Medical Claims Investigator — Analytics-Driven Claims Auditor
MultiPlan, Inc
Claritev seeks a claims data analyst to review medical paid claims against provider contracts and policies, ensuring accurate payments. You will employ data mining and coordination of benefit techniques to analyze hospital and physician claims for errant payments. Role emphasizes HIPAA compliance, collaboration across departments, and adherence to coding guidelines; high-PHI exposure is expected. A bachelor’s or medical billing/coding certification is preferred, with two years’ direct experience. #J-18808-Ljbffr MultiPlan
$50k - $55k
JOB SUMMARY This role reviews medical paid claims against provider contractsand policiesto ensure... ..., and growth results. 2. Utilize analytics and data mining and coordination of benefits... ...direct experience in medical claims investigation or data mining / coordination of...MedicalWork at office$38.46 - $52.4 per hour
...systems, hospitals and medical clinics are under immense... ...The Inpatient Coding Auditor will be responsible for... ...is initiated before the claim is rebilled to the... ...Visio, SharePoint) ~ Analytical skills (problem solving... ...schedule in a deadline driven environment ~ Requires...MedicalHourly payPermanent employmentFull timeWork at officeLocal areaImmediate startRemote workFlexible hoursDay shift- ...consulting firm is seeking an experienced Medical Billing Specialist to handle claims processing and contribute to AI-powered... ...with coding systems and strong analytical skills are essential. Join us to help enhance AI-driven medical billing solutions in a collaborative...MedicalRemote job
- ...seeking a Data Mining Recovery Collections Specialist to pursue collections on errant healthcare claims with providers. The role blends healthcare expertise with analytics-powered solutions to improve financial integrity and operational efficiency. You will make outbound...Medical
$46.99k - $122.4k
...The Program Integrity Auditor is responsible for the... ...review of records for medical, behavioral, transportation... ...funds or rebilling of claims, and referral to state... ...with further investigation and/or reports to state... ...with QuickBase. Strong analytical and critical thinking...MedicalHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours- ...Senior Auditor Employment Type: Full Time, Mid-level CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses...MedicalFull timeRemote workFlexible hours
$71.1k - $97.8k
...our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety... ...auditor to review inpatient hospital claims for proper reimbursement, handle... ...disputes in a result-oriented and metrics-driven environment. If you are looking to...MedicalBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...Department Director, the Vendor Auditor is responsible for independently conducting claims and vendor performance audits to... ...actions. The Vendor Auditor analyzes medical, pharmacy, and PBM claims data... ...this role requires exceptional analytical, critical thinking,...MedicalFull timeLocal areaDay shift
$101k - $155k
...audit program, leading a team of auditors, developing audit methodology... ...the Autonomous IT company. Driven by AI and real-time endpoint... ...package consisting of medical, dental and vision plan, family... ...job offers coming from people claiming to be Tanium employees. Tanium...MedicalFull timeLive inWorldwideFlexible hours- ...is seeking a highly skilled Auditor to provide general auditing and... ...services in support of fraud investigations involving potentially complex... ...records, healthcare claims, tax records, correspondence,... ...reviewing and understanding medical records and knowledge of medical...MedicalFull timeWork experience placementInterim roleWork at officeLocal areaFlexible hours
$130k - $150k
...programs (Excel, Word, PowerPoint, MS Project, etc.)Excellent analytical and writing skills.Familiarity with Federal Acquisition RegulationsKnowledgeable... ...overall qualifications. Benefits include Health Care Plan (Medical, Dental & Vision), Retirement Plan (401k, IRA), Life Insurance...MedicalTemporary workWork at officeImmediate startWork from home- ...Description Job Description As a CISA Auditor at Greenberg-Larraby, Inc. (GLI), your... ...controls, and compliance regulations. Analytical mindset with strong problem-solving... ...preferred. Benefits Health Care Plan (Medical, Dental & Vision) Retirement Plan (401...MedicalTemporary work
$98k - $163k
...pharma are helping people live healthier lives, while medical devices enable patients to proactively maintain... ...learning methods in addition to conducting advanced analytics using big datasets, including claims, affiliations, payer, sales, and other sources. You will...MedicalFull timeWork experience placementLocal areaImmediate startRemote workFlexible hours- ...is hiring a (Hybrid) Senior Auditor at our Tysons, Virginia location... ...including the use of data analytics. Develop internal, business... ...package including robust medical, dental and vision plan options... ...or participating in an investigation of same. PenFed will also reasonably...MedicalFull timeWork at officeLocal areaWorldwide
