Remote Health Plan Quality Auditor - Claims & Compliance
$25.38 - $36.76 per hourSHPCA SCAN Health Plan
- Remote job
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 experience. The ideal candidate should possess auditing experience in health plans, strong organizational and analytical skills, and be proficient in Microsoft Office. This position offers a remote work option and a competitive pay range of $25.38 to $36.76 per hour. #J-18808-Ljbffr SHPCA SCAN Health Plan
$25.38 - $36.76 per hour
...SCAN is a nonprofit health organization... ...serve. The Job The Quality Auditor will perform routine... ...audits across health plan operations... ...but not limited to Claims, Grievances and Appeals... ...Materials to ensure compliance with regulatory... ...hour. Work Mode: Remote. Annual bonus program...Remote workClaimsHealth InsuranceHourly payWork at office$35k - $48k
...We are currently looking for a Quality Auditor in United States. This role plays... ...part in ensuring the accuracy, compliance, and consistency of health plan claims processing within a regulated... ...and continuous improvement in a remote healthcare operations setting....Remote jobClaimsHealth InsurancePermanent employmentFull timeWork at office- ...is seeking a Coding Auditor responsible for... ...retrospective audits to ensure compliance with internal... ...and state Medicaid plans. Review charge information, claim forms, insurance... ...Requirements This is a REMOTE role but requires... ...ordinances). ~ Health Benefits / Dental /...Remote workClaimsHealth InsuranceTemporary workWork at officeLocal area
- ...its mission to inspire health and make it easy.AZ... ...as hybrid, onsite or remote. While the majority of... ...: Customer Service, Claims Processors, and Correspondence... ...OF THE JOB The Quality Assurance Coder/Auditor will develop a risk... ...Advantage health plan experience 5 years...Remote workClaimsHealth InsuranceFull timeWork experience placementWork at office1 day per week
- ...completeness, and quality of pharmacy-related... ...quality Ensure compliance with applicable state... ...and pet insurance plans. Employees receive... ...are provided for remote workspace. ABOUT DANE... ...200,000 insurance claims annually for... ..., Auto, and Group Health Carriers, Third-Party...Remote workClaimsHealth InsuranceTemporary workWork at officeWork from home
$46.67k - $65.67k
...A healthcare firm supporting agriculture seeks a Claims Auditor for remote work, ensuring compliance with health benefits plans. The role involves coding new business, verifying plans, and maintaining efficiency in processes. Candidates should have a BS/BA degree and...Remote workClaimsHealth Insurance- ...seeking a Business Analyst who can work fully remote but must adhere to PST hours. This role... ...validate and document requirements for health plan initiatives. Candidates should have at... ...actionable requirements. Knowledge of claims processing and tools like Facets is advantageous...Remote workClaimsHealth Insurance
$55k - $65k
...Whiteboard Risk & Insurance Solutions is looking for a Claims Manager to work fully remotely. The role requires serving as a liaison for... ...5,000 to $65,000 annually, with benefits including competitive compensation, health credits, and retirement plans. #J-18808-Ljbffr...Remote workClaimsHealth Insurance- ...American Health Plans is seeking a Medicare Risk Adjustment Coding Specialist to... ...-payment coding reviews to ensure compliance with CMS regulations. This remote role requires strong knowledge of... ...experience with Medicare and Medicaid claims, and excellent communication...Remote workClaimsHealth Insurance
- MEM is seeking a Medical Only Claims Representative (Remote) to manage workers' compensation medical-only... .... You will handle claims to ensure compliance, coordinate medical care, and... ...collaborative culture, with benefits including health plans and generous PTO. #J-18808-LjbffrRemote workClaimsHealth Insurance
$96k - $125k
...Litigation Specialist for a remote position. The ideal candidate... ...experience and handle claims in the Mid-Atlantic Region and... ...negotiating settlements, and ensuring compliance with legal requirements. The... ..., along with comprehensive health care plans and other benefits. #J-18808...Remote workClaimsHealth Insurance- ...A nationwide health solutions company is seeking an Associate Actuary... ...analyses and manage health plan-specific actuarial needs. Applicants... ...role offers flexibility with remote working options and a... ...understanding of health care claims is preferred. #J-18808-Ljbffr...Remote workClaimsHealth Insurance
- ...Warrenville, IL seeks a Senior Coding Quality Auditor to conduct compliance audits, communicate results, and... ...career growth pathways, and various health plans. A hybrid work model allows for flexibility between on-site and remote work. #J-18808-Ljbffr NorthShore University...Remote workHealth InsuranceFull time
- ...Working remotely, the Senior RN Clinical Quality Auditor will support care management products by reviewing processes for compliance, conducting audits, and collaborating on quality improvement... ...3+ years of proven experience in health plan quality improvement Demonstrated...Remote workHealth Insurance
