- Novo Nordisk Inc. (Plainsboro, NJ)
- …with global auditors and NNI employees to assist with the execution of the audit and follow-up on any remediation actions Reviews and analyses high risk activities, ... knowledge and clear understanding of the Anti-Kickback Statute and False Claims Act, FDA rules and regulations regarding the promotion of pharmaceuticals,… more
- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve ... 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
- CenterLight Health System (NY)
- …effectiveness of the claims department by timely and accurate processing of claims appeals and performing claims audit , ensuring payment integrity and ... monies and proper application of transaction by our TPA. + Perform in-depth claims audit to confirm that all medical claims paid and denied accurately.… more
- Old Dominion Freight Line (Thomasville, NC)
- …pay as needed + Review financial information and determining settlement of downtime claims + Audit and process independent adjuster invoices + Write settlement, ... keep OD the premier transportation solutions provider. Effectively handle property damage claims due to OD vehicle accidents and incidents. Perform other duties… more
- LA Care Health Plan (Los Angeles, CA)
- … is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted ... requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted… more
- TEKsystems (Springfield, MO)
- …this role. Skills Claims , RxClaims, Pharmacy benefits, Health insurance, Claims Analyst, Audit , support, analysis, workflow, claim, Healthcare, Medical ... Terminology Top Skills Details Claims ,RxClaims,Pharmacy benefits,Health insurance, Claims Analyst, Audit ,support,analysis Additional Skills & Qualifications… more
- Monroe One Boces (Fairport, NY)
- …of Education. He/she must have the necessary knowledge and skills to effectively audit claims including experience with purchasing, bidding, and claims . ... classified in the civil service exempt class. DUTIES: 1. Verify and audit appropriateness of all claims for payments. 2. Examine all claim forms with respect to… more
- Gates Chili Central School District (Rochester, NY)
- …strives to dismantle exclusion, bias, racism, and prejudice of all forms. Deputy Internal Claims Auditor To audit and approve each claim (except contracted wages ... The individual appointed to the position should be independent, qualified to audit the claims , and should receive any necessary training. The claims auditor… more
- Robert Half Accountemps (Minneapolis, MN)
- …Process appeals and adjustments in alignment with established procedures and guidelines. * Audit claims for accuracy and adherence to organizational standards. * ... Description We are looking for a highly skilled MCO Claims Analyst to join our team on a long-term...In this role, you will analyze and process healthcare claims while ensuring strict compliance with industry standards, organizational… more
- CVS Health (Scottsdale, AZ)
- …audit results using SQL coding analytics. + Coordinating the correction of Medicare Part-D claims and PDEs These audit programs help keep CVS Health plans in ... and every day. **Position Summary** As the Medicare Pharmacy Audit Programs Project Manager you will be responsible for...you will be responsible for administering Medicare Part-D Pharmacy Audit Programs. In this role, you will be expected… more
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