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
- ...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...ClaimsWork 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
$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... ...on other components. Quality Orientation: Setting high standards...ClaimsContract workWork at office- ...role that requires someone who can navigate detailed claims analysis with finance leadership one hour and walk a... ...on site surveys and implement recommendations Ensure compliance with all insurance-related regulatory requirements and support audit processes Requirements...ClaimsWork at office
- MS ACSC Management Services Inc is seeking a Claims Compliance Analyst to support regulatory compliance activities. This role includes managing complaint investigations, analyzing legal changes, and collaborating with various teams to ensure compliance with regulations....Claims
- ...Description JOB SUMMARY The Compliance Coordinator – Claims Management is responsible for supporting regulatory compliance, audit readiness, and reporting functions within the Claims Department of the Managed Services Organization (MSO). This role coordinates internal...ClaimsWork at office
$75k - $80k
...Regulatory Compliance Specialist @ Astrix Our client, a leading manufacturer of food products, is... ...Approval Program. Collaborate with Sales and Quality Assurance teams to meet customer and... ...COOL, Prop 65, and Nutritional/Health Claims. Experience with NLEA guidelines and...ClaimsFull timeWork at officeMonday to FridayWeekend work- 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
- ...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
- ...limited to: benefits administration, administrative duties, conducting New Employee Orientation, handling of worker’s compensation claims, unemployment claims, employee verifications, employment, i.e. qualifying applicants, references, and background testing. Positon supports...Claims
$25.38 - $36.76 per hour
The Quality Auditor - Enrollment will perform routine and targeted operational quality audits across health plan operations including but not limited to Enrollment to ensure compliance with regulatory requirements, internal policies, contractual obligations, and operational...Hourly payWork at officeRemote work$25.38 - $36.76 per hour
SHPCA SCAN Health Plan seeks a Quality Auditor - Enrollment to conduct operational quality audits across its operations, ensuring compliance with regulatory standards and policies. This position involves monitoring accuracy, identifying areas for improvement in member and...Remote jobHourly pay- Capstone Logistics in California is seeking a Vendor Compliance Auditor to ensure the quality and compliance of incoming loads. This role involves monitoring shipments to identify violations and documenting findings through photographs and reports. The ideal candidate...Shift workWeekend work
- ...to "Saving Lifestyles" by providing high‑quality patient care in a collaborative and... ...background in medical billing, insurance claims processing, and patient account management... ...patients with billing inquiries. Maintain compliance with HIPAA, coding guidelines, and...ClaimsWork at office
$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 staffing firm in insurance is seeking a Claims Assistant Manager to oversee the claims lifecycle and drive improvements within... ...workflows, and cultivating key relationships while ensuring compliance. Candidates should have over 3 years of claims experience and managerial...Claims
- ...IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth...Claims
- 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 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
- 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
- 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
$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
- Kemper is looking for a Special Investigator 1 based in California, responsible for field and desk investigations of insurance claims. The role involves analyzing evidence to support our Special Investigative Unit and claims organization, and it serves as a career pathway...ClaimsRemote job
- ...comprehensive client information, enabling conflict checks, ensuring regulatory compliance, and documenting the preliminary scope of representation.... ...Information: For matters involving insurance coverage or claims 4. Medical Information Release: For personal injury or...
$26.49 - $50.24 per hour
...Field Auto Appraiser for a remote territory-based role. This position involves creating detailed damage estimates for material damage claims and negotiating settlements. The ideal candidate must have skills in auto estimating and auto insurance claims. The role requires...ClaimsRemote jobHourly pay- Chumashcareers is seeking a dedicated Risk Manager to oversee the risk management team. This role includes managing insurance and claims, ensuring compliance with regulations, and fostering a safe work environment. Candidates should have a Bachelor's degree and five years of...Claims
- ...conducting various types of investigations related to insurance claims, including surveillance and fraud detection. The ideal... ...Candidates should expect to work independently and meet deadlines while providing high-quality results. #J-18808-Ljbffr J T Becker & Co IncClaimsFlexible hours
- AvonRisk, a leading specialty risk manager based in California, is seeking a full-time Claims Adjuster. This role involves investigating and analyzing insurance claims, assessing vehicle damage, and determining appropriate liability. The ideal candidate should possess...ClaimsRemote jobFull time
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