Medical Claims Processor & Quality Validator
ProKatchers LLC
ProKatchers LLC is seeking a claims processor to handle medical and surgical service claims in a structured environment. The role screens for complete member and provider information and ensures compliance with processing manuals and administrative policies. The ideal candidate will review service descriptions on claims, authorize information requests, and examine pended claims for contractual or payment discrepancies while maintaining production and quality goals. #J-18808-Ljbffr ProKatchers LLC
- ...Position Overview The Claims Examiner I is responsible for the... ...Process claims involving medical and/or surgical services; screens... ...services on claims to determine validity of charges of the presence of... ...Maintains production and quality goals established for the department...QualityMedical
- ...Position Overview The Claims Quality Analyst is responsible for reviewing claims to determine... ...used in settling claims to determine the validity of payment of claims and reports... ...plan contracting, delineation of risk, medical terminology, and standard industry reimbursement...QualityMedicalContract work
- ...required. General Description Process claims involving medical and/or surgical services; screens for... ...of services on claims to determine validity of charges of the presence of errors... ...discrepancies Maintains production and quality goals established for the department...QualityMedical
- ...expert guiding complex casualty claims to strong outcomes. You’ll... ...plans and improve claim handling quality. Leverages customer feedback... ...knowledge of insurance contracts, medical terminology and legal aspects... .... Occasional travel; a valid driver’s license with an acceptable...QualityMedicalLocal areaWork from home
$30 - $33 per hour
...Job Description Job Title: Claims Processor Location: New York City,... ...timely processing of provider medical claims, ensuring compliance... ...processing guidelines. Audit and validate claims for accuracy and... ...daily productivity and quality standards. Update claims...QualityMedicalFull timeWork at officeLocal areaMonday to FridayShift work$55.13k - $110.64k
...states. Job Summary This Lost Time Claims Specialist, Workers’... ...disease claims. The role supports Medical Only Claims Specialists and Claims... ...claims costs and promote quality medical care. Facilitate safe... ...and meet quality standards. One valid workers’ compensation adjuster...QualityMedicalTraineeshipWork at officeRemote workFlexible hours$55.13k - $110.64k
...manage Workers' Compensation Lost Time and Medical Only claims within multiple jurisdictions. However,... ...to manage the claims costs and promote quality medical care. Works collaboratively... ...and meet quality standards. One valid workers’ compensation adjuster license...QualityMedicalTraineeshipWork at officeRemote workFlexible hours$26 - $28 per hour
...Claims Examiner / Accounts Payable Assistant Position: Claims... ...departmental production and quality goals Required Experience... ...entry skills Knowledge of medical terminology, CPT, ICD, and Revenue... ...Review claims to determine validity of charges and identify...QualityMedicalMonday to FridayShift workDay shift- Mount Sinai Morningside is seeking a professional to perform DRG validation and ensure compliance with regulatory requirements. You will conduct quality reviews of medical records, validate ICD-10 codes, and work closely with the coding team to improve accuracy. The ideal...QualityMedical
$22.45 - $37.69 per hour
Quality Assurance Claims Specialist The Quality Assurance Claims Specialist reviews... ...requirements. This role validates claim data, reconciliations... .... Collaborate with claims processors, servicing teams, and leadership... ...Welfare Coverage: Optional medical, dental, vision, life, and...QualityMedicalRemote jobHourly payInterim roleWork at officeWeekend work- Lead and oversee Test Method Validation (TMV) execution activities. Review and support development... ...FDA regulations, design controls, and quality requirements. Required Qualifications... ...and hardware validation within the medical device industry. Preferred Qualifications...QualityMedical
$162.9k - $271.5k
...strategy, compliance requirements, control, quality, and continuous improvements. In the... ...management of compliance functions (e.g., validation, documentation, and training) in support... ...days, paid caregiver/parental and medical leave, and health benefits to include medical...QualityMedicalPermanent employmentTemporary workFor contractorsWork experience placementH1bWork at officeLocal areaVisa sponsorshipWork visaRelocation packageShift workDay shift$85k - $95k
...integrity solutions including DRG Validation, Cost Outlier and Readmission... ...are supported within the medical record Must be able to... ...reviews with a high emphasis on quality Demonstrates the ability to work... ...consider nurses with inpatient claims auditing experience or case...QualityMedicalFull timeRemote workMonday to Friday$23.16 per hour
...processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive... ...insurance claims 3 years of experience with medical terminology Preferred: 3 years of experience in a...QualityMedicalWork at officeLocal area- Visa Hunt is seeking an experienced claims adjudication specialist to review and process medical claims in a remote team. You will apply plan benefits, COB rules... ...to approve, pend, or deny claims while maintaining quality standards. This role supports coordination with...QualityMedicalRemote job
