Claims Auditor: Medical Claims Analysis & Reporting
Southwest Service Administrators Inc
Southwest Service Administrators Inc. seeks a Claims Auditor to oversee audit activities for medical and dental claims, supporting the team manager and generating statistical audit reports and documentation. Responsibilities include auditing and reporting, applying plan designs, staying current with policies and compliance, researching claim issues, preparing management summaries, and assisting in system testing during upgrades. Strong attention to detail is essential. #J-18808-Ljbffr Southwest Service Administrators Inc
- ...seeking a Health Care Fraud Auditor to work within the... ...auditor uses knowledge of medical terminology, medical... ...law (primarily the False Claims Act, 31 U.S.C. 3729-373... ...and accurate audit reports, charts, summaries, and... ...conclusions from your analysis and investigation. Responsibilities...MedicalClaimsFull timePart timeFor contractorsWork at officeRemote workRelocation
$71.1k - $97.8k
...our caring community The Inpatient Medical Coding Auditor extracts clinical information from a variety... ...complex to complex issues where the analysis of situations or data requires an in-... ...auditor to review inpatient hospital claims for proper reimbursement, handle...MedicalClaimsBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$43.89k - $102.08k
...and Licensure regulatory and state reporting requirements. This role provides support... ...1-3+ years of business analysis experience in reporting, finance operations... ...preferred Experience working with medical and/or pharmacy claims data preferred Education Bachelor’...MedicalClaimsRemote jobHourly payFull timeTemporary workLocal area$15 per hour
The Claims Auditor is responsible for all audit activities for medical and/or dental claims while supporting the team manager to create, maintain and provide statistical audit reports and documentation.ResponsibilitiesAuditing & ReportingGain and maintain the understanding...MedicalClaimsLocal area$46.99k - $122.4k
...Position Summary The Program Integrity Auditor is responsible for the review of records for medical, behavioral, transportation, and... ...of funds or rebilling of claims, and referral to state regulators... ...audit documentation and reports for review for internal and external...MedicalClaimsHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hours$50 - $60 per hour
...2 weeks Senior Auto Claims Adjuster Job in Phoenix, AZ... ...damage claims . Review medical records, demand packages, vehicle... ...(PDB) / License Information Report showing all active or... ...comparative negligence Coverage analysis and policy limits...MedicalClaimsHourly payLong term contractContract workVisa sponsorship$18 per hour
...monthly updates for management reports. + Maintains appropriate file... ...knowledge of data flows for medical bill review and other charge-... ...of insurance programs, claims and implications to outstanding... ...troubleshooting, problem solving, analysis, and discretion; ability to...MedicalClaimsPart timeWork at officeLocal area- ...administration, leave management, compliance, and analytics with a focus on self-funded medical plans. In this role you will administer plans, analyze claims data, prepare leadership reports, coordinate with TPAs and brokers, ensure ERISA/HIPAA compliance, and support...MedicalClaims
$60k - $70k
...Description Job Description Staff Auditor - Phoenix, AZ - $60K-$70K DOE... ...and present detailed audit reports summarizing observations,... ...audit software and financial analysis tools. ~ Proficiency in... ...Benefits: ~$60K-$70K DOE ~ Medical, Dental Vision ~401K Plan...MedicalWork at officeLocal area- ...stakeholders regarding workers' compensation claims and processes. The position... ...oversees staff development, manages reporting and data analysis, supports division initiatives, and assumes... ...practices, and procedures.Advanced medical terminology.Arizona Department of...MedicalClaimsFull timeTemporary workPart timeWork at officeLocal areaRemote work
- ...Aid planning, execution, and reporting of audit projects, including... ...sourced partners and external auditors to ensure successful completion... ....Perform root cause analysis to determine appropriate management... ...package, including:Comprehensive medical, pharmacy, dental, & vision...MedicalTemporary workRemote workFlexible hours
- ...Sr Internal Auditor (Finance) As a Senior Internal Auditor here at... ...of our operations. You will report directly to our Internal Audit... ...standards. Proficiency in data analysis and audit software Due to... ...includes: Employer-subsidized medical, dental, vision and life insurance...MedicalPermanent employmentTemporary workWorldwideFlexible hours
- ...manage litigated California habitability claims from assignment through resolution... ...Evaluate documentation, expert reports, inspection findings, medical records, and other evidence Establish... ...Management Coverage Evaluation and Liability Analysis Negotiation of Settlements Active...MedicalClaims
- ...questionable and suspicious claims for our partners, communicating... ...but not limited to accident reports, accident scene reconstructions... ...investigations to include analysis and organization of critical... ...information (including family medical history), physical or mental...MedicalClaimsLocal area
