Claims Audit Manager

Job DescriptionJob DescriptionPOSITION SUMMARY Strong background on Medi-Cal, Commercial, and Medicare benefits, including coordination of benefits. Works closely with all departments necessary to ensure that processes, programs and services are accomplished in a timely and efficient manner in accordance with AMM policies and procedures and in compliance...

Job DescriptionJob DescriptionPOSITION SUMMARY Strong background on Medi-Cal, Commercial, and Medicare benefits, including coordination of benefits. Works closely with all departments necessary to ensure that processes, programs and services are accomplished in a timely and efficient manner in accordance with AMM policies and procedures and in compliance...

Our client, is in need of a Temporary Workers' Compensation Claims Examiner for their Long Beach Office to work on a remote basis. The ideal candidate will have 3+ years of California Workers Compensation Experience.Required Qualifications:3+ years of experience handling Workers' Compensation claims in California.Ability to negotiate settlement of...

Job DescriptionJob DescriptionRole InsightsThis role of the Claims Examiner III is considered an essential position within the organization as well as the Claims Department. The Claims Examiner is responsible for collaborating with the Claims Team to meet productivity goals as well as ensure quality. This candidate should possess claims knowledge,...

Job DescriptionJob DescriptionRole InsightsThis role of the Claims Examiner III is considered an essential position within the organization as well as the Claims Department. The Claims Examiner is responsible for collaborating with the Claims Team to meet productivity goals as well as ensure quality. This candidate should possess claims knowledge,...

Job DescriptionJob DescriptionRole InsightsThis role of the Claims Examiner III is considered an essential position within the organization as well as the Claims Department. The Claims Examiner is responsible for collaborating with the Claims Team to meet productivity goals as well as ensure quality. This candidate should possess claims knowledge,...

Job OverviewPosition SummaryThe Claims Processing Associate is an entry-level role within the Claims Division at Advanced Medical Manage. This position is essential in supporting the Claims Team through various tasks such as data management, investigation, and organization. The ideal candidate will demonstrate strong multitasking abilities, a commitment to...

Job DescriptionJob DescriptionRole InsightsThis role of the Claims Clerk is considered an entry-level position within the Claims Department. The Claims Clerk is responsible for providing additional support to the entire Claims Team which involves data entry, researching, organizing, etc. This candidate should possess excellent multi-tasking capabilities, the...

Job DescriptionJOB DESCRIPTIONJob Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding...

Job OverviewAs a Clinical Review Nurse, you will leverage your clinical expertise to assess documentation for medical necessity and the appropriate level of care. Your role will involve utilizing MCG/InterQual guidelines, state and federal regulations, billing and coding standards, and Molina policies to validate medical records and claims submitted,...

Job DescriptionJob DescriptionPOSITION SUMMARYThe Clinical Audit Coordinator, assisting and informing the Manager of any barriers that may preventing tasks from being completed in a timely and efficient manner. Individual must be able to execute effective communications verbally and in writing, maintain patient confidentiality, and promote departmental and...

Job DescriptionJob Description[Confidential] We are a healthcare company has a contract with the Center of Medicaid and Medicare Services (CMS) and an MAPD plan for 2024. We are looking for a Senior Claims Manager to join our growing company with many internal opportunities.Are you ready to join a company that is changing the face of health care across the...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. KNOWLEDGE/SKILLS/ABILITIES Evaluates the adjudication of claims using standard principles...

We are seeking a highly skilled and strategic Director of Claims Operations to lead our claims department and ensure the precise and efficient processing of healthcare claims. The ideal candidate will have a strong background in claims management, revenue cycle management, and healthcare operations, with a proven track record of implementing process...

We are seeking a highly skilled and strategic Director of Claims Operations to lead our claims department and ensure the precise and efficient processing of healthcare claims. The ideal candidate will have a strong background in claims management, revenue cycle management, and healthcare operations, with a proven track record of implementing process...

Roles & Responsibilities Requirements:- To update the claim information including date of receipt of claim, project number and claim amount in the database. To check the claims and seek clarifications with grantees on queries arising from their claim submissions to ensure that all queries are satisfactorily resolved. To seek PUB advice on...

About JobotJobot is a dynamic and expanding accountancy firm with a strong presence across the United States. We are committed to growth and innovation in the financial sector.Why Work With Us? Attractive salary with the potential for an annual performance bonus. Comprehensive health benefits including medical, dental, and vision coverage. Generous Paid Time...

Description: Remote - Candidate has to be in CA. Min 5 years of CA claims handling experience is mandatory. SIP is preferred. PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of...

Description:PRIMARY PURPOSE: To analyze complex or technically difficult workers compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify...

Claims Examiner - Workers Compensation BC Forward is looking for Claims Examiner - Workers Compensation in Remote Position: Claims Examiner - Workers CompensationLocation: California, Remote Duration: 3+ Months of Contract with possible extension Pay-Rate: $33.00/Hr on W2Job Description:Primary Purpose: To analyze complex or technically difficult workers'...