- ...will have experience processing healthcare claims in a high-volume Claims Department. Must... ...sessions as directed. Participate in quality projects as required by management. Required... ...depth knowledge of adjustment processing, medical terminology, CPT, ICD‑P, and revenue...QualityMedicalWork at office
$60k - $75k
...Position Description E-J is seeking a Claims Assistant who will work closely with the Vice... ...has a 126-year reputation for integrity, quality, and exceptional service in the... ...packages Comprehensive benefits, including medical, dental, vision, and a 401K plan Paid holidays...QualityMedicalFor contractorsWork experience placementWork at officeLocal area$116k - $165k
...Medical Malpractice Focused Complex Claims Consultant You have a clear vision of where your career can go. And we have the leadership to help you get... ...and exposure in accordance with company protocols, quality and customer service standards. You will also partner...QualityMedicalWork experience placementWork at officeLocal areaFlexible hoursShift work- A fast-paced healthcare company in New York is seeking a Quality Analyst to manage the medical file review process and ensure excellence in client interactions. The ideal candidate will have strong communication skills, critical thinking abilities, and experience in healthcare...QualityMedicalRemote job
$100 per hour
Claims Specialist | $100/hr Remote | Mercor This range is provided by Crossing Hurdles. Your... ...documentation including police reports, medical records, and vendor estimates. Claims... ...regulatory deadlines, and assess communication quality. Documentation: Maintain clear and...QualityMedicalRemote jobHourly payContract workFor contractorsFlexible hours- Commercial Auto & General Liability Claims Examiner II Role Summary Empower your professional... ...that prides itself on autonomy, high-quality claims administration, and a professional... ...Full suite of premium benefits, including medical, dental, vision, and Paid Time Off (PTO)....QualityMedicalFull timeRemote work
$50k - $55k
Claims Representative, Auto | Property Damage PRIMARY PURPOSE OF THE ROLE: To analyze and... ...assigned. Supports the organization's quality program(s). QUALIFICATIONS Education: Bachelor... ...is offered including but not limited to, medical, dental, vision, 401k and matching, PTO,...QualityMedicalContract workWork at officeLocal areaFlexible hours$100k - $120k
Sr. Claims Specialist | Medical Malpractice | Professional Liability PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult medical... ...other duties as assigned. Supports the organization's quality program(s). Qualifications Education & Licensing: 6 years...QualityMedicalLocal areaFlexible hours$122.4k - $183.6k
Claims Consultant FL - CV07GE We’re determined to make a difference and are proud to be an... ...through negotiations to achieve high‑quality outcomes. Proactively manage litigation and... ...injury matters required. Experience handling medical malpractice or allied health preferred....QualityMedicalTemporary workWork at officeRemote work3 days per week- Claims Examiner, Auto | Bodily Injury PRIMARY PURPOSE OF THE ROLE: To analyze and process... ...as assigned. Supports the organization's quality program(s). Qualifications Education &... ...comprehensive benefits offering including medical, dental vision, 401K on day one. Work Environment...QualityMedicalWork at officeLocal areaFlexible hours
- Claims Examiner - Auto, General Liability & Bodily Injury | NY, FL, and/or TX license Required... ...assigned. Supports the organization’s quality program(s). Travels as required.... ...comprehensive benefits offering including medical, dental vision, 401K on day one. Sedgwick...QualityMedicalFull timeWork at officeRemote workFlexible hours
$75k - $100k
...technically difficult general liability claims to determine damages; to work with high exposure... ...assigned.* Supports the organization's quality program(s).* Travels as required.**... ...duration, cost containment principles including medical management practices and Social Security...QualityMedicalWork at officeLocal areaFlexible hours$100k - $125k
...Financial Services & Insurance. Overview Sr. Claims Specialist, Professional Liability | E&O,... ...assigned. Supports the organization's quality program(s). Qualifications Education &... ...is offered including but not limited to, medical, dental, vision, 401k and matching, PTO,...QualityMedicalRemote jobWork at officeLocal areaFlexible hours$60k - $68k
Sr. Group Life Claims Examiner (HYBRID or REMOTE) (260000BU) About the Role At Equitable... ...deliverables are achieved. Review and interpret medical records, utilizing resources as... ...inquiries and maintaining expected service and quality standards. Work within a fast‑paced...QualityMedicalRemote jobContract workTemporary workWork experience placementLocal areaFlexible hours2 days per week3 days per week- ...Title Responsibilities Review hospital claims and determine action needed to resolve... ...manually or through claims work flow Validate information entered in hospital claims module... ...entering and updating hospital or medical claims in a health insurance or benefits...Medical
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