Claims Quality Auditor - Regulatory Compliance
Lsmamso
A leading healthcare organization is seeking a Quality Control Auditor – Claims Management to ensure accuracy and compliance in claims processing. The role involves auditing claims activities, identifying trends, and ensuring adherence to federal and state regulations. Candidates should have substantial experience in managed care claims auditing with a focus on detail and regulatory standards. Preferred qualifications include relevant degrees and certifications. This position supports operational improvement while minimizing financial risk. #J-18808-Ljbffr Lsmamso
$25.38 - $36.76 per hour
SHPCA SCAN Health Plan is seeking a Quality Auditor to conduct compliance audits across various health plan operations. This role ensures quality standards, compliance with regulatory requirements, and identifies areas for improvement to enhance our member and provider...ClaimsRemote jobHourly payWork at office- ...Shield of California is looking for an Operational Quality Services Specialist, Associate to join their Medi-Cal... ...team. This role involves performing audits on claims processing and ensuring compliance with regulatory requirements. Candidates should have at least 1 year...ClaimsWork at officeRemote work
- JOB SUMMARY The Quality Control Auditor - Claims Management is responsible for performing detailed audits of claims processing activities to ensure accuracy, regulatory compliance, and adherence to contractual, coding, and reimbursement requirements within the Managed Services...ClaimsWork at office
- ...Audit team is responsible for performing compliance and contractual audits such as... ...Scorecard, and Federal Employee Program. The Quality Assurance Auditor, Specialist will report to the... ...supervision. Audit multiple areas, including Claims, Customer Service, Enrollments, etc....ClaimsContract workWork at officeLocal area2 days per week
$102.96k
...function, including insurance, claims management, risk control, and... ...type incident costs. Ensures compliance of both Team Member and guest... ...performed in accordance with regulatory compliance requirements such... ...of the organization. Quality Orientation Setting high standards...ClaimsContract workWork at office- The State of California is seeking a Supervising Insurance Compliance Officer to oversee the resolution of consumer claims within the Department of Insurance. The role involves planning, organizing, and directing staff to ensure effective claims handling practices. Candidates...ClaimsRemote job
- ...eligibility for State Disability Insurance benefits, ensuring quality customer service and compliance with laws. This full-time position requires in-office... ...include conducting interviews, processing claims, providing training, and identifying fraud. #J-18808-Ljbffr...ClaimsFull timeWork at office
$79.5k - $119.5k
...Nationwide Mutual Insurance Company seeks a Regulatory Solutions Specialist for a full-time... ...This role involves analyzing regulatory compliance, resolving customer complaints, and consulting... .... Ideal candidates have experience in claims or customer solutions and a background...ClaimsRemote jobFull time- Your Role The Medi‑Cal Operations team ensures claims are processed accurately and in a timely manner. The Operational Quality Services Specialist, Associate reports to... ...revisions to policies and procedures to comply with regulatory changes and train internal staff or...ClaimsFull timeWork at officeLocal area
$68.5k - $104.1k
...exceptional agent and customer experience through efficient, high-quality chat-based claims and inquiry support. This leader manages a team of 10-15... ...strategies that enhance team effectiveness, ensures compliance with claim handling standards, and drives expert execution...ClaimsBase plus commissionWork from home$7,951 - $9,889 per month
Job Overview Supervising Insurance Compliance Officer - Department of Insurance Salary: $7,951.00 - $9,889.00 per month We are seeking a dynamic professional to oversee the resolution of consumer claims and support the department’s mission in protecting California consumers...ClaimsWork at officeRemote workNight shift$112k - $180k
...expertise helps shape outcomes and safeguard the business. This in-house counsel position sits within the Claims Matter Counseling (CMC) team-part of the Business Law & Compliance Property Liability practice group. Our mission is clear: protect the Company while enabling smart,...ClaimsRemote jobWork at officeWork visa- ...Description Role Insights The Director for Quality and Risk Adjustment is responsible for... ...including medical management, claims payment, consumer experience, product... ...operations and ensure clinical initiatives for regulatory compliance and organizational alignment. ·...Claims
$75k - $80k
Regulatory Compliance Specialist @ Astrix Our client, a leading manufacturer of food products, is... ...Program. Collaborate with Sales and Quality Assurance teams to meet customer and audit... ...COOL, Prop 65, and Nutritional/Health Claims. Experience with NLEA guidelines and...ClaimsFull timeWork at officeMonday to FridayWeekend work$21.2 - $34.69 per hour
