Claims Integrity & Quality Examiner
Molina Healthcare of Illinois
Molina Healthcare is seeking a detail-oriented claims support specialist to evaluate adjudication of claims, gather supporting records, and identify errors in coding and processing. You will manage a caseload, make recommendations, and help improve efficiency within the claims function. Responsibilities include meeting quality standards, handling multiple projects, and providing strong verbal and written communication, with proficiency in Microsoft Office. #J-18808-Ljbffr Molina Healthcare
$46.99k - $122.4k
...ourselves accountable and prioritize safety and quality in everything we do. Join us and be part... ...a time. Position Summary The Program Integrity Auditor is responsible for the review of... ..., recoupment of funds or rebilling of claims, and referral to state regulators for...QualityClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$148.99k - $165k
The Sr QA Analyst Claims assists QA team in ensuring overall quality assurance, and is responsible for driving in-sprint automation with Java, Selenium.... ...outcomes. QA Lead supports and works with peers on integration, downstream testing to ensure no defects impact production...QualityClaimsTemporary workWork experience placement- ...healthcare platform focused on providing high-quality care across multiple programs and... ...revenue cycle process, including billing, claims management, collections, denials,... ...improvements, workflow enhancements, and integration of acquired or new programs. Qualifications...QualityClaimsContract work
- ...Scrubber to support our clinical and revenue integrity teams. This role focuses on reviewing... ...documentation improvement, audits, and quality initiatives across the practice. Primary... ..., and clinical staff to support clean claims Collaborate and assist our Authorizations...QualityClaimsFull timeWork at office
- ...to work for a global company that values integrity, teamwork, and loyalty? Company... ...Resolution & Insurance Manage all litigation, claims, investigations, and dispute resolution... ...legal spend and ensuring high-quality, cost-effective representation. Develop...QualityClaimsContract workLocal areaRemote workWorldwideFlexible hours
- ...Drives efficiency improvements related to speed, quality, and simplification by eliminating rework,... .../certification preferred Experience with Claims within (Medicaid, Medicare, Commercial) Strongly preferred Payment Integrity experience preferred Strong data analysis...QualityClaimsTemporary work
- ...Specialty Meat Group is seeking a detail-oriented FSQA Auditor to evaluate raw material quality against specifications. You will perform physical and visual assessments, submit supplier claims, and coordinate with FSQA, Merchandising, and Accounting to ensure proper...QualityClaims
- ...substances and meet the highest standards of quality and safety. We’re a team of athletes,... ...rebate assumptions. Pursue under-claimed or historically uncollected rebates, working... ...maintain procurement reporting tools that integrate COGS actuals, contract terms, supplier...QualityClaimsContract workShift work
- ...Position: Quality Control Supervisor Location: Winter Garden, FL Job Id: 1246 # of Openings... ...standard. Guided by its core values of Integrity, Trust, Collaboration, and Innovation,... ...identified during inspections. Create warranty claims and repair documentation as required....QualityClaimsTemporary workWork at officeLocal areaFlexible hours
$75k - $85k
...regulations while providing clients the highest quality of customer service. We require someone... ...and to maintain the organizational integrity and proper office administration. You... ...negotiate medical bills Reviewing policies, claims and other records to determine insurance...QualityClaimsFull timeWork at office- ...navigation tools. We strive to enhance the quality of care and member experience while... ...structures. Translate underwriting concepts, claims analytics, and cost-containment... ...ClearPoint’s qualification standards and pricing integrity. Coordinate cross-functionally with...QualityClaimsFull time
- ...investigative services. We investigate all types of insurance claims including workers' compensation, suspected fraud, liability and... ...aimed at mitigating expenses for our clients and delivering high-quality results. We are seeking a detail-oriented and proactive...QualityClaimsFlexible hours
- ...83 in Atlanta, Georgia with one single goal: To offer quality service to its customers with integrity and honesty. Be a part of a rapidly growing company whose... ...with the insurance companies to manage customers claim to insure the best customer experience. Maintains communication...QualityClaimsLocal areaImmediate start
- ...client management solutions. With a focus on quality, professionalism, and client-centered... ...abuse cases, and defective product claims, the firm ensures that clients are guided... ...be part of an organisation that values integrity, efficiency, and a commitment to justice...QualityClaimsRemote job
$18 per hour
