Quality Auditor III: Health Claims & Provider Calls
1199SEIU Benefit and Pension Funds
1199SEIU Benefit and Pension Funds is seeking a detail-oriented professional to conduct audits of Provider Relations call center inquiries across systems such as Vitech, QNXT, and Call Tracking. You will communicate with providers, collection agencies, hospitals, doctors, dentists, and others to resolve health claim inquiries and provide backup coverage to Telephone Representatives. The role requires at least two years of high-volume call center experience in a health plan environment, strong #J-18808-Ljbffr 1199SEIU Benefit and Pension Funds
- ...suddenly when in apparent health, when unattended by a... ...maintain the highest quality Service: Innovate to meet... ...examiner cases and claim only cases. Supervises... ...candidates will be required to provide a DNA sample by... ...assigned to Assignment Level III, individuals must have...ClaimsFull timeWork at office
- ...preparations, including but not limited to providers' time and calendar management while... ...correspondence related to appeals on denied claims, including compiling all necessary information... ...disability paperwork. Assesses calls to understand patient needs, prioritizes...ClaimsWork at officeLocal area
- XO Health is seeking a Healthcare Support Advocate for its remote USA... ...contact for members and providers across phone, email, and chat,... ...proficiency with MS Office and CRM/claims systems. Expect collaboration... ...functional teams and rotating on-call shifts. #J-18808-Ljbffr XO...ClaimsRemote jobRotating shift
$48k - $55k
The Role: The Member and Provider Experience Specialist... ...providers, delivering high-quality, compassionate, and... ...benefit, eligibility, and claims-related inquiries while... ...will: Answer inbound calls from members and... ...Experience with innovative health insurance plan designs,...ClaimsRemote workMonday to Friday$72.47k - $154.91k
DescriptionThe Management Analyst III provides analytical and project management support, utilizing... ...Unity and InclusionThe Mount Sinai Health System is committed to fostering an... ...supporting local communities by delivering high-quality care to all who need it. Through the...SuggestedTraineeshipWork experience placementLocal area$145.2k - $217.88k
...processes at the Mount Sinai Health System. AIR·MS is a... ...Data Product Manager III is a senior technical specialist... ...validation and quality control/assurance... ...health data (e.g., EHRs, claims, clinical quality measures... ...Sinai Health System (MSHS) provides salary ranges that...ClaimsTraineeshipWork at officeLocal area$35.3 - $43.88 per hour
...to apply for the Coder III - Psych/Neurology - Remote... ...role at UC San Diego Health 1 week ago Be among the... .... This range is provided by UC San Diego Health.... ...team with a commitment to quality, collaboration, and continuous... ...coding errors and claim edits. Accurately interpret...ClaimsRemote jobFull timePart timeImmediate startRelocation package$106.11k - $174.72k
...The Data Science Analyst III is a senior role,... ...analytics and tools to provide information, insights and... ...community of the Mount Sinai Health System. Serves as... ...technology, enrollment, claims, pharmacy, clinical, contract... ...Works to improve data quality where possible within...ClaimsContract workTraineeshipLocal area- ...complex challenges in Health, Defense, and Civilian... ...proven Empower AI Platform® provides a practical,... ...Medical Review Specialist III (Medical Reviewer III)... ...comprehensive medical record and claims review to make payment... ...DME claims. Meeting quality and production...ClaimsFor contractorsCasual workWork at officeLocal area
- 1199SEIU seeks a detail-oriented health benefits specialist to assist members, providers, and facilities by handling eligibility, claims inquiries, and documentation requests. You will verify coverage, verify schedules for procedures, and guide providers on program changes...Claims
- Empower AI is seeking a Medical Review Specialist III to perform Medicare comprehensive medical record and claims reviews. This casual role requires a Registered Nurse with at least four years of experience, focusing on payment determinations for Medicare PART A services...ClaimsCasual work
- Oscar Health in New York is seeking a Senior Director to lead escalated provider issue resolution within the Network & Provider Management team. You will guide a multi-disciplinary... ..., set operating standards, and partner across Claims, Network, Utilization Management, and Analytics...Claims
$46.99k - $122.4k
...re building a world of health around every individual... ...prioritize safety and quality in everything we do. Join... ...Analyst will support provider-facing operations with... ...activities, ensuring accurate claims processing, issue... ...and claims escalation calls with assigned health systems...ClaimsHourly payFull timeContract workTemporary workWork experience placementWork at officeLocal area$18 per hour
Bi-lingual Pharmacy Support Call Center Representative Contract Remote... ...Remote US) As the only global provider of commercial solutions, IQVIA... ...utilizing an Opus Health program. Call Center Representatives... ...preferred) Experience in medical claim processing is a plus Bi-...ClaimsHourly payFull timeContract workPart timeImmediate startRemote workWork from homeWorldwideShift work- Empower AI is seeking a Medical Review Specialist III in Idaho. This role involves performing comprehensive medical record and claims reviews for Medicare Durable Medical Equipment payment determinations. Qualified candidates must be Registered Nurses with extensive claims...Claims
