quality Control Claims Specialist for a potential contract to support disaster relief. This position involves receiving, ... meticulous attention to detail and adherence to FEMA guidelines. Audit and Quality Control Claims Specialist will...to FEMA guidelines. Audit and Quality Control Claims Specialist will objectively review, investigate, process, and evaluate… more
- CVS Health (Franklin, TN)
- …timely and accurate policy and claim decisions. + Coordinate with the Ancillary Claims processing and Audit Quality teams. + Provide documentation and advisement ... to medical and policy history. This position involves reviewing health records, claims , and related documentation to ensure alignment with policy requirements and… more
- Providence (WA)
- …organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending ... to department leaders for claims management improvement opportunities and claims -related trends through audit , data analytics, and training observations +… more
- Conduent (Los Angeles, CA)
- … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
- Sedgwick (San Diego, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Best Workplaces in Financial Services & Insurance Workers' Compensation Claims Team Lead | Roseville, CA or San Diego,...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +… more
- Sedgwick (Toledo, OH)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead, Auto (BI + Liability) **PRIMARY PURPOSE**...: To supervise a team handling auto rental car claims ; to monitor colleagues' workloads, provide training, and monitor… more
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