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. · ...

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 ...

We are seeking an experienced and detail-oriented Senior Accident and Health Claims Auditor to join our team. · The ideal candidate will have extensive knowledge of insurance claims processes auditing standards regulatory requirements related to accident health insurance The Seni ...

+h2>Job summary · Automotive OEMs rely on DEKRA to ensure their dealership networks follow warranty policy submit accurate documentation maintain integrity of warranty claims as retail warranty auditor you will conduct in-depth audits of dealership repair orders identify non-comp ...

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 ...

+ Reviews inpatient medical records to validate assignment and sequencing of ICD-10 diagnosis and procedure codes · + Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter · + Follows proper procedure for referral to Clinical Nurse ...

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 ...

Join us as a Claim Governance and Control Lead to play your part in the transformation of the way we help customers manage risk. · Drive a strong control framework working in close collaboration with the Technical Business lines, Operations and Claim Legal. · ...

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 ...

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. · ...

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 ...

We are seeking a highly skilled and versatile accounting and finance leader to support the Corporate Controller. ...

The Clinical Provider Auditor II role enables associates to work virtually full-time with maximum flexibility and autonomy. · This approach promotes productivity supports work-life integration ensures essential face-to-face onboarding and skill development.A proud member of the E ...

The Virtual Premium Auditor II provides timely, professional and consultative audit services utilizing limited supervisory guidance. · The Virtual Auditor reviews relevant policyholder records to identify and communicate risk exposures and ensure appropriate premiums are charged. ...