...experience in handling homeowner, commercial, or auto liability claims. Candidates must be able to work 8am-5pm Pacific time zone... ...of violations of the laws with the Office of Federal Contract Compliance Programs. To view the FMLA poster, click "here". This poster summarizing...ClaimsRemote jobContract workCurrently hiringWork at officeVisa sponsorshipWork visa- A leading insurance claims organization is seeking Independent Insurance Claims Adjusters in California, MO. This role offers the chance to make a significant impact on clients' lives while enjoying a flexible career path and competitive compensation. Candidates should...ClaimsFlexible hours
$134k - $175k
Zūm Services, Inc. is seeking a Claims Manager to enhance the insurance function within the organization. The role involves analyzing claims trends, managing relationships with insurance brokers, and designing risk management strategies. Candidates should have a degree...Claims- A leading claims adjusting firm is seeking Licensed Insurance Claims Adjusters in California, MO. The role involves aiding individuals and businesses in recovering from disasters while enjoying flexible working conditions. Candidates will receive comprehensive training...ClaimsFlexible hours
- MileHigh Adjusters Houston is looking to hire an Independent Insurance Claims Adjuster in California, United States. This position offers flexibility, autonomy, and competitive compensation. The demand for claims adjusters is rising due to storm-related events, and licensed...ClaimsFlexible hours
- A leading insurance claims adjusting company in Missouri seeks Independent Insurance Claims Adjusters. This role is vital in aiding recovery efforts for clients affected by disasters, providing a rewarding career with flexibility and competitive compensation. You will...Claims
- A national insurance adjuster company is seeking Independent Insurance Claims Adjusters to join their team in California, MO. This role offers a dynamic career path with flexibility and competitive compensation. The company provides comprehensive training to equip new...ClaimsFlexible hours
- Independent Insurance Claims Adjuster Join MileHigh Adjusters Houston as an Independent Insurance Claims Adjuster. This role offers flexibility, autonomy, and competitive compensation. Why This Opportunity Matters Demand for claims adjusters is growing due to increased...Claims
$130.33k - $195.5k
...need us most. The Manager of Compliance & Delegate Oversight Reporting... ..., accountability, and regulatory alignment across internal operations... ...entity performance across claims, encounters, provider data, UM... ..., report scheduling, or data quality validation workflows; familiarity...ClaimsRemote job$56.7k - $94.9k
Blue Cross Blue Shield of Michigan seeks Claim Representatives I, II, and III in California. These positions involve verifying insurance coverage, investigating claims, and facilitating return-to-work processes. Candidates should have a bachelor’s degree and relevant experience...Claims- A leading contents restoration provider in Missouri is seeking a dedicated Project Manager to oversee insurance claims from initiation to completion. The ideal candidate will manage project schedules, maintain records, and communicate regularly with clients and field teams...Claims
- A claims adjusting company is looking for Independent Insurance Claims Adjusters in California. This role offers the opportunity to make a positive impact in people's lives by assisting with recovery from disasters. Ideal candidates will be licensed adjusters or willing...ClaimsFlexible hours
- ...of healthcare data: eligibility files, claims, enrollment lists, utilization metrics... ...Operations (Risk Adjustment & Quality) will support the execution and day‑to... ...support operational performance, maintain compliance with regulatory requirements, and drive continuous improvement...ClaimsWork at office
- A leading claims adjusting company in California is seeking Independent Insurance Claims Adjusters to join their team. This is a dynamic career opportunity where you will help individuals and businesses recover from disasters. Whether you are an experienced adjuster or...ClaimsFlexible hours
- A leading claims adjusting training provider in California is looking for Independent Insurance Claims Adjusters. Join this rewarding career where you can make a difference while enjoying flexibility and competitive compensation. You'll receive comprehensive training to...ClaimsImmediate startFlexible hours
- ...Vice President, Business Development • Claims Department: Claims Services Company Overview... ...supported by centralized governance, compliance, and technology infrastructure. This integration... ...efficiency while maintaining the high‑quality investigative services and specialized...ClaimsContract workWork at officeFlexible hours
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