Health Stop-Loss Claims Auditor: Precision & Compliance
RSC Insurance Brokerage, Inc.
Brown & Brown, Inc. is seeking a Health Claims Stop Loss Claims Auditor to conduct in-depth audits of high-complexity claims files for accuracy, compliance with procedures, and regulatory requirements. The role involves reviewing claims for accuracy, documenting findings, recommending corrective actions, identifying trends, and supporting audit reporting and analytics to improve claim practices across the organization. #J-18808-Ljbffr RSC Insurance Brokerage, Inc.
- Imagine360, LLC is looking for a Stop Loss Claims Auditor to join their team in a fully remote capacity. This individual will work within the Stop Loss Department, ensuring claims are examined, audited, and processed accurately to support multiple functions. The ideal...ClaimsRemote job
- Imagine360 is seeking a Stop Loss Claims Auditor to join the team! This position is part of the Stop Loss Department and supports multiple functions... ...and review all claims information including employer health plans, stop loss insurance contracts, provider documentation...ClaimsTemporary workWork at officeRemote work
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$118k - $178k
Medical Stop Loss Underwriting Practice Lead - Accident & HealthWho... ...expectations.Analyze group medical claims data, demographics, and plan... ...and confidence.Ensure compliance with underwriting guidelines,... ...understanding of healthcare payers, health plan administration, and...ClaimsFull timeWork at office- Machinify is a leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy,...ClaimsRemote jobWork from home
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- Imagine360 is currently seeking a Health Plan Relationship Manager/Relationship Manager to join our Client Experience team! In... ...annually. This includes renewal of TPA services, stop loss coverage, claims review and audit services renewal and other vendors contracted...ClaimsRemote work
$80k - $90k
...Administrator (TPA) that powers innovative health plans centered on care navigation,... ...do this by efficiently processing claims, ensuring regulatory compliance, and building technology that... ...service and innovation. The Role: The Stop Loss Specialist is responsible for...ClaimsContract workWork at officeRemote work- ...department from the ground up. This full-time, hybrid role combines front-end claims management with team leadership to build efficient processes and drive results in collections and compliance. The role requires proven medical billing experience, familiarity with EMR...ClaimsFull time
- ...: Stryker CorporationPosted: 2026-08-10Ohio Department of Behavioral Health seeks detail-oriented Behavioral Standards Health Surveyors to evaluate providers and residential facilities for compliance with licensure and certification rules. The role involves on-site surveys...
- CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit (SIU), ensuring coding accuracy and compliant documentation across medical, behavioral health, transportation and other healthcare providers....Claims
- ...Enhancement is hiring a Program Integrity Auditor in New York, NY. This full-time position involves auditing medical records for compliance with coding standards, identifying... ...candidates will have 3-5 years of experience in claims data review, industry coding guidelines,...ClaimsFull time
- Processing and auditing insurance claims in a remote capacity, the full-time Remote Medical... ...Specialist will ensure accuracy and compliance while collaborating with internal teams... ...claims systems preferred #J-18808-Ljbffr Community Health Systems, Inc. (CHSPSC, LLC)ClaimsRemote jobFull time
$18 - $20 per hour
..., NJ (Hybrid), managing full‑cycle billing operations, verifying insurance, and resolving claims issues. Collaborate with patients, payers, and internal teams to ensure compliance with HIPAA standards and drive timely reimbursements. Ideal for detail‑oriented professionals...ClaimsPermanent employmentTemporary workMonday to Friday$38.46 - $52.4 per hour
...better consumer outcomes. Health systems, hospitals and medical... .... The Inpatient Coding Auditor will be responsible for the auditing... ...guidelines. Monitor compliance of coding guidelines and ensure... ...is initiated before the claim is rebilled to the insurance....ClaimsHourly payPermanent employmentWork at officeLocal areaImmediate startRemote workFlexible hoursDay shift- Gainwell is seeking a Medical Claims Auditor to review and analyze medical claims for accuracy, compliance, and proper coding. The role emphasizes auditing provider submissions, validating ICD-10/CPT/HCPCS coding, and identifying discrepancies to improve billing integrity...ClaimsRemote job
$55k - $65k
...specialize in resolving complex healthcare insurance claim denials and delays. Our mission is to empower hospitals and health systems by optimizing their revenue cycle,... ...prowess. Commitment to upholding HIPAA compliance and company policies. Why Join Us 100% Remote:...ClaimsRemote workFlexible hours- Oscar Health Insurance is seeking a Senior Analyst, SIU Clinical Investigator to detect and audit aberrant billing patterns in claims and clinical documentation. You will review medical records to ensure alignment with guidelines and regulations, and identify schemes such...ClaimsRemote jobWork at office
$46.99k - $122.4k
We're building a world of health around every individual - shaping... ...The Program Integrity Auditor is responsible for the review... ...recoupment of funds or rebilling of claims, and referral to state... ...documentation rules. Maintain compliance with company policies and procedures...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours- CVS Health is seeking a Program Integrity Auditor to review provider records for medical, behavioral, transportation and other services. You will determine... ...recoupment as needed. The role requires 3-5 years of claims review experience, CPT/HCPCS/ICD-10 coding expertise,...Claims
- ...Nurse for remote work in the US. You will be part of a dynamic team, performing audits on medical claims, ensuring adherence to guidelines, and collaborating with other auditors. An associate or bachelor's nursing degree and experience in auditing or clinical documentation...ClaimsRemote job
$85k - $90k
...technology firm is seeking a Nurse Coder DRG Auditor to validate coding accuracy and medical necessity of inpatient claims. The role involves applying industry standards... ...,000 is offered, along with a comprehensive benefits package. #J-18808-Ljbffr Trend Health PartnersClaims- Trend Health Partners is seeking a Nurse Coding Auditor to review medical records and itemized bills for accurate CPT/HCPCS/revenue code usage on hospital claims. The role emphasizes CMS guideline adherence, documentation review, and audit accuracy in a dynamic, tech-enabled...Claims
- Imagine360 is seeking a Claims Internal Auditor to join our team. This role analyzes operations and internal controls to ensure alignment with... ...plans, identifying improvement opportunities and ensuring compliance. Responsibilities include developing audit scopes,...ClaimsRemote job
$85k - $90k
TREND Health Partners is a tech-enabled payment integrity company... ...and more. The Nurse Coder DRG Auditor’s primary responsibility is... ...medical records and associated claim information to validate... ...be asked to complete certain compliance requirements set forth by our...ClaimsWork at office- ...presenting and monitoring safety events, claims management, loss prevention and reduction, patient... ...management activities the Mount Sinai Health System (MSHS).,The Clinical Risk Manager... ...to assure regulatory and accreditation compliance. Will serve as a champion for...ClaimsTraineeshipLocal areaFlexible hoursShift work
$78k - $112k
...and risk analysis. Ability to analyze claims and quantify losses. Financial proficiency.... ..., personal accident and supplemental health insurance, reinsurance, and life insurance... ...to equal employment opportunity and compliance with all laws and regulations pertaining...ClaimsLocal area- Sprinter Health seeks an Associate Medical Coding Auditor to conduct audits ensuring CMS and payer compliance, and to educate coders and providers to improve documentation quality. You will uphold HIPAA and privacy standards in a remote environment. Responsibilities include...Remote job
$140k - $160k
...quality of care, and minimize loss to protect the assets of the facility... ...New York State Department of Health and other accrediting agencies... ...: reporting potential claims as well as cases of concern by... ...quality of care and regulatory compliance: Hospital Safety Committee; Nursing...ClaimsTraineeshipLocal area
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