...ensuring the accuracy, completeness, and integrity of patient information within the... ...exceptional patient care, regulatory compliance, quality reporting, and reimbursement accuracy.... ...resolve data discrepancies between EMR, claims, payer, referral, scheduling, and...QualityClaimsHourly payContract workTemporary workInterim roleWork at office- ...ensure timely follow-up on outstanding claims Investigate and resolve denials, rejections... ..., weekly, and monthly productivity and quality standards Support special projects and... .... Exact Billing Solutions (EBS) Culture Integrity. Dependability. Attention to detail. All...QualityClaimsWork at officeFlexible hours
- ...inspection processes at a Sysco Specialty Meat Group location. The role involves visually assessing materials, submitting supplier claims, and coordinating with FSQA, Merchandising, and Accounting to settle disputes. Ideal candidates have 1-3 years in meat/seafood QC within...QualityClaims
- ..., has a need for a Workers’ Compensation Claims Manager. The WC Claims Manager works with... ...implementation of company standards and internal quality control, by conducting audits. Maintains... ...just policies and practices. It is an integral part of who we are as a company, how we...QualityClaimsWork at officeFlexible hours
- ..., collect, assess, monitor and document claims and encounter coding information as it pertains... ..., education and training related to, quality of documentation, level of service and... ...models and inspires high levels of integrity, lives up to commitments and takes responsibility...QualityClaimsWork at officeFlexible hoursWeekend work
$74.8k - $112.2k
...Monitors the medical treatment to ensure quality, effective, and cost-efficient care.... ...appropriate. Advises on highly complex claims at multidisciplinary clinical review roundtables... ...and normal activities. Reviews clinical integration systems and determines appropriate...QualityClaimsTemporary workWork at officeRemote work3 days per week- ...consistent medical decision‑making while promoting program integrity and high‑quality care for Medicare beneficiaries. Salary Range 275,000-300,0... ...improvement or interventions to address the issues. Conduct claim reviews when appropriate and provide technical assistance...QualityClaimsContract workFor contractorsLive inLocal areaImmediate startRemote work2 days per week
- ...plans and employers to improve the safety, quality, and affordability of healthcare.... ...recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals... .... Analyze healthcare utilization, claims, authorization, and operational data to...QualityClaimsContract work
- ...enhancing member relationships through quality conversations and cross-selling credit union... ..., safe deposits box services, fraud claims, and credit card disputes.* Support and... ...accomplish tasks.* Exhibit a high degree of integrity, trustworthiness, and professionalism...QualityClaimsFull timeContract workPart timeFor contractorsWork at officeShift work
$105k - $135k
CopperPoint Insurance Companies is seeking a fully remote Supervisor Workers Comp Claims to lead a team in ensuring high-quality claims management. This role involves overseeing adjusters and collaborating with regional teams for customer-focused results. Candidates should...QualityClaimsRemote job- ...The Quality Manager is responsible for leading site-level quality operations, ensuring compliance with the Quality Management System... ...driven recommendations. Partner with leadership to reduce warranty claims and customer credits through prevention-driven improvements....QualityClaims
- ...Quality Assurance Specialist We’re seeking a detail-oriented Quality Control Specialist to ensure product quality, regulatory compliance... ...vendor samples for quality and record findings consistently. Claims Management: Investigate customer and vendor claims, document evidence...QualityClaims
- ...Strong knowledge of regulatory compliance, quality improvement, and risk management... ...business model operates on a customized claim processing system offering unlimited capability... ...benefit programs that are clinically integrated. We are proud of the fact that we have retained...QualityClaimsWork at officeLocal areaMonday to Friday
$17 - $24 per hour
...You will make an impact by: Ensuring high-quality products are available in our prepared... ...policies and procedures by properly handling claims and returns, zoning the area, arranging... ...procedures, and standards of ethics and integrity by implementing related action plans;...QualityClaimsHourly payMinimum wageFull timeTemporary workPart timeImmediate startFlexible hours- ...patients and clients with respect to program integrations offered by the pharmacy Maintains established procedures concerning quality assurance, security of controlled... ...problems promptly, and resubmits rejected claims for payment on a timely basis Resolves and...QualityClaimsWork at officeImmediate startAfternoon shift
- ...and knowledge of this sector allows us to be able to source high quality products at highly competitive prices, savings which are passed... ...through FSVP scoring and advise purchasing department Product Claims & Quarantines Investigate product-related claims and internal...QualityClaims
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