- ...have a strong background in operations, particularly in healthcare benefits or claims processing. Responsibilities include developing policies, mentoring staff, and overseeing service calls. Strong leadership and communication skills are essential for success in this role...ClaimsRemote job
- Judi Health is seeking a Senior Lead Provider Network Onboarding and Integration to drive expansion by onboarding and integrating national and regional... ...defining technical requirements, and enabling secure, scalable integrations across claims, #J-18808-Ljbffr Triwill GroupClaims
$70.1k - $126.2k
...million members. Centene is transforming the health of our communities, one person at a time.... ...impact to business applications, claims operations, payment integrity processes,... ...and presentation based on audience level. Provides guidance to business partners regarding emerging...ClaimsFull timePart timeH1bWork at officeRemote workFlexible hours- CVS Health in Pennsylvania seeks a Lead Director, Claim Management for Provider Digital Operations to guide the strategy and operations for Aetna’s provider-facing Claim submissions, status, attachments and remittance workflows. You’ll partner with technology teams to define...Claims
$60k - $120k
...navigate our products, processing claims and inquiries, and developing... ..., asking for referrals, cold calling, and other marketing... ...products and services while providing ongoing guidance throughout their... ...clients. Qualifications Previous health insurance or life insurance...ClaimsWork at office- ...Remote Client Service Delivery Associate III to provide exceptional customer service across... ...handle benefits, billing, eligibility, and claims inquiries, ensuring accurate, timely resolutions... ...with internal teams in a fast-paced call center environment. #J-18808-Ljbffr...ClaimsRemote job
- Judi Health is a health technology company delivering unified claims processing and price transparency, serving employers, unions, health plans and government entities... ...NYC, Denver, and Charlotte, and reports to the provider network management function. The Medical Network...Claims
$20 - $24 per hour
...San Francisco‑based, Series D health‑tech startup that is revolutionizing... ...with clear routing details, claim updates, and actions taken.... ...with partner pharmacies, provider offices, and insurance carriers... ...reroute queue even during extended call hold times (e.g., multitask...ClaimsFull timeWork at officeRemote workMonday to FridayShift workAfternoon shiftEarly shift$22 - $24 per hour
...Geode Health is a rapidly growing, national provider of outpatient mental health services. Our Mission... ...and timely insurance claims follow-up and accounts... ...office administration or call center ~ Ability to read... ...maintaining the highest-level of quality in every patient...ClaimsHourly payTemporary workWork at officeFlexible hours$187.6k - $234.5k
...About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions... ...with the industry's first Unified Claims Processing™ architecture,... ...innovations that will drive higher quality and affordability, rolling up to...ClaimsContract workWork experience placementLocal areaFlexible hours3 days per week$32 per hour
...Employer Info Our client provides top-ranked care, dozens... ..., and mental health services with a team of... ...Pharmacists Levels I, II & III, and management team.... .... Answers telephone calls and assists as needed.... ...information, adjudicate claims, and print labels. Skills...ClaimsHourly payFull timeContract workTemporary workInternshipShift work$92k - $115k
...About Judi Health Judi Health is a health... ...technology company providing benefit... ...industry's first Unified Claims Processing architecture... ...IT Engineer II and III staff, and internal... ...in off-hours or on-call support rotations asrequired... ...ontimely, high-quality problem resolution...ClaimsWork at officeLocal areaRemote workFlexible hours- ...helping them get back to good health, back to their families and... ...specialists nationwide, Lantern means quality care is within driving... ...are making a difference by providing guidance and support in navigating... ...‑functionally with care, claims, product, and marketing teams...ClaimsTemporary work
$45k - $70k
...collaborate with healthcare providers, insurance companies, and patients... ...control costs, and maintain quality care. \3 Key... ...Care Guidelines, InterQual, or health plan specific guidelines/criteria... ...process over 200,000 insurance claims annually for leading national...ClaimsTemporary workWork at officeRemote workWork from home$20 - $24 per hour
...platform that includes mobile health services, population health,... ...‑wall healthcare system by providing high quality, highly affordable care to... ...issues surrounding unbilled claims, authorizations, Physician Certification... .../outbound customer service call Provide excellent customer...ClaimsHourly payWeekly payFull timeRemote work
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