- ...focus on denial follow-up and claims resolution, doing everything... ...rewarding career opportunity in the medical industry, we encourage you to... ...resolution, with a results-driven approach. Knowledge of... ...Medicare guidelines. Strong analytical skills, attention to detail,...MedicalFor contractorsWork at office
$47.59k - $87.56k
...group of remarkable individuals driven by intellectual inquiry, a... ...Resources website.The Internal Auditor will perform primary duties... ...assessment, problem identification, analytical problem solving, and issue... ...package that includes medical, dental, vision, disability and...MedicalHourly payWork at office3 days per week- ...accomplished Senior Internal Auditor to serve as a strategic advisor... ..., risk assessments, and data-driven reviews aligned with Global... ...corrective action plans, and data analytics, you will transform results... ...automatic bar to employment) Medical examination including a drug...MedicalContract workWork experience placementWork at office
- A government services entity in Washington, DC, is seeking a skilled Senior Auditor to conduct forensic investigations and analyze medical claims data. Candidates should have over 5 years of relevant experience, with roles including financial analysis and report preparation...MedicalFlexible hours
$104k - $160k
...System monitoring tools and performance analytics platforms Qualifications REQUIRED... ...technical problems and propose data-driven solutions · Effective collaboration... ...days, 12 paid holidays, and sick time Medical, dental, and vision plans for you and your...MedicalPermanent employmentTemporary workWork experience placementFlexible hours- Senior Auditor Location US- ID 2026-1563 Remote Yes... ...large and complex auditing investigations as required in support of litigation... ..., Medicare billing and claims systems, or DoD inventory systems... ...and childbirth or related medical condition or on any other...MedicalFull timeContract workInterim roleRemote workWork from homeHome officeFlexible hours
- ...reinvent Underwriting and Claims through process... ...transformation, data-driven decisioning, and AI-enabled... ...with advanced analytics and agentic AI and technology... ...of benefits including medical, dental, vision, life,... ...in furtherance of an investigation, proceeding, hearing,...MedicalLive inWork at officeLocal area
$67.95k - $136.38k
...estimates derived from ML models, automated journal entries, AI-driven reconciliations). Communication & Team Collaboration Support... ...Team The AI Specialist team sits within Deloitte's Valuation & Analytics practice, embedded in Audit & Assurance. We work with engagement...InternshipWork at officeLocal areaVisa sponsorship- Children's National Hospital is seeking an Analytics Developer for health plan operations... ...actionable dashboards and reports supporting claims, membership, eligibility, and regulatory... ..., and IT teams is essential. #J-18808-Ljbffr Children's National Medical CenterMedical
$130k - $160k
...implementation and monitoring; results-driven technical assistance and... ...healthcare administrative or claims data. Direct experience... ...applying SAS in research or analytical settings, particularly in health... ...or mental disability, medical condition (e.g., cancer), sex...MedicalFull timeFixed term contractH1bWork at officeLocal areaRemote work$35 per hour
...CareTalk Health is a virtual medical practice that... ...credentialing through claims processing, payment posting... .... You’re organized, analytical, proactive, and at... ...with a willingness to investigate issues Ability to work... ...Collaborative, mission‑driven remote work environment...MedicalHourly payWork at officeRemote workMonday to Friday- ...thrive in a collaborative, team-driven culture. At KPMG, our people... ...for change orders and claims, reasonableness of the estimate... ...presentation materials using analytics and visualization tools Team... ...package includes a variety of medical and dental plans, vision coverage...MedicalContract workH1bLocal area
$65k - $108k
...Guidehouse is seeking a Coding Quality Reviewer to assess medical record documentation, coding accuracy, and abstracting against policy and facility guidelines. You will access records via EMR or scanning tech and enter reviews daily into Guidehouse quality tracking software...Medical- ...builders—we’re a team of driven, collaborative and... ...Department to mitigate claims by ensuring Safety is... ...assist with incident investigations.Essential Functions:*... ...company-paid premiums for Medical, Dental & Vision for... ...throughs, etc.* Strong analytical and organizational skills...MedicalTemporary workWork at officeLocal areaFlexible hours
$118.8k - $169.7k
...capabilities.SummaryThe Principal Data & Analytics Delivery Leader will lead the Medicaid... ...including MITA areas, MMIS Reporting including Claims, Encounters, Payer and Financial Reports... ...pregnancy, childbirth, or related medical condition), age, sexual orientation, status...MedicalFull timeLocal areaFlexible hours$139.5k - $188.7k
...exceptionally talented, bright, and driven people. The Worldwide... ...We are seeking a meticulous, analytically rigorous and collaborative individual... ...reported data and narrative claims meet the standards required... ...including health insurance (medical, dental, vision, prescription...MedicalWorldwideFlexible hours
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