Claims Oversight Auditor

Found in: Careerbuilder One Red US C2 - 2 weeks ago

Rancho Cucamonga CA United States Inland Empire Health Plan Full time
What you can expect

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversight Auditor is responsible for ensuring the compliance of IEHP’s claims payment system and processes by auditing claim payments using standard principles and State and Federal regulations. The auditors are also responsible for documenting and reporting findings and ensuring appropriate actions have been taken to resolve payment issues with the affected departments within IEHP, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary.
Hybrid schedule.
CalPERS retirement.
State of the art fitness center on-site.
Medical Insurance with Dental and Vision.
Life, short-term, and long-term disability options
Career advancement opportunities and professional development.
Wellness programs that promote a healthy work-life balance.
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Education & Experience

Four (4) years auditing claims in a managed care environment including contract and financial DOFR interpretation.
Two years (2) claims processing including Medi-Cal and Medicare.
High school diploma or GED required.

Key Qualifications

Yes, must have a valid California Driver's License.
Knowledge of Medi-Cal and CMS guidelines for claim payments.
Strong analytical and problem-solving skills. Must be able to review cause and impact of problems and recommend realistic solutions both in writing and in meetings. Microsoft Office including being able to manipulate large data sets in Excel files.
Excellent oral and written communication skills.

Start your journey towards a thriving future with IEHP and apply TODAY

  • Claims Oversight Auditor

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plans Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversight Auditor is responsible for ensuring the compliance of IEHP’s claims...

  • Claims Oversight Auditor

    2 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Under the direction of the Claims Oversight Supervisor, the Internal Claims Oversight Auditor is responsible for ensuring the compliance of IEHP’s claims...

  • Compliance Auditor III

    Found in: beBee jobs US - 2 weeks ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    Find joy in serving others with IEHPWe welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experienceThe Compliance Auditor III is responsible to lead and conduct key activities of the IEHP Compliance Audit Program.The Compliance Auditor III is responsible for conducting compliance audits,...

  • Auditor - Provider Recovery

    2 weeks ago

    Rancho Cucamonga, United States Experis Full time

    Title: Auditor - Provider Recovery Location: Rancho Cucamonga, CA (HybridTues, Wed, And Thursday onsite. Mon/Friday (remote)) Duration: 6-month contract Rate Range: $25 to $30/hr. on W2. Responsibilities:Summary Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit...

  • Compliance Auditor I

    2 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! Under the general supervision of the Compliance Audit & Oversight Manager, the Compliance Auditor I conducts and assists with compliance audits and supports...

  • Financial Compliance Auditor

    7 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    Overview:What you can expect!Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience!Under the direction of the IPA Financial Compliance Manager, the Financial Compliance Auditor is responsible for conducting financial monitoring and oversight of...

  • Manager, Claims Processing

    1 week ago

    Rancho Cucamonga, United States CareerBuilder Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! The Manager, Claims Processing - Covered California is responsible for oversight and direction of claims and auditing activities of the Covered California (CCA) vendor...

  • Financial Compliance Auditor

    2 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! Under the direction of the IPA Financial Compliance Manager, the Financial Compliance Auditor is responsible for conducting financial monitoring and oversight of IEHPs...

  • Financial Compliance Auditor

    2 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Under the direction of the IPA Financial Compliance Manager, the Financial Compliance Auditor is responsible for conducting financial monitoring and oversight...

  • Medical Claims Auditor

    Found in: Jooble US O C2 - 2 weeks ago

    City of Industry, CA, United States Innovative Management Systems Incorporated Full time

    This position is responsible for reviewing and processing claims, including facility claims, to ensure accuracy prior to payment release. This position is the lead responder to Health Plans and IMS Clients for all products and lines of business. Responsible for management and monitoring of claims compliance with all products and lines of business for managed...

  • Financial Compliance Auditor

    5 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! Under the direction of the IPA Financial Compliance Manager, the Financial Compliance Auditor is responsible for conducting financial monitoring and oversight...

  • Sr. Physician Coding Compliance Auditor

    Found in: Careerbuilder One Red US C2 - 2 days ago

    San Diego, CA, United States CEDARS-SINAI Full time

    Job Description What will I be doing in this role? The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with, educates, and trains providers and staff on results, identifies issues and/or risks...

  • Sr. Physician Coding Compliance Auditor

    Found in: Careerbuilder One Red US C2 - 2 weeks ago

    Arco Plaza, CA, United States CEDARS-SINAI Full time

    Job DescriptionWhat will I be doing in this role?The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with, educates, and trains providers and staff on results, identifies issues and/or risks...

  • Physician / Administration / California / Permanent / Health Plan Medical Director Job

    1 week ago

    Rancho Cucamonga, United States IEHP Full time

    1. Develop and implement medical policy for utilization management activities and functions, including benefit manual statement, policies and procedures, and Utilization Management Subcommittee Guidelines. Provide training and consultation for both internal staff and medical personnel of the Plan regarding policy application.2. Provide direction and control...

  • Physician Billing Auditor, Medical Records

    Found in: Jooble US O C2 - 5 days ago

    Sacramento, CA, United States Cedars-Sinai Full time

    Job Description What will I be doing in this role? The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with, educates, and trains providers and staff on results, identifies issues and/or...

  • Auditor - Entry Level (Maryland)

    Found in: Careerbuilder One Red US C2 - 2 days ago

    Fort George G Meade, MD, United States National Security Agency Full time

    Responsibilities The Office of the Inspector General (OIG) at NSA conducts independent oversight that promotes wise use of public resources; adherence to laws, rules, and regulations; and respect for Constitutional rights. The OIG also detects and deters waste, fraud, abuse, and misconduct, and promotes economy, efficiency, and effectiveness in the...

  • MANAGER OF CLAIMS

    Found in: Careerbuilder One Red US C2 - 3 days ago

    , OR, United States Sigma Inc Full time

    267099 - Manager of Claims - Health Plans - Corvallis, OR - Full Time Direct HireSigma Healthcare team is looking for a Manager of Claims - Health Plans to work onsite at our client's facility in Corvallis, OR.Shift : Days, Full Time.Job Summary/Purpose: Oversees and manages the Health Plans Claims Department. Is responsible for accurate and timely claims...

  • Sr. Physician Coding Compliance Auditor

    Found in: Jooble US O C2 - 5 days ago

    Sacramento, CA, United States Cedars-Sinai Full time

    Job Description What will I be doing in this role? The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with, educates, and trains providers and staff on results, identifies issues and/or risks...

  • Claims Compliance Remediation Analyst

    Found in: Careerbuilder One Red US C2 - 4 days ago

    New York, NY, United States MetroPlusHealth Full time

    Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealth provides the highest...

  • Mission Compliance Test Auditor with Security Clearance

    Found in: Careerbuilder One Red US C2 - 7 days ago

    Chantilly, VA, United States SAIC Full time

    Description SAIC is seeking a Mission Compliance Test Auditor to join our team in our Chantilly, VA office. This position provides specialized engineering, analysis, and operations support to a variety of US Government (USG) customers. We support the generation after next of national security- related systems based in space, in the air, and on the ground. We...