Claims Audit & Compliance Specialist
Highmark Health
Highmark Health in Pennsylvania is seeking a Claims Auditor to review medical, dental, vision, FSA and HRA claims for accuracy and compliance. You will examine coding, benefit rules and documentation, and document audit results to support monthly reporting. The role requires detail orientation, strong problem-solving and communication skills, and the ability to work independently or within a claims team in a fast-paced environment. #J-18808-Ljbffr Highmark Health
- Judi Health seeks a Pharmacy Auditor to conduct comprehensive audits of network pharmacies, ensuring compliance with contracts, regulatory requirements and client expectations. You will evaluate claims, dispensing practices, inventory records, and supporting docs to identify...Claims
- Tapestry in New York seeks an Analyst, Green Trade Compliance to support Global Trade & Customs Compliance and ESG initiatives for Coach... ...maintenance, internal controls, reporting, and supporting sustainability claims substantiation; you will #J-18808-Ljbffr Tapestry (Coach/Kate...Claims
- Conducting audits of billing, documentation, insurance claims, and regulatory compliance activities, the full-time Audit Specialist will ensure adherence to Medicare, Medicaid, and commercial insurance requirements while identifying opportunities for improving reimbursement...ClaimsFull time
$55k - $65k
...redefining affordable housing. Description SMC is seeking a Compliance Specialist to join our compliance department. Under the supervision... .../corrections, repayment agreements, and process special claims Pre-audit LIHTC/HUD and HOME tenant files for all properties...ClaimsFull timePart timeWork at officeLocal areaFlexible hours- To ensure the accuracy and compliance of revenue cycle processes, the full-time RCM Audit Specialist will conduct audits, monitor key performance indicators, and identify... ...quality reviews and audit revenue cycle claims against established standard operating procedures...ClaimsFull timeRemote work
$80k - $100k
...is responsible for administering labor compliance, certified payroll reporting, apprenticeship... .... Support labor compliance audits, investigations, and agency requests.... ...Assist with documentation related to bond claims and surety requests. Audits, Reporting...ClaimsHourly payFull timeContract workFor contractorsApprenticeshipFor subcontractorWork at officeLocal areaRemote workFlexible hours3 days per week$88k - $100k
...asset. NCBFAA Certified Customs Specialist is an asset. Strong working... ...to: Developing and launching Audit Program Completing and... ...requirements Vet documents to ensure compliance with CBP and all other... ...required. Examples include USMCA claims, Post Summary Corrections and...ClaimsRemote workWork from homeMonday to FridayShift work- ...Principal Regulatory Affairs Specialist to lead and execute regulatory... ...communications for compliance with applicable European regulatory... ...requirements and approved product claims. Support product... ...Maintain complete, accurate, and audit-ready regulatory documentation...ClaimsWork at officeLocal area
$70.1k - $126.2k
...Assist in maintaining Centene Corporation’s Compliance Program. Provide regulatory... ...projects, and develop and implement compliance auditing and monitoring strategies. Key Details:... ...from key operational areas (such as SIU, claims, program integrity, provider network, pharmacy...ClaimsFull timeContract workPart timeInterim roleH1bWork at officeRemote workFlexible hours$55k - $80k
...Consulting Services to customers while ensuring compliance with Customs and trade regulations,... ...timely manner (tariff classification, claims, etc.). Conduct research pertaining... ...bonds ~ Standard CF28/CF29 audits ~ USMCA & TPL Audits via CF28 ~ Increased...ClaimsFull timeTemporary work- ...overviews and documenting processes across notification and registration. The role collaborates across product development, claims review, packaging compliance, EPR and sustainability, working closely with cross-functional teams and external partners. This hybrid role requires...Claims
$90k - $150k
...Adjuster who is ready to take the next step into a formal supervisory role. The ideal candidate will have strong New York liability claims experience, a solid understanding of New York Labor Law, and the ability to mentor adjusters while overseeing claim quality,...ClaimsFor contractorsRemote workFlexible hours$75k - $85k
...The Provider Credentialing Specialist is responsible for managing provider... ..., provider effective dates, claims issues, and payer updates.... ...operational systems. Compliance & Reporting Monitor upcoming... ...relationships. Participate in audits and regulatory reviews as...Claims- Regulatory Affairs Specialist 12-month contract Remote CST hours (Local to Cary, IL is preferred... ...regulatory documentation to ensure compliance with U.S. 510(k) and EU MDR requirements... ...Provide regulatory guidance on product claims, labeling, and strategy for submissions....ClaimsContract workLocal areaRemote work
$95k - $130k
