Claims Auditor
Community First Health Plans
POSITION SUMMARY/RESPONSIBILITIES
Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowledge of CFHP claims payment processing system, Amisys.EDUCATION/EXPERIENCE
High school diploma or equivalency is required. Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred. #J-18808-Ljbffr Community First Health PlansVacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Claims Auditor in San Antonio, TX vacancy
- ...Health is seeking a dedicated and detail-oriented Senior Integrity Auditor to join our Compliance team. This pivotal role is responsible... ...areas such as coding, billing, medical record documentation, claims, and clinical data. - Routinely review University Health’s revenue...Claims
- ...on departmental charge capture, perform charge reconciliation and support billing compliance. You will analyze denials and unbilled claims, conduct department account audits, collaborate with the Revenue Management and Compliance teams, and drive process improvements to...ClaimsFull time
$70k - $75k
...Best Workplaces in Financial Services & Insurance Attorney Auditor ** This is a fully remote position, and candidates residing... ...this or other roles. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating...ClaimsLocal areaRemote workWork from homeFlexible hours- A health plans organization in San Antonio is seeking a Claims Auditor to manage and enhance their claims auditing program. The role involves overseeing claims processing standards and ensuring high-quality service delivery to customers. Candidates should have at least...Claims
$100k
Join to apply for the Premium Field Auditor (Hybrid) role at Brown & Joseph AR Management | an ARMStrong IS Company 2 days ago Be among... ...LEADER-R&D - MANAGER-R&D - Quality Systems & Auditing Complex Claims Consultant - Architect & Engineer Liability GROUP LEADER-R&D -...ClaimsWeekly payFull timePart timeLocal areaImmediate startRemote workWork from homeHome office2 days per week3 days per week- ...SUMMARY/RESPONSIBILITIES The Risk Adjustment Data Validation (RADV) Auditor is responsible for auditing medical records to validate ICD-10-... ...systems, electronic health records (EHRs), HEDIS, RADV, and claims data analysis is a plus. LICENSURE/CERTIFICATION Coding...Claims
- ...such as co-pays and deductibles, and generating reports for all of these activities. Duties may also require follow-ups on denied claims, daily insurance claims, and posting payments made by patients to their account. • You will have to solve collection and registration...Claims
- ...Senior Vice President, Head of Claims Intake About the Company Insurance claims operations leader focused on efficient intake, reporting, and client relations. Industry Insurance Type Privately Held About the Role The Company is seeking an SVP,...Claims
- ...established and growing law firm is seeking a skilled and dedicated attorney with significant experience in first-party homeowner property claims to join its dynamic team. The ideal candidate will bring a strong background in representing policyholders in disputes with...ClaimsFull time
- ...Role Summary Performs a variety of AR activities and related tasks in order to recognize the maximum reimbursement from each claim. This position will be responsible for navigating the electronic medical record (EMR) and billing systems to obtain/produce and transmit the...ClaimsWork at office
- SWBC is seeking a qualified claims professional to investigate, evaluate, and negotiate auto claims, including CPI and GAP, to determine liability and settle claims for multiple lines of coverage. You will issue settlement payments to the Named Insured and handle disposition...Claims
- Kforce has a client in San Antonio, TX that is seeking an Auto Adjuster. Summary: Your work will focus on adjusting non-injury auto claims and you will work under supervision to investigate, evaluate, negotiate, and adjust low complexity auto insurance claims presented...Claims
- ...denials, insurance follow-ups, and appeals based on their tier level in a hospital setting. Ensures accurate and timely submission of claims, works to resolve outstanding balances, and communicates effectively with insurance companies to maximize reimbursement....Claims
- Liberty Mutual Insurance is seeking Senior Claims Specialists to manage attorney represented auto and homeowner's bodily injury claims. You will investigate, resolve, and settle claims within authority while maintaining high service levels for policyholders. The role offers...ClaimsWork at officeRemote work
$1,000 per month
