Claims Integrity Auditor & Investigator II
Qlarant
Qlarant is seeking an individual to ensure the integrity and accuracy of claims processes in the United States, Kentucky. The candidate will conduct audits and investigations into customer claims, focusing on identifying fraud, waste, and discrepancies while adhering to industry regulations. The ideal candidate should have a Bachelor's degree and 2-4 years of experience in claims processing, with a Certified Fraud Examiner designation preferred. Strong analytical skills and attention to detail are essential for this role. #J-18808-Ljbffr Qlarant
- Qlarant is seeking an experienced candidate to ensure integrity in claims processes. This role requires conducting thorough audits/investigations, analyzing data to assess claims validity, and providing recommendations for resolution. You will compile detailed records and...Claims
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills... ...providing training and support to other auditors/investigators, contributing to the...ClaimsWork experience placement
- ...Summary Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail,...ClaimsWork experience placement
- A healthcare integrity solutions provider is looking for an Outpatient Payment Integrity Coder Auditor in New York City. In this role, you will audit outpatient medical claims for coding accuracy and compliance with CMS guidelines. The ideal candidate must have advanced...ClaimsRemote work
$46.99k - $122.4k
Hispanic Alliance for Career Enhancement in Georgia is hiring a Program Integrity Auditor responsible for auditing healthcare records. This role requires 3-5 years of experience in claims data review and medical coding standards (CPT, HCPCS, ICD-10). Candidates should hold...Claims$46.99k - $122.4k
...Hispanic Alliance for Career Enhancement is seeking a Program Integrity Auditor based in New Jersey. This role involves auditing medical... ...standards. The ideal candidate will have 3-5 years of experience in claims data interpretation and hold certifications such as CPC or...ClaimsFull time$46.99k - $122.4k
...a time. Position Summary The Program Integrity Auditor is responsible for the review of records... ..., recoupment of funds or rebilling of claims, and referral to state regulators for... ...internal staff and assisting with further investigation and/or reports to state regulators...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$120k - $140k
BerryDunn is hiring a Senior Consultant focused on Medicaid program integrity and claims audits. The ideal candidate will provide assistance on risk assessments and compliance, conduct audits, and develop corrective action plans. This position allows for remote, hybrid...ClaimsRemote work- A health insurance company is seeking a Senior Specialist, Coding Auditor to join their Payment Integrity team. This remote position involves supporting issue resolution, ensuring claims repayment quality, and assisting in root cause analysis. Candidates should have 1+...ClaimsRemote job
- Stryker Corporation seeks a Program Integrity Auditor who will review records for various healthcare providers, ensuring compliance with coding... ...standards. Responsibilities include auditing Medicaid claims and providing education to providers on coding rules. The ideal...Claims
- Cotiviti is hiring a Payment Accuracy Specialist 2 based in Idaho to support healthcare payment integrity. This role involves developing audit concepts, conducting detailed audits, and mentoring team members while working under moderate supervision. The ideal candidate...
