6 clinical review auditor jobs found in Dallas

Overview The Clinical Product Manager (CPM) shapes and optimizes ancillary healthcare services in workers’ compensation, overseeing processes and vendors managing: DME, PT/OT, diagnostics/imaging, transportation/translation, home health, IME/peer review and other supporting vendors related to managed care medical spend. This cross-functional role blends strategy, clinical insight, and operational execution to improve outcomes, reduce costs, and enhance experiences for injured workers, adjusters, and clinical teams. Collaboration with vendors, stakeholders, and leadership is essential to drive measurable improvements and ensure program integrity.   Amtrust is looking for a critical thinker who can bring structure and innovation to our workers’ compensation managed care programs. In this role, you will own vendor performance and process management in a broad variety of areas — making sure the right partners are in place, performance stays strong, and programs...

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....

Job Description: Avant Specialty Benefits is seeking a detail‑oriented, service‑driven Centralized Leave Management Coordinator to support one of our dedicated clients in navigating the complexities of employee leave. This role is ideal for someone who thrives on providing exceptional support, ensuring regulatory compliance, and enhancing the employee experience during critical life events. In this role, you will guide employees, HR partners, and internal stakeholders through leave of absence processes, deadlines, and documentation requirements. Drawing upon your knowledge of FMLA, ADA, and state-specific leave laws, you will help ensure employees receive the accommodations and support they need—promoting accessibility, inclusion, and compliance every step of the way. What You’ll Do Coordinate FMLA and disability programs in accordance with Federal and State laws as well as company procedures. Serve as the primary point of contact for FMLA questions and eligibility...

Overview AmTrust Financial Services, a fast-growing commercial insurance company, has a need for a Clinical Pharmacist. This role is out of one of our office locations in the United States on a hybrid schedule.   PRIMARY PURPOSE:  The Clinical Review Pharmacist has the responsibility of reviewing the medical necessity, appropriateness, and quality in the appropriate setting for workers’ compensation injured employee as it pertains to their medications. Additionally, they will work with Amtrust adjusters and nurses to take proper interventions in the care of the injured employee. This position primarily requires timely reviews of pharmacy prior authorizations to determine appropriateness and medical necessity of treatment. This position assesses the medical appropriateness of proposed medications for our injured employees and partners with the AmTrust claims team to expedite medically necessary treatment. Responsibilities...

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...

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency:  English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Direct and manage a staff of highly experienced accountants, analysts and managers in the performance of a variety of more complex financial analysis and reporting activities. Provide leadership in the development, design, implementation and on-going management of assigned financial analysis processes. Provide training and guidance to subordinates with respect to understanding, analyzing and...