$61.59k - $66k
...Internal Auditor Job No: 541069 Work Type: Full-time... ...create formal, written audit reports that contain value-added recommendations... .... Performing root cause analysis in affected areas that... ...package including: ~ Affordable medical, dental, life, and short-term...MedicalFull timeTemporary workLocal area$114.36k - $190.61k
...and your family members Medical, dental, vision plans... ...position will be part of the Claims Legal team, which will provide... ...responsibilities that include the analysis of unique jurisdictional concerns... ...complex claim files that are reported to Claims Legal....MedicalClaimsTemporary workWork at officeLocal areaWork from homeVisa sponsorshipFlexible hours- ...Address: Compliance Section/Claims Division 800 W. Washington Street... ...direct and indirect reports in compliance with all rules,... ...workers’ compensation law. Basic Medical terminology. Basic English Basic... ...parties. Master-level analysis of insurance, medical and legal...MedicalClaimsFull timeTemporary workPart timeWork at officeImmediate startRemote workWork from home
- ...supporting operational analytics through data reporting from EHR systems. The successful... ...settings. Responsibilities include analyzing claims performance and generating insightful... ...competitive benefits, including paid time off, medical plans, and financial support programs....MedicalClaimsFull time
- ...quarterly, and annual financial reporting activitiesEnsure accurate... ...contingencies, change orders, claims, and project estimatesOversee... ...reporting, or accelerate business analysis. At Koch companies, we are... ...Our benefits plan includes - medical, dental, vision, flexible...MedicalClaimsFlexible hours
- ...organizational revenue.Must HaveData Analysis Modeling: Gather clean and consolidate financial claims, pharmacy enrollment, and... ...Maintain deep familiarity with medical terminologies, ICD10CM coding,... ...Audit Support: Provide backend reporting and data validation to assist with...MedicalClaims
- ...complex commercial trucking liability claims involving severe bodily injury,... ...evaluations based on accident investigations, medical records, expert reports, and other claim documentation Direct... ...Claim Documentation Coverage Analysis Reserve Establishment Multi-State Claims...MedicalClaims
- ...Handle high-exposure commercial liability claims involving severe bodily injury,... ...preparation • Review evidence, expert reports, and medical documentation • Establish, evaluate, and... ...Liability Claims Management Coverage Analysis Litigation Management Claims Investigation...MedicalClaims
- ...clients using Applied Behavior Analysis. Use contingencies of... ...functional assessment procedures.Reports variables that might affect the... ...(e.g., illness, relocation, medication).Generates objective session... ...status, socio-economic status, claims experience, medical history,...MedicalClaimsPermanent employmentRelocation
$105k - $120k
...Commercial General Liability Claims Specialist to their team. This... ...position include coverage analysis, investigation, evaluation, negotiation... ...capability to write routine reports and correspondence, speak... ...Extremely competitive Medical, Dental, Vision and Life plans...MedicalClaimsRemote work- ...and retrospective reviews of patient medical records to verify the medical necessity... ...in resource use, care delays, and claim denials for reporting purposes.Education:Associate Degree in... ...preferred.Knowledge:Medical Necessity Analysis: This skill involves a detailed...MedicalClaimsPart time
- Handle large, catastrophic claims with a strong emphasis on California losses, including... ...resolution Review evidence, expert reports, and medical documentation Establish and maintain... ...Active Adjuster License Insurance Policy Analysis ATS Optimization Keywords Hard Skills...MedicalClaims
- ...and other parties regarding claim status or transportation assistance... ...doctors for follow-up reports and instructions, and hospitals... ...claimants, attorney representatives, medical sources, and other parties as... ...activities requiring analysis and judgment. Required Skills...MedicalClaimsWork at office
$80k - $95k
Commercial General Liability Claims Representative Our client, an... ...coverage, liability, and damage analysis on all claim assignments.... ...communication skills, including reporting, correspondence, and... ...Ability to work remotely. Medical, Dental, Vision and Life plans...MedicalClaimsFull timeRemote work- ...Reviews and appeals unpaid and denied claims, includes analysis of coding that Analyze daily financial... ...exceptions from the charge capture audit reports to determine areas of leakage and... ...assigned duties Qualifications 7 years medical billing experience Ophthalmology background...MedicalClaims
- ...system, thus establishing a medical home for our patients. In caring... ...Leadership Team via data and reporting tools. This position is... ...Health Record database, data analysis, dashboard, and report build... ...reports specific to healthcare claims submission performance, and effectiveness...MedicalClaims
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