- Grant Thornton (Philadelphia, PA)
- As a Process Risk & Claims Audit Manager, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand ... and help you achieve more, confidently. Your day-to-day may include: + Leverage claims operations experience and claim audit experience to review and analyze… more
- CVS Health (Harrisburg, PA)
- …regulation and identify process enhancement opportunities to reduce or eliminate risk of future client audit exceptions. This includes having an extensive ... as (but not limited to) benefit setup, prior authorizations, claims payment, and pharmacy contracting in order to review... process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well… more
- Sedgwick (Harrisburg, PA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Ryder System (Harrisburg, PA)
- …**SUMMARY** This position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling ... issues, and complex and high exposure bodily injury and property damage claims . **Maintain an active inventory of claims , ensuring appropriate follow-up,… more
- Highmark Health (Harrisburg, PA)
- …to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and ... OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and… more
- AmeriHealth Caritas (Newtown Square, PA)
- …and other internal/external key stakeholders to ensure regulatory alignment and mitigate audit risk _Provider Support & Stakeholder Engagement_ + Lead the ... engagement strategies that promote transparency and trust throughout the claims auditing process + Act as a...+ Use analytics to proactively identify emerging issues, support audit readiness, and drive continuous optimization + Evaluate and… more
- IQVIA (Wayne, PA)
- … claims processing** . + Identify and manage **payment data related to claims , rebill, and manage overrides.** + Audit readiness and fraud detection-including ... key growth drivers and trends. + Leads the monthly management forecast process for **pharmacy rebate manufacturers.** + Recommends and implements system solutions… more
- Fujifilm (Harrisburg, PA)
- …assessment. Support development of new or updated polices to address new risk areas or to improve operations and/or internal controls. + Conduct healthcare, ... anti-corruption, antitrust, anti-corruption, and anti-money laundering compliance risk analysis. Identify potential areas of compliance vulnerability and risk .… more
- Akumin (Harrisburg, PA)
- …opportunities for improvement. + Ensure data integrity across systems and support audit readiness. **Compliance & Risk Management** + Maintain up-to-date ... oversee all facets of the billing lifecycle, including charge capture, claims management, collections, cash application, denial resolution, and system optimization.… more
- Burns & McDonnell (Conshohocken, PA)
- …Negotiate prime contracts, CM contracts, subcontracts, and change orders. + Participate in risk review process . + Implement assigned sections of the Project ... client, supplier and company commissioning and startup teams as needed. + Implement, audit , and oversee project documentation. + Implement process for confirming… more
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