- 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 ... granted as required by law. The **PBM Compliance Manager ( Claims Audit )** is responsible for coordinating pharmacy...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… 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 ... healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and submitting ... 011250 CCA- Claims **_This position is available to remote employees...for ensuring CCA's operational compliance with state and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vice-president-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime … more
- Molina Healthcare (Caldwell, ID)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, provider claims inquiries, reconsiderations, claims adjudication, and ... coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims . Ensures that claims are settled in a timely fashion and… more
- Grant Thornton (Los Angeles, CA)
- …and the overall effectiveness and efficiency of processes. + Oversee internal audit outsourcing and co-sourcing engagements for clients. + Manage the risk ... 4 years of direct experience with diverse life sciences companies or healthcare providers, including hospitals, academic medical centers, healthcare systems, and… more
- Molina Healthcare (San Antonio, TX)
- …and appeals experience. **Required Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, ... * Reviews and analyzes collective grievance and appeals data along with audit results on unit's performance; analyzes and interprets trends and prepares reports… more
- The Cigna Group (Bloomfield, CT)
- …Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits ... as needed. Education & Experience: The Quality Review & Audit Analyst will have a high school diploma and...and have excellent organization skills * Understanding of medical claims submissions is preferred * Ability to meet timeline,… more
- LogixHealth (Dania, FL)
- …teams to provide cutting edge solutions that will directly improve the healthcare industry. You'll contribute to our fast-paced, collaborative environment and bring ... issues and appeal if necessary, using software or other resource tools + Prepare audit results and keep department manager current of all findings and audits and… more
- Providence (WA)
- …we must empower them.** **Providence St Joseph Health operates a self-administered claims program for General and Healthcare Professional Liability, Directors ... organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending… more