...responsible for undertaking a range of internal audit activities from initial planning through... ...effectiveness, financial reliability and compliance with all applicable directives and... ...insurance products, risk engineering and claims management services that enable our clients...ClaimsTemporary workWork experience placementLocal areaFlexible hours- ...Forensics - Insurance and Federal Claims Services - Insurance Adjuster - ManagerLocation... ...insurance recovery, claims preparation, compliance, and financial analysis.The opportunity... ...Adjuster, Large Loss Adjuster, Complex Claims Specialist, Business Interruption Adjuster, or...ClaimsWork at office
$200k - $320k
...regulatory, transactional, reimbursement, compliance, and enforcement matters. The... ...Anti-Kickback Statute, Stark Law, False Claims Act, fee-splitting restrictions, and corporate... ...reimbursement, billing compliance, overpayments, audits, recoupments, and payor disputes....ClaimsLocal area$120k - $150k
...Complex Claims Director – Management LiabilityAt AIG, we are reimagining the way we help customers to manage risk. Join us as a Complex Claims Director – Management Liability to play your part in that transformation. It's an opportunity to grow your skills and experience...ClaimsWork at office- Position Overview Reporting to the Director of Claims Quality, the Claims Manager, Audit & Complaints will oversee operational excellence and regulatory compliance by collaborating with cross‑departmental teams to ensure that claims‑related regulatory audits and complaints...Claims
$78k - $114.4k
Job Description: Job Purpose The Compliance Analyst will support the Compliance function in... ...appropriate documentation, controls, and audit trails supporting transparency reporting... ...be cautious of scam recruitment offers claiming to be from Xeris. Xeris will never request...ClaimsTemporary workInternshipWork at officeLocal areaWeekend workAfternoon shift3 days per week$104.8k - $192.3k
...EY's Forensics Insurance and Federal Claims Services practice specializes in helping... ...insurance recovery, claims preparation, compliance, and financial analysis. The opportunity... ..., Large Loss Adjuster, Complex Claims Specialist, Business Interruption Adjuster, or similar...ClaimsSummer holidayWork at officeFlexible hours- ...existing and/or proposed business practices to identify regulatory compliance issues and recommending risk mitigation options Drafting and... ...prohibitions ~ HPAA and patient privacy provisions ~ False Claims Act ~ Healthcare Fraud Statute ~ Experience with state...Claims
$130k - $140k
...responsible for administering the agency’s operating and capital budget. BFS oversees the Budget, Payment Services, Claiming and Revenue Accounting and Audit and Compliance Functions; ensures that funds are available for the procurement of goods and services, invoices are paid...ClaimsFull timeContract workFor subcontractorWork at office- ...basis prohibited by the laws that govern its operations. Senior Manager, Quality Assurance and Audit, North America Claims Reporting to the Head of Quality Assurance and Compliance, Claims Shared Services, this role will lead, oversee, enhance and optimize the North...ClaimsWork at office
- ...Eames Consulting has partnered with a leading P&C insurance carrier looking to add an experienced Claims Manager . This role offers the chance to take ownership of complex general liability and litigated claims. This is a great opportunity to advance your career with...Claims
$250k
Job Title Claims Manager - Cyber Division Group Claims Location United States Reports... ...a thorough knowledge of and ensure compliance with relevant regulation, minimum claim... ...Where applicable, conduct file reviews or audits as required, and resolve any issues identified...ClaimsImmediate start$126.1k - $168.13k
A prominent title insurance company is seeking a Senior Claims Counsel to manage title insurance and escrow claims from investigation to resolution. The role demands excellent communication, negotiation, and organizational skills. The ideal candidate holds a law degree...Claims- ...Risk and Claims Management - expanding our team! A specialized risk management brokerage and safety consulting firm is in search of a claims professional with experience to oversee active claims for clients. This role involves managing and monitoring the activities of...ClaimsFor subcontractor
$160k - $180k
...professionals. These individuals will be actively involved in the tax compliance services noted above on multiple client engagements. Tasks... ..., W-8EXP, and W-8IMY to ensure proper administration of treaty claims for reduced U.S. withholding tax Final sign-off and review...ClaimsWork experience placementWork at officeRemote work2 days per week- A prominent claims adjusting firm in New York is seeking Independent Claims Adjusters to respond to the growing demand due to recent storm events. This rewarding career offers flexibility, autonomy, and comprehensive training programs for both new and experienced adjusters...ClaimsFlexible hours
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