...restoration company that does more than just build — they advocate . They help homeowners and business owners navigate complex insurance claims and ensure they get fully funded for property repairs after storm damage. Their service delivers peace of mind and zero out-of-...ClaimsFull timeContract workImmediate startRemote workFlexible hours- Independent Insurance Claims Adjuster (Licensed) 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 and advancement. Why This Opportunity...Claims
$39.1k - $58.86k
...in your career Job Description We are looking for a talented individual… to join our team as an entry level Commercial Energy Auditor! You will be in a customer-facing role meeting with commercial and industrial business owners and operators to install energy...Hourly payFull timeFor contractorsLocal areaMonday to Friday- ...business successful, thus enhancing the career goals of every employee. We have an immediate opening for an experienced Property Claim Supervisor. Candidate must have excellent leadership and supervisorial skills with the ability to guide and develop a team of adjusters...ClaimsWork at officeImmediate start
- ...Overview Role Summary: Performs a variety of AR activities and related tasks in order to recognize the maximum reimbursement from each claim. This position will be responsible for navigating the electronic medical record (EMR) and billing systems to obtain/produce and...ClaimsWork at office
- ...DescriptionThe Denial Management Analyst manages disputed or denied claims by analyzing medical records and payer policies to recover... ...between internal departments and external parties (e.g., payers, auditors) to address claim and audit issues.Ensure all work is performed...ClaimsContract workWork at office
- ...Are you detail-oriented and passionate about aviation compliance? Join STE San Antonio Aerospace, Inc. as a Quality Assurance Auditor , where you'll lead internal audits, monitor regulatory compliance, and support continuous improvement across departments. You'll...Work at office
- ...Overview SWBC is seeking a talented individual to supervise the staff and activities involved in the accurate processing of mortgage claims to include resolving complex claims, training employees, and overseeing the department in management’s absence. Why you'll love...Claims
- ...Hiring Alert | Business Analyst Guidewire Claims Location: San Antonio, TX (Onsite) Employment Type: Full-Time Experience Required: 8 10 Years Visa Type: USC / GC Only Must-Have Skills: Business Analysis P&C Insurance Domain Property...ClaimsFull time
$99k - $232k
...Bachelor's Degree- 5 years of experienceWhat Sets You Apart- Education, certifications and/or experience in Duck Creek policy, billing or claims preferred- Knowledge of P&C Insurance domain (Policy, Claims, and Billing applications)- Proficiency in Duck Creek Policy, Billing,...ClaimsFull timeH1b$40k - $60k
...customer accounts and update information in the database. Assist customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with underwriters to ensure timely policy issuance. Qualifications...ClaimsFor contractorsWork at office- ...Obtaining police reports/incident reports # Obtaining driver records # Obtaining cell phone records # Handling property damage claims # Making Open Records Requests for reports, dash cam and body camera videos from law enforcement # Verifying insurance and...ClaimsWork at office
$175.3k - $322.9k
...composable insurance platform that helps regional, national, and global insurers deliver better customer experience while enabling claim professionals to adjudicate claims more effectively and accurately. This is a great opportunity to be on the frontlines of Deloitte’...ClaimsLocal area- ...document requirements per FIAR methodology. Monitor, track and obtain accurate and complete PBC request from internal and external auditors. Review and evaluate computer-based systems, audit general and application controls in complex information technology...For contractors
- ...customer accounts and update information in the database. Assist customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with underwriters to ensure timely policy issuance. QUALIFICATIONS:...ClaimsWork at officeLocal areaFlexible hours
- ...transactions. Discuss financing options, including CareCredit, when appropriate. Assist patients with insurance documentation and claim information. Maintain accurate patient records and documentation. Follow up with prospective patients and encourage scheduling...ClaimsWork at officeFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Claims Auditor. Be the first to apply!
Related searches
- sales auditor San Antonio, TX
- safety auditor San Antonio, TX
- security auditor San Antonio, TX
- coding auditor San Antonio, TX
- medical records auditor San Antonio, TX
- auditor San Antonio, TX
- compliance auditor San Antonio, TX
- remote nurse auditor San Antonio, TX
- inventory auditor San Antonio, TX
- medical claims auditor San Antonio, TX