- ...enhance the delivery of high-quality, cost-effective medical... ...reviews, and ensure compliance with clinical goals in a remote setting. Key responsibilities... ...clinical expertise for claims determinations Guide the... ...residency Knowledge of health plan claims adjudication and utilization...Remote workClaimsHealth InsuranceFull time
- MedPOINT Management is seeking a Hospital Claims Auditor responsible for ensuring the quality of claims processes and compliance with health plan and hospital regulations. The role... ...expertise in medical coding and contracting. This is a remote position. #J-18808-LjbffrRemote workClaimsHealth Insurance
- ...military families is seeking a Claims Representative to manage... ...property claims. This remote position requires... ...investigations, and ensuring compliance with quality standards. Ideal... ...employee benefits including health insurance and retirement plans. Applicants should be located...Remote workClaimsHealth InsuranceRelocation
$60k - $75k
...is seeking a Research & Regulation Compliance Specialist to oversee regulatory... ...for Life, Annuity, and Disability claims. This remote position requires a Bachelor's degree... ...with extensive benefits including health insurance, retirement plans, and paid time off. #J-18808-...Remote workClaimsHealth Insurance- ...specialized team in a remote setting, the full-time... ...will enhance first-pass claim payment accuracy by optimizing... ..., Clinical Review, and Compliance to ensure accurate... ...or healthcare plan configuration, with at... ...logic Proficiency in health plan systems such as HealthEdge...Remote workClaimsHealth InsuranceFull time
- ...Leading health plan operations, the full-time Florida Licensed Health... ...functions, ensuring compliance and alignment with member satisfaction... ...goals while working remotely. Key responsibilities Organizes... ...network administration and claims operations, ensuring regulatory...Remote workClaimsHealth InsuranceFull time
- Brighton Health Plan Solutions, LLC is seeking a Manager of Provider Compliance to lead the investigation and resolution of provider... ...to the No Surprises Act. This remote role includes overseeing... ...candidate will have strong healthcare claims processing skills, provider...Remote jobClaimsHealth InsuranceContract work
- ...Leading comprehensive claims quality and compliance programs, the full-... ...Senior Healthcare Claims Auditor will execute audits... ...excellence in a remote environment. Key Responsibilities... ..., Business, Health Information Management... ...experience within a health plan or payer environment...Remote workClaimsHealth InsuranceFull time
$34 - $35 per hour
...Clinical Quality Assurance Nurse Auditor Fully Remote • Redding, CA 96002 Overview Salary Range $34.00 - $... ...integrity and that all work is in full compliance with client contractual agreements... ...carriers, law firms, third-party claim administrators and government...Remote workClaimsHourly payFull timeLocal areaMonday to Friday- ...Title- Claims Compliance Analyst Onsite or Remote: onsite Start/end time: 7:00 am to 3:30 pm Shift : Day... ...internal and external customers, health plan's, providers and/or members by... ...Managed Care Management Team and other auditors, to ensure QA programs are...Remote workClaimsHealth InsuranceContract workImmediate startShift work
- Solventum is looking for a Product Manager to lead the development of health plan solutions that integrate clinical and claims data. This role is critical in addressing the most pressing challenges in healthcare. The ideal candidate will have extensive experience in healthcare...Remote jobClaimsHealth Insurance
- SHPCA SCAN Health Plan is looking for a Director of Claims Operations in Long Beach, New York. The successful candidate... ...are managed efficiently and in compliance with regulations. Key responsibilities... ...a competitive salary and a mostly remote work environment. #J-18808-Ljbffr...Remote jobClaimsHealth Insurance
- ...recruiting for a fully remote Case Manager position.... ...extend, and focuses on health care management and coordination... ..., and treatment plans. - Care Plan... ...issues with providers, claims, or services from a remote... ...coordination, remotely. - Compliance: Maintain confidentiality...Remote workClaimsHealth InsurancePermanent employmentTemporary work
$65k - $72k
...experience) Location: Fully Remote (Working EST hours)... ...Medicaid agencies, PBMs, and health plans • Maintain accurate and up-... ...licenses, accreditations, and compliance documentation • Monitor payer... ...enrollment issues impacting claims • Route and manage provider...Remote workClaimsHealth InsuranceContract workFlexible hours- ...the Baylor University Health Center by ensuring accurate... ...departments to manage claims, resolve billing issues... ...is eligible for remote work. A high school... ...filing with commercial plans, Tricare and other federal... ...university staff Maintain compliance with HIPAA, FERPA,...Remote workClaimsHealth InsuranceFull timeWork experience placement
$130k - $168k
...Attorney to cover litigated claims throughout Massachusetts. This position is fully remote with required travel to... ...Comprehensive benefits including health coverage, retirement plan with employer match, paid... ..., and ensuring compliance with legal and regulatory standards...Remote workClaimsHealth Insurance
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