14 clinical review auditor jobs found

Primary Details Time Type: Full time Worker Type: Employee Specialist, Claims Operations Location: USA –Marblehead, MA and Atlanta, GA Work Arrangement: Hybrid   The salary range for this role is:  $76,000-125,500K The Opportunity The role supports the day-to-day operational execution of A&H Claims by managing workflows, coordinating with internal and external partners, and driving consistency across intake, reporting, and process execution. The focus is on improving efficiency, data quality, and overall claims operations performance. Your new role Responsibilities: Support day-to-day claims operations by tracking workflows, following up on outstanding items, and ensuring workflows are progressing as expected Coordinate with internal teams and external partners to gather claim information and assist with issue resolution Help manage intake and backlog by organizing incoming work and routing items appropriately Review...

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: Plan and direct software engineering services for a major line of business or multiple lines of business to meet strategic and operational goals. Set the vision; establish effective standards/ processes; set/monitor quality performance expectations/results. Interface with senior executives across the enterprise to develop a strategic plan for delivering Information Technology (IT) solutions which...

Overview AmTrust Financial Services, a fast-growing commercial insurance company, has an opportunity for a Manager, RN Branch Manager of Telephonic Case Management for Workers Compensation where your clinical talent and leadership abilities contribute to our competitive edge.    PRIMARY PURPOSE: The RN Branch Manager for telephonic case management services will oversee operations as well as a team of experienced worker’s compensation nurse case managers. The ideal candidate will have a minimum of three (3) or more years’ experience overseeing a nursing claims management program as well as in-depth understanding of worker’s compensation injury claims and utilization management review programs. The Manager will lead the nurse case management team to strategize with claim professionals in management of medical and disability exposure, delivering quality telephonic case management to proactively drive best in class outcomes including appropriate medical...

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 Risk Analyst PRIMARY PURPOSE :  Gathers, analyzes, and presents information on various risk management initiatives; manages certificate of insurance requests, security arrangements and inquiries for international travel, and maintains vital risk management information.  ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages all certificate of insurance requests including handling non-standard broker and carrier requests, ensuring new certificates are correct and...

AI Model Validation Lead Be part of something groundbreaking   At AIG, we are making long-term investments in a brand-new, innovative Generative AI team, designed to explore new possibilities for how artificial intelligence can be applied in insurance and beyond, and we need your help.  With the support and investment needed to explore new frontiers in generative AI, you’ll be working alongside talented colleagues, innovating and leading projects that will transform how we manage risk and serve our customers.   This team is central to our vision of the future and the core of our business offering. We will incorporate best-in-class engineering and product management principles and your guidance and collaboration will be critical to its success. To rapidly advance and innovate, we need your skills and expertise to build world-class products. If you’re excited by the opportunity to create meaningful impact at scale, we’d love to hear from you.  How you will create an...

Description   Our Health and Benefits business helps large and mid-size clients control health and welfare plan costs, improve health outcomes and promote employee engagement through broad-based, state-of-the-art interventions. We provide solutions encompassing creative plan design, vendor evaluation and management, pricing and funding strategies, data analytics, valuation support, compliance and governance strategies. We also provide Specialty consulting services including clinical/health management program design, pