Claims Auditor
Personify Health
Personify Health is seeking a Senior Configuration Quality Audit Analyst to oversee end-to-end audits of complex claims configurations, ensuring accuracy against client requirements, contracts, and regulatory guidelines. You will translate SPDs and contracts into precise system rules, validate changes before go-live, and analyze claims for correct adjudication. The role emphasizes root-cause fixes, test strategy development, and cross-functional collaboration to improve automated processing. #J-18808-Ljbffr
- ...CVS Health seeks a Program Integrity Auditor to review medical, behavioral health, transportation and other provider records, ensuring... ...findings to regulators as needed. Ideal candidates have 3–5 years in claims data and medical record review, with CPT/HCPCS/ICD-10 coding...Claims
- Jobtailor is seeking a Health Insurance Claims Auditor to conduct pre- and post-pay audits for Medicare/Medicaid, ensuring CMS compliance and high-quality processing. You will collaborate with delegated processors to correct errors before payments and support ad-hoc audits...ClaimsWork at office
- ...Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards Work closely with delegated claim processor to ensure...ClaimsWork at office2 days per week3 days per week
$25.64 per hour
...a fulfilling long-term career. JOB SUMMARY: Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims. Collaborates with other Health plan departments and Management to ensure claims are processed in accordance with Federal, State and...ClaimsHourly pay$87.5k
...Facebook, Twitter and LinkedIn. Brief summary of purpose: The SIU Code Auditor will conduct coding audits of medical records provided by... ...resolution. Reporting, education, and regulatory support: Assist with claim denial reporting, respond to regulatory agency complaints,...ClaimsLocal area- CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. The role focuses on ensuring correct coding, proper documentation, and compliance with state, federal, and company guidelines. Strong communication...Claims
- ...Description Summary:**ModMed is hiring a driven **Medical Coding Auditor** to join our positive, passionate, and high-performing BOOST... ...analyzes coding denials and provides needed corrections of these claims when applicable, and performs quality assurance on the global...ClaimsWork at officeLocal areaRemote workFlexible hours
- ExlService Holdings, Inc. is seeking a Clinical Validation Auditor to review inpatient records and validate billed DRG codes. You will apply clinical judgment to ensure accuracy and fairness in claims coding while working remotely. Ideal candidates are licensed nurses with...ClaimsRemote job
- ...strong understanding of inpatient care and a passion for getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your clinical judgement to review...ClaimsRemote work
- CVS Health is seeking a Program Integrity Auditor to review medical, behavioral, transportation, and other provider records for correct... ...providers and recover funds. Candidates need 3-5 years in claims data review and coding, plus active CPC/CCS/CPMA certification....ClaimsFull time
- ...We are excited to announce our search for a full-time Premium Auditor! In this role, you will have the opportunity to impact the FrankCrum... ...and internal customers (i.e., underwriting, policy processing, claims and accounting) with information to assist in their...ClaimsFull timeTemporary workWork at officeLocal areaImmediate startFlexible hours
- Humana Inc. is seeking a Senior Medical Coding Outpatient Auditor to lead coding-focused audit activities, validate coding accuracy, and... ...the Manager, Payment Integrity. The role involves researching claims anomalies, applying CPT/HCPCS guidelines, and collaborating...ClaimsRemote job
- ...energizing this might be a great place for you!**Job Title: Compliance Auditor****Department:** Compliance**Reports To:** Director of... ...audits of clinical documentation, medical records, billing, coding, claims submission, service authorization, and operational processes.*...ClaimsTemporary workWork at office
- Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient hospital claims, assign ICD-10-CM, ICD-10-PCS and DRG codes, and ensure accurate reimbursement. You will audit coding quality, resolve provider disputes, and collaborate...ClaimsRemote job
- ...attorneys with financial, healthcare, and forensic accounting analyses for civil fraud cases. The role includes reviewing records, claims, contracts, and grants, and preparing detailed reports and timelines for investigations and trials. Responsibilities also cover analyzing...ClaimsWork at office
$75k - $85k
...your business’s unique risks. Summary / Job Purpose: The Staff Auditor II’s primary focus is to perform internal audit activities with... ...risk financing programs, insurance products, risk engineering and claims management services that enable our clients to effectively and...ClaimsTemporary workWork experience placementWork at officeLocal areaRemote workFlexible hours- ...-rated insurance carrier, is seeking a motivated Field Premium Auditor to join our team. Responsibilities Audit insured records to determine... ...underwriting eligibility and acceptability. Communicate with claims and underwriting associates, appointed agents and insureds....ClaimsLocal areaWork from home
- WHAT WE’RE LOOKING FOR The Claims Auditor ensures claims are processed in accordance with contractual, regulatory, and internal performance requirements. The individual in this role supports quality assurance efforts by auditing claims processing activity, documenting...ClaimsLocal area
$46.99k - $122.4k
...one community at a time. Position Summary The Program Integrity Auditor is responsible for the review of records for medical,... ...limited to) provider education, recoupment of funds or rebilling of claims, and referral to state regulators for any suspected fraud, waste...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$71.1k - $97.8k
...part of our caring community The Senior Medical Coding Outpatient Auditor is responsible for coding-focused audit activities, including... ...the Manager, Payment Integrity. Key Responsibilities Research claims anomalies to identify outpatient audit opportunities Apply CPT/...ClaimsFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$71.1k - $97.8k
...caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost...ClaimsFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to FridayShift work- Cotiviti is seeking a Senior Auditor, Team Lead, to supervise a Clinical Validation auditing team. You will manage workflow, ensure quality... ...while training new hires. The role focuses on accurate claims auditing and client satisfaction. The position requires nursing...Claims
- Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify... ...site visits, desk audits, and collaboration with a team of auditors to document findings and input data into audit systems. The...ClaimsRemote jobFull timeLocal area
- CommunityCare, Inc. in Tulsa, OK, is seeking a Medical Review Examiner Nurse to audit provider and facility claims and contribute to quality improvement initiatives. The role requires an Oklahoma RN or LPN license, an associates degree, and five years in hospital or health...ClaimsFull time
- ...distributed Weigh or count items for distribution within the plant to determine and ensure meet company standards Report damages and claims to inventory control Arrange stock parts in a specific order for assembly by other workers Process inbound/outbound orders safely...ClaimsWork at officeLocal areaWorldwideMonday to FridayFlexible hours
- Oliver James Associates Ltd. seeks an Internal Auditor to lead and execute audits of third-party administrators handling life, health,... ...or annuity products. The role focuses on policy administration, claims processing, and financial controls. You will develop risk-based...Claims
$65.21k - $75k
Staff Internal Auditor Job Announcement: The County Auditor investigates all financial claims against the county and pays the bills. The Auditor’s Office also examines the financial books kept by the other county officials to see that accurate and complete records are...ClaimsWork at officeMonday to Friday$95k - $130k
...your business’s unique risks. Summary/Job The Senior Internal Auditor’s primary focus is to provide an independent, objective assurance... ...financing programs, insurance products, risk engineering and claims management services that enable our clients to effectively and...ClaimsTemporary workWork experience placementWork at officeLocal areaFlexible hours- ...A leading training provider for claims adjusters is looking for Independent Insurance Claims Adjusters in Woodside, NY. This role involves helping clients recover from disasters while enjoying flexibility and autonomy. The company offers comprehensive training programs...ClaimsFlexible hours
- ...MileHigh Adjusters Houston Inc. seeks independent insurance claims adjusters in Kentucky. Join a team offering proactive training and opportunities for growth, with autonomy and flexible compensation as you manage storm-related claims. We welcome both seasoned professionals...ClaimsFlexible hours
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