Strategic Healthcare Claims & Vendor Auditor
Johns Hopkins Health Plans
Johns Hopkins Health Plans is seeking a Vendor Auditor to independently conduct claims and vendor performance audits, ensuring compliance with contracts, regulations, and quality standards. The role oversees high‑risk vendors, evaluates claims accuracy, and monitors remediation, producing reports and scorecards for leadership review. The ideal candidate will have advanced knowledge of claims adjudication, Medicare/Medicaid reimbursement, and healthcare policies, with strong analytical and #J-18808-Ljbffr Johns Hopkins Health Plans
- ...Hopkins Health Plans, Hanover, MD 21076 Category:Healthcare Operations Schedule:Day Shift Employment Type:... ...general supervision of the Department Director, the Vendor Auditor is responsible for independently conducting claims and vendor performance audits to ensure...ClaimsFull timeLocal areaDay shift
- ...interpretation of medical records and claim documentation to assist with... ..., or other qualified healthcare provider.Other skills required... ...relationships with clients, vendors and/or any other representatives... ...productivity; Works quickly.Strategic Thinking - Develops...Claims
- A government services provider is seeking a skilled Senior Auditor in Arlington, VA. This role entails conducting complex financial analyses and forensic investigations related to healthcare claims. Candidates must have over 5 years of experience in financial auditing...Claims
$71.1k - $97.8k
...community The Inpatient Medical Coding Auditor extracts clinical information from a... ...coding auditor to review inpatient hospital claims for proper reimbursement, handle... ...to encourage personal wellness and smart healthcare decisions for you and your family while...ClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$38.46 - $52.4 per hour
...leadership in the markets they serve. We help healthcare organizations build innovation... ...create your future. The Inpatient Coding Auditor will be responsible for the auditing of... ...corrective action is initiated before the claim is rebilled to the insurance. Conduct...ClaimsHourly payPermanent employmentFull timeWork at officeLocal areaImmediate startRemote workFlexible hoursDay shift- A government services entity in Washington, DC, is seeking a skilled Senior Auditor to conduct forensic investigations and analyze medical claims data. Candidates should have over 5 years of relevant experience, with roles including financial analysis and report preparation...ClaimsFlexible hours
- ...Vice President, Strategic Solutions & Delivery About the Company Innovative provider of cost containment technology & case management... ...include serving as a thought leader in casualty operations, claims modernization, and AI-enabled business processes, as well as positioning...Claims
- ...Healthcare Legal Solutions IT Specialist Healthcare Legal Solutions, LLC is a fast-growing... ...technology used to process insurance claims and supporting documents. The IT Specialist... ...and competition; Aligns work with strategic goals. Business Necessity – The needs...Claims
$85k
...Healthcare Legal Solutions Attorney Position Healthcare Legal Solutions, LLC is a fast-... ...will be able to settle a high volume of claims using creative, innovative, and flexible... ...even when dealing with emotional topics Strategic Thinking - Develops strategies to...ClaimsFull timeContract workWork at officeFlexible hours$43.26 per hour
...CONSULTING, LLC Washington, DC The Travel Auditor, Research Analyst will provide Defense Travel Administrator (DTA) support to Strategic Systems Programs’(SPS) Department and... ...to obtain information regarding expenses claimed, methods of reimbursement, and validation...ClaimsWork at officeLocal area$145.1k - $210k
...transformation of the entire healthcare ecosystem for the better, improving... ...stakeholders by supporting strategic partnerships and connectivity... ..., strategic alliances and vendor contracts;Structure and... ...supporting provider revenue cycle and claims workflows;Work cross-...ClaimsH1bWork at office$46.99k - $122.4k
...prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds,... ...to prevent payment of fraudulent claims committed by insured's, providers, claimants... ...manages use of outside resources and vendors to perform activities necessary for investigations...ClaimsHourly payFull timeTemporary workWork experience placementWork at officeLocal areaFlexible hours- ...goals. In short, We Enable Possibility. Strategic Analytics is a dynamic and growing team... ...digital operations across underwriting and claims functions. Reporting to the SVP of AI &... ..., process management teams, external vendors, and members of the Strategic Analytics...ClaimsTemporary workWork experience placement
$210k - $250k
...negotiate client project contracts, vendor contracts, software license... ...the General Counsel with claims management and litigation... ..., as well as think strategically to provide critical analysis... ...addition to 100% covered employee healthcare costs and 401k contributions...ClaimsContract workWork at office- ...Senior Auditor Employment Type: Full Time, Mid-level CGS is seeking a Senior Auditor... ...legal staff by conducting medical claims data analysis, forensic investigations,... ...related party transactions. Analyze healthcare claims and other data. Create financial...ClaimsFull timeRemote workFlexible hours