$50k - $75k
...Workers’ Compensation Claims Adjuster II - California | 100% Remote Opportunity General Summary The Work comp Claims Adjuster II is responsible... ...for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability,...ClaimsRemote workWork from home- ...Staff Auditor Applicants must be permanent in the Management Auditor... ...for protecting the integrity of social services programs administered... ...at verifying that expenses claimed by providers and reimbursed by... ...placement in Assignment Level II individuals must have, in addition...ClaimsPermanent employmentFull timeWork at officeMonday to Friday
$130k - $150k
Job Title: Product Manager II - Financials, Access & Integrations Job Location: Remote Job Type: Full-time About Snapsheet Snapsheet is claims technology the way it should be: purposeful, precise, and designed to deliver outcomes. Where others bolt things on, we engineer...ClaimsFull timeTemporary workCasual workLocal areaRemote workVisa sponsorshipWork visaFlexible hours$20.55 - $34.25 per hour
Property Preservation Specialist II page is loaded## Property Preservation Specialist IIremote... ...R86217# **Overview:**This position is an integral role within M&T's property preservation... ...includes monitoring the insurance claim process for damaged properties and repair...ClaimsHourly payWork experience placement- ...a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic... ...Assessment forms and completes Crime Victim's Board (CVB) claim forms. 5. Endorses clinically relevant examination findings...ClaimsFull timeWork at officeShift work
$61 - $72 per hour
...Opportunity Details Full Time EEO Investigator EEO Investigator JOB-1004... .... Their vision is to be a fully integrated health system that enables New Yorkers... ...retaliation, including sexual harassment claims, to ensure compliance with federal, state...ClaimsHourly payFull timeContract workTemporary workWork at officeLocal areaShift work- Direct Jobs in Georgia is seeking a Rev Cycle Specialist II to handle complex account follow-up and claims resolution. The ideal candidate will have at least 3 years of billing experience and a high school diploma. Responsibilities include reviewing insurance claims, account...Claims
$66.33k - $145.86k
...individual contributor role supports complex investigations and contributes to organizational... ...identifying fraud risks, supporting program integrity efforts, and helping to prevent... ...identifies providers submitting non-NSA claims to CIDRE. Prioritizes and manages cases...ClaimsHourly payFull timeTemporary workLocal area$58.9k - $80.07k
The Investigator within the Special Investigations Unit (SIU) will be responsible for effectively... ...field, or five years of insurance claims investigation experience or professional... ...requirements Must demonstrate a high degree of integrity & appropriate treatment of confidential...ClaimsRemote jobTemporary workWork experience placementLocal area- Field Claim Investigator RC Services is seeking experienced and motivated Field Claims Investigators to support insurance claim investigations... ...work. You'll be part of a team that values accuracy, integrity, and high‑quality investigative work. RC Services, LLC is an...ClaimsContract workFlexible hoursAfternoon shift
$62.5k - $115.5k
Remote Jobs is seeking a Field Claims Specialist II to manage claims effectively while providing outstanding customer service. This role requires a minimum of three years in claims handling and excellent communication skills. You will solve insurance claims issues promptly...ClaimsRemote work- Qlarant is seeking an entry-level professional to ensure the accuracy and integrity of claims processes in Idaho. The role involves conducting audits and investigations into customer claims, analyzing data, and communicating findings. Candidates must have a minimum Bachelor...Claims
- ...Staff Auditor The Bureau of Internal and Contracted Audits (BICA) is recruiting for... ...DSS-AO) is responsible for protecting the integrity of social services programs administered... ...strategy aimed at verifying that expenses claimed by providers and reimbursed by DSS/DHS/...ClaimsWork at officeMonday to Friday
$26 - $30 per hour
...Overview Claims Investigator – Part Time Brooklyn, NY Uncover the Truth. Protect the Integrity. Advance Your Career. At CoventBridge Group, every claim tells a story — and as a Claims Investigator , you’ll be the one uncovering it. Using your investigative instincts, field...ClaimsHourly payPart timeH1bH2bWork from homeWorldwideFlexible hoursNight shift$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities...ClaimsRemote job$85k - $90k
...TREND Health Partners is a tech-enabled payment integrity company. Our mission is to facilitate... ...parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information to validate accuracy of DRG assignments...ClaimsWork at officeRemote work- Qlarant in the United States seeks a Claims Auditor to ensure the integrity of claims processes. This role involves conducting audits, analyzing data, and implementing strategies to prevent fraud. The ideal candidate has a Bachelor's Degree and 2-4 years of experience,...Claims
$50k - $55k
...leading authority in payment integrity solutions including DRG Validation... ...Appeals Coordinator level II team member will assist... ...level II performs research, investigation, and analysis of appeals, grievances... ...~ Experience in inpatient claims, DRG and High-Cost Outlier claims...ClaimsRemote work- ...Medical Billing Auditor Our client is seeking a detail-oriented, analytically strong Medical... ..., and support risk mitigation and revenue integrity efforts. Responsibilities: Conduct comprehensive audits of submitted claims, billing records, medical documentation,...ClaimsLocal area
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