13 clinical review auditor jobs found

The Quality Assurance Nurse is responsible for case management quality assurance and mentorship of operations staff, providing tools and calibrating processes, while ensuring consistent delivery of CorVel’s case management services. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Develop, implement, and provide ongoing quality assurance calibration of processes as well as a case management mentoring, both managed and delivered at the operational level Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations Provide national account and regulatory quality oversight As applicable, provide oversight and management of URAC compliance and renewals Work with executive, general and case management department management to ensure the case management department successfully implemented and is adhering to CorVel standards (including quality assurance, reporting, and...

You have a clear vision of where your career can go. And we have the leadership to help you get there.  At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.  JOB DESCRIPTION: For over three decades, CNA has been a trusted provider of insurance solutions for technology companies of all sizes, from emerging startups to global enterprises—across software, IT services, hardware, media, and telecommunications. Our Global Technology Practice delivers specialized coverage including Technology Errors & Omissions (Tech E&O), Cyber Liability, comprehensive international solutions, to complement our traditional Property & Casualty lines. With deep industry expertise, flexible capabilities, and a collaborative approach, we craft innovative insurance programs tailored to the unique needs of each client. CNA remains the carrier of choice...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Assistant | Brea, CA (Onsite) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.  Be a part of a rapidly growing, industry-leading global company known for its...

Primary Details Time Type: Full time Worker Type: Employee The Opportunity: This position will assist in the delivery of a compliance quality control function by performing compliance reviews and identifying and mitigating potential risks. Location: o California o Council Bluffs, Iowa o Fargo, North Dakota o Eau Claire, Wisconsin o North Carolina • Work Arrangement: This role will be remote unless you are within 50 miles of a NAU office, which then you will be required to work on a hybrid schedule. • The salary range for this role is: o California ($28.00 - $42.00) o Council Bluffs, Iowa ($25.50 - $38.25) o Fargo, North Dakota ($25.50 - $38.25) o Eau Claire, Wisconsin ($25.50 - $38.25) o North Carolina ($25.50 - $38.25) Your new role Use established guidelines to review, analyze and make recommendations regarding basic RMA (Risk Management Agency) required compliance reviews and make necessary corrections to insured’s Schedule of Insurance, acres, yield, etc....

UFG is currently hiring an Executive Surety Underwriter who will actively work towards building and maintaining a profitable mix of new and existing surety business by developing and maintaining strong working relationships with the agency force. Demonstrate strong analytical skills to evaluate risks for acceptability within their higher authority and company underwriting parameters. Independently underwrite complex submissions. Review of accounts and bid requests that exceed individual underwriter’s authority levels. Make regular agency visits and calls to assess growth and profitability of agents in their territory including accompanying other underwriters on their visits.  Prospect and appoint new quality agents. Visit current and potential contractor’s place of business to better assess acceptability and quality of the accounts. Help underwriters produce a profitable mix of new and existing business. Assist upper management in the development of underwriters....

Job Description: Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead – our policyholders count on us to be there when it matters most. It’s a big ask, but it’s one that we have the power to deliver when we work together. We collaborate and innovate – pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it’s the right thing to do. Pacific Life is more than a job, it’s a career with purpose. It’s a career where you have the support, balance, and resources to make a positive impact on the future – including your own. How you'll help move us forward: Prior investment accounting experience not required. The team has a strong mentorship core and will provide training. As an Investment Accountant III, you will be involved in the Financial Reporting, Accounting and operations for the Private Equity asset class and your responsibilities will include the following: Financial...

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 is responsible for the technical underwriting and account management of Middle Market construction casualty programs. 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. Underwrites, prices and prepares Casualty quote proposals based on objective and subjective risk characteristics utilizing existing product set and in compliance with regulatory filings.  Routinely engages with internal...

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...

The Claims Training Specialist is responsible for developing curricula to ensure adherence to CorVel’s best practice guidelines, special customer handling requirements, improve quality of audit metrics and overall claims outcomes. This includes ensuring that a designated geographical claims area of CorVel is equipped with an Operations workforce that can optimize its current and future goals and objectives, and deliver quality services that can meet our clients’ requirements and service expectations.  In order to efficiently execute daily responsibilities, the Claims Training Specialist must first obtain a deep understanding of the business to articulate what our claims model does and to clearly demonstrate all aspects of the Operations roles in order to be able to successfully conduct and oversee the department training.   Other duties to be carried out by Claims Training Specialist will include conducting classroom, virtual, and field training to internal employees/colleagues,...

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary responsibility is evaluating claim handling quality, accuracy, and timeliness in categories including but not limited to: coverage analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. This role has the ability to interpret results and trends in order to deliver operational reporting, and participate in the development and presentation of training.   This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Model ethical behavior and executes job responsibilities in accordance with CorVel’s core values, ethics, and information protection policies Serve as technical QA lead to assigned offices or departments Lead QA projects and serve as primary coordinator for senior leadership of assigned offices Support...

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℠. The Assistant Vice President within Arch Construction is responsible for the technical underwriting and account management of large account construction casualty programs. PRINCIPLE DUTIES 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. Assesses insurance and related financial risk and structures appropriate loss sensitive program to effectively protect against frequency, severity, catastrophic and credit risk Engage other internal resources as necessary Underwrites prices and prepares proposals based...

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Appropriately document work and final conclusions in designated computer program Additional duties as assigned   KNOWLEDGE & SKILLS: Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology Knowledge of applicable fee schedule and or applicable U&C Guidelines Proficient in Microsoft Office applications Technical...

Objective: Heffernan Financial Services is looking for an experienced, motivated, and focused Tax Advisor to join its expanding team. The Tax Advisor will play a vital role in supporting the financial well-being of our employees and clients by providing accurate, timely, and strategic tax guidance. This position requires a combination of technical tax knowledge, excellent communication skills, and a customer-centric approach.   Core Responsibilities Include:  Provide tax advice and planning strategies to internal employees and existing clients. Prepare or review federal and state tax returns for individuals, trusts, and small businesses. Develop tax strategies that align with clients’ financial goals and investment strategies. Assist in the preparation of financial statements and reports as needed. Offer year-round support for tax questions, notices, and audits. Collaborate with Financial Advisors to identify tax-saving opportunities as part of...