5 clinical review auditor jobs found in Dallas

- The Senior Support Analyst role combines both analytical and technical skills.   This role is responsible for ensuring the successful ingestion and validation of Bordereau data files from insurance agencies. This role plays a critical part in verifying data layout and schema compliance, analyzing data quality, building and managing data pipelines & data flows to ingest data and designing insightful experience reporting using Power BI. The analyst serves as a key liaison between internal teams and external partners to ensure data integrity and reporting excellence. Key Accountabilities/Deliverables: Engage with insurance agencies to review and validate Bordereau file layouts for ingestion readiness. Confirm data schemas align with internal ingestion requirements and standards. Analyze and validate data fields for completeness, accuracy, and consistency. Build and maintain data pipelines and dataflows within Microsoft Fabric (e.g., Dataflows Gen2, Pipelines)....

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.    This position will be hybrid out of our Dallas, TX or Overland Park, KS office. Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities...

About Us  We’re not like other insurance companies. From our specialty products to our business model, our culture to our results — we’re different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn’t just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us.  RLI is a Glassdoor Best Places to Work company with a strong, successful background. For decades, our financial track record has been stellar — a testament to our culture and validation of our reputation as an excellent underwriting company....

About Us  We’re not like other insurance companies. From our specialty products to our business model, our culture to our results — we’re different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn’t just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us.  RLI is a Glassdoor Best Places to Work company with a strong, successful background. For decades, our financial track record has been stellar — a testament to our culture and validation of our reputation as an excellent underwriting company....

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary: The Assistant Vice President within Arch Construction Specialty Products is responsible for the day-to-day technical underwriting and account management of construction professional liability (PL) and contractor’s pollution (CPL) book of business.  Responsibilities and Accountabilities: 1. Technical Underwriting Solicits and reviews new and renewal account information required to evaluate a risk. Identifies all potential exposures and hazards in relation to coverage requested and individual risk characteristics. Engage other internal resources as necessary Underwrites prices and prepares proposals based on objective and subject risk...