$46.99k - $122.4k
...Position Summary The Program Integrity Auditor is responsible for the review of records... ..., behavioral, transportation, and other healthcare providers. The Auditor must have the ability... ..., recoupment of funds or rebilling of claims, and referral to state regulators for...ClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours- ...to lead end-to-end data extraction and enrichment, enhancing underwriting and claims operations. You will drive AI-driven automation and collaborate with senior leaders, IT teams, and vendors to deliver advanced solutions. You will mentor offshore resources and shape Arch...Claims
- Claritev is seeking a Contracts Specialist to handle pre-claim and OON physician contract negotiations across clients nationwide. The role involves negotiating with providers, coordinating with senior facilities, and documenting claim outcomes while ensuring HIPAA compliance...ClaimsContract work
- ...and led organization, ensuring everyone has access to quality healthcare is what inspires us. The magic we’ve created lies in Carbon Health... ...play a critical role in resolving billing issues, processing claim resubmissions, managing patient escalations, and ensuring a positive...Claims
- ...party administrator focused on self-funded healthcare operations and continued growth.... ...healthcare operations, stop-loss programs, and claims management. The successful candidate will be responsible for a combination of strategic and tactical activities to support the company...ClaimsRemote work
$186.49k - $278.88k
...evaluation of work performed against vendor Statement of Work (SOW). •... ...- Stay focused on key strategic objectives, be accountable for... ...processing fee, even if claimed you will be reimbursed, this... ...Pharmaceutical Co., Ltd. is a global healthcare company with the corporate...ClaimsFull timeContract workTemporary workLocal areaRemote workWorldwideFlexible hours$150k - $190k
...transformation of the entire healthcare ecosystem for the better, improving... ...insights from administrative claims and EHR data. This is an... ...can be implemented to key strategic business problems using high-... ...evaluation of data analytic vendors and tools. Maintain compliance...ClaimsH1b$90k - $125k
...both 2025 and 2026 on Modern Healthcare's ‘Best Places to Work,’ Tribunus... ...fee schedule analysis. Data Vendor Lead: Lead relationships with... ...vendors (price transparency, claim utilization, etc.) and... ...functionality improvements. Strategic Data Utilization: Analyze contracts...ClaimsHourly payFull timeContract workPart timeRemote workFlexible hours$85k - $90k
...customer experience for our strategic customers. By combining proactive... ...actions. Manage claims processes for assigned accounts... ...resolution. Partner with carriers, vendors, and internal teams to... ...the goods we consume to the healthcare we rely on. At Kuehne+Nagel,...ClaimsFull timeWork at officeLocal area- ...Officer About the Company Dynamic healthcare technology (HealthTech) company Industry... ...Computing Healthcare Healthcare Claims Clearinghouse Provider Portal... ...corporate development activities, and driving strategic initiatives across the enterprise. A strong...Claims
- ...hiring a Corporate Development Principal - Remote. This role leads strategic alliances, evaluates growth opportunities, and coordinates... ...governance and drives execution across Product Distribution, Legal, Claims, Marketing, Finance, Technology, and #J-18808-Ljbffr CSAAClaimsRemote job
$150k - $250k
...operations include education, media, healthcare, automotive, manufacturing, and restaurants... ...generalist — we provide oversight, strategic advisory services and additional capacity... ...candid, grounded assessments of AI vendor claims, tool evaluations, and build‑vs‑buy decisions...ClaimsTemporary workWork at officeLocal areaImmediate startRemote work- ...call center environment. Assist members with health benefits, claims, eligibility, and coverage inquiries via phone, email, and written... ...issues to supervisors as needed. Ensure compliance with healthcare regulations, policies, and procedures. Requirements High school...Claims
- ...Auditor Employment Type: Full-Time, Mid-Level Department: Financial CGS is seeking a highly skilled Auditor to provide general... ...volume of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence...ClaimsFull timeWork experience placementInterim roleWork at officeLocal areaFlexible hours
$90k - $120k
...with at least three years of experience in healthcare policy or management specific to... ...developments to commercial impact.•Work with claims and reimbursement datasets, applying quantitative... ...structures and incentives to impact on vendor success.•Synthesize findings into clear,...ClaimsFull timeWork at officeWork from homeFlexible hours
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