Claims Auditor - Atlanta, GA

Job summaryCloses claim files against Claims Handling Guidelines or Best Practices to ensure company procedures are followed. · This will include claims handled by our Third Party Administrators (TPAs) as well as claims handled by our internal claims staff. · Perform audits throu ...

This role involves reviewing claim files to ensure compliance with company procedures. · ...

Claims Auditor at Starr Insurance Companies. · This position involves reviewing and evaluating closed and open claim files to ensure compliance with company procedures. · Key responsibilities include performing audits through claim systems, conducting on-site visits, preparing au ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. · Performs audits of high dollar claimsEnsures claim payment accuracy by verifying various aspects of the claim including eligibility, · pre-authorization and medical necessity · ...

We are seeking an experienced Senior Claims Auditor to join our team.The ideal candidate will have extensive knowledge of insurance claims processes, auditing standards, and regulatory requirements. · ...

We are seeking an experienced and detail-oriented Senior Accident and Health Claims Auditor to join our team. · Claims Audit: Conduct thorough audits of accident and health insurance claims to verify accuracy, policy compliance, and proper adjudication. · ,Compliance Verification ...

A leading Fortune-level organization seeks a Senior Risk Manager to oversee company-owned captive insurance entities while advancing analytics, reporting and RMIS capabilities. · Oversee day-to-day operations of company-owned captive insurance entities · Maintain captive governan ...

The DRG Validation Auditor is responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans. · The role involves rendering appropriate decisions which may result in the identificatio ...

The DRG Validation Auditor reviews medical records to determine accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans. · Reviews inpatient medical records to validate assignment and sequencing of ICD-10 diagnosis and procedure codes. ...

The Clinical Provider Auditor II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.This role requires associates to be in-office - 2 days per week. · ...

The DRG Validation Auditor is a member of the CGI Healthcare Compliance team responsible for reviewing medical records to determine accuracy of coding and reimbursement. · Reviews inpatient medical records to validate assignment and sequencing of ICD-10 diagnosis codes. · Provide ...

The DRG Validation Auditor is a member of the CGI Healthcare Compliance team responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered.The review process may result in changes to payment for previously-rendered ...

A leading Fortune-level organization is seeking a Risk Manager to join its Risk Management team. · This position is ideal for a risk or insurance professional who enjoys strategic oversight, data-driven insights, and cross-functional collaboration, · without being tied to a daily ...

The individual in this position will be responsible for managing the administrative appeal of reimbursement claims denied by Medicare or Medicaid. · Maintain a high level of understanding of DRGs and MS/DRGs. · Resolve differences of opinions among coders as to the most appropria ...

The Clinical Provider Auditor II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. · ...

Brown & Brown is seeking a Head of Finance - Captives to join our growing team · This position is a hybrid role and can be located in one of our hub offices located in Atlanta, GA, Dallas, TX, Chicago, IL, New York, NY, Daytona Beach, FL or Tampa, FL. · The Head of Finance – Capt ...

The Clinical Provider Auditor Sr is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse. The role requires associates to be in-office 1 - 2 days per week. · ...

We are seeking a Clinical Provider Auditor II to identify issues and/or entities that may pose potential risk associated with fraud and abuse. · The ideal candidate will have experience in medical coding/auditing, including fraud, waste abuse experience. · Examines claims for com ...

Anticipated End Date: · Position Title: · Clinical Provider Auditor SeniorJob Description: · Clinical Provider Auditor Senior · Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to su ...

The Field Senior Premium Auditor provides timely, professional and consultative audit services utilizing limited supervisory guidance. · Responsibilities include scheduling audits, conducting reviews, and providing a summary of results to policyholders and internal stakeholders, ...