Claims Integrity Auditor & Investigator II
Qlarant
Qlarant in California seeks an experienced auditor to ensure the accuracy of claims processes and protocols. You will conduct audits/investigations, analyzing data and documenting findings while adhering to regulatory standards. A Bachelor's Degree and relevant experience are required. The ideal candidate will have strong analytical skills and be able to communicate effectively with stakeholders. Experience in fraud prevention is preferred, along with a Certified Fraud Examiner qualification. This is a critical role in safeguarding the integrity of claims. #J-18808-Ljbffr Qlarant
- Job Summary Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills... ...providing training and support to other auditors/investigators, contributing to the...ClaimsWork experience placement
- ...Summary: Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail,...ClaimsWork experience placement
- Qlarant is seeking an entry-level professional in Los Alamitos, California, to conduct audits and investigations of customer claims. The role requires attention to detail and analytical skills to assess claims validity and identify fraud opportunities. A Bachelor's Degree...Claims
- ...knowledge of Perry Homes construction procedures regarding the Phase II process (from sheetrock tape and float to home completion) and... ...from sharing personal or sensitive information with any party claiming to represent our company outside of these channels. We do not at...ClaimsFor contractorsLocal area
$19.64 - $42.55 per hour
...Job Title Investigative Support For Special Investigation Unit Job Description Provides... ...following review of post-payment claims. Essential Job Duties Independently... ...Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of...ClaimsRemote jobHourly payFull timeContract workWork experience placementWork at officeLocal area$70k - $85k
...Risk Adjustment Coding Specialist II - Orange County We are currently seeking a highly... ...Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As... ...identify, assess, monitor, and document claims and encounter coding information as it...ClaimsWork at office$66k - $71k
...Sr. Integrated Absence Specialist Fully Remote Signal Hill Office - Signal Hill, CA 90755 Overview Salary Range $66,000.00 - $71... ...Paid Family Leave, Short Term Disability and Long-Term Disability Claims in accordance with TRISTAR ICS protocols. DUTIES AND...ClaimsFull timeTemporary workWork at officeRemote workLong distanceShift work- ...opening for a Workers Compensation Claims Specialist within the West... ...as a Claims Specialist II, Senior Claims Specialist I,... ...Responsibilities Plans and conducts investigations of claims (including such... ...serve. We value your hard work, integrity and commitment to make things...ClaimsWork experience placementLocal areaRemote work
$105k - $175k
...Development, Customer Focus, Quality and Excellence, Respect and Integrity, we look to foster a passionate and collaborative work... ...discover your future at Altasciences. About The Role The Sub-Investigator I is responsible for supervising clinical activities for the...- ...queues. Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool... ...duties as assigned. In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above. Assists...ClaimsFull timeContract work
- ...highly analytical and detail-oriented Manager, Payor Contract Integrity & Delegation Operations to serve as the operational bridge between... ...role is responsible for ensuring that capitation payments and claims-based reimbursements are accurate and aligned with contracted...ClaimsContract workFlexible hours
- ...Office of Energy Infrastructure Safety is seeking a Senior Policy Investigator (Analyst III) in Sacramento, Oakland, or Lakewood to perform... ...technical experience, one year of which must be equivalent to an Analyst II. #J-18808-Ljbffr Board of Certified Safety ProfessionalsWork experience placementWork at office
- ...A prominent claims adjusting firm in California is seeking Licensed Claims Adjusters to join their team. This role is not just about the job; it's a rewarding career path that offers flexibility, autonomy, and competitive compensation. Successful candidates will assist...Claims
- ...Field Technician II Electric Power Systems (EPS) is a NETA-accredited independent electrical testing and engineering organization... ...recruiters or third party recruiting agencies, and will not recognize claim to any unsolicited resumes or candidate information....ClaimsRelocation
- ...A nationwide claims adjusting firm is actively recruiting Independent Insurance Claims Adjusters to join their dynamic team in California. This role offers a chance to assist individuals and businesses in recovery efforts after unforeseen events. As part of our team,...ClaimsFlexible hours
- A leading claims adjusting company in California is seeking Licensed Claims Adjusters to join their team. As an Independent Insurance Claims Adjuster, you will help individuals and businesses recover from disasters while enjoying flexible work and competitive compensation...ClaimsFlexible hours
- A prominent claims adjusting firm in California is seeking Licensed Claims Adjusters to join their team. This role is not just about the job; it's a rewarding career path that offers flexibility, autonomy, and competitive compensation. Successful candidates will assist...Claims
- ...news: The Mission Our Healthcare Claims Compliance Auditors are warriors for justice in Revenue... ...without sacrificing accuracy or integrity. You believe deadlines are promises... ...Advocate for patients and providers. Investigate & enforce unfair payment trends....ClaimsHourly pay
- ...Minimum of two years recent continuous experience in a business office Extensive knowledge of Medicare, Medi-Cal, Caloptima, and CCS claim adjudication. Benefits ~ Medical, dental and vision coverage is provided for all full time and part time employees* ~...ClaimsDaily paidFull timePart timeWork at office
- ...entry-level professional in Los Alamitos, California, responsible for auditing claims processes. The role focuses on maintaining accuracy and integrity in claims, conducting investigations, and identifying discrepancies. The ideal candidate possesses problem-solving abilities...ClaimsAfternoon shift
$32.6 - $43.27 per hour
...and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we’re a people focused, operations driven organization that prioritizes reasonable caseloads, strong training,...Claims$20 - $24 per hour
...Job Description Job Description Overview Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in...ClaimsWork experience placementWork at officeLocal area$64k - $92.6k
...Senior Claims Resolution Analyst Founded in 1977 as the Senior Care Action Network... ...Our work spans Medicare Advantage, fully integrated care models, primary care, care for the... ...Analysts are responsible for investigating and resolving complex insurance claims....ClaimsRemote work- ...Responsibilities Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail,...ClaimsAfternoon shift
- ...Healthcare Business Analyst to support eligibility, benefits, claims, and provider data exchange initiatives. The ideal candidate will... ..., hands‑on experience with Availity portal and clearinghouse integrations, and the ability to collaborate effectively with business,...Claims
- ...from occurring.* Tests electrical systems and equipment for the integrity and proper function.* Works from blueprints, drawings, and maps... ...of other corporations created pursuant to the Alaska Native Claims Settlement Act, in accordance with Title 43 U.S. Code 1626(g).*...ClaimsContract workLocal area
- ...pricing, promotions, sales team training and claims development Perform periodic external... ...develop new products and services and play an integral role in the new product commercialization... ...device manufacturer, ideally FDA Class II devices Familiarity with Dental, Sleep...Claims
$105k - $175k
Altasciences in Cypress, California is seeking a Sub-Investigator I to supervise clinical activities for assigned trials. You will ensure subject safety and protocol adherence, while also documenting events in compliance with Good Clinical Practices. The ideal candidate...- ...up to ensure tests are completed and records results. Reviews, investigates and responds to work requests and complaints. Responds to... ...California Class C Driver’s License. Grade I Water Treatment and Grade II Water Distribution Certification issued by the State Water...For contractorsLocal area
- The Board of Certified Safety Professionals is seeking a Senior Policy Investigator in California. This role involves conducting comprehensive investigations into underground incidents and safety concerns, analyzing data, and preparing detailed reports. The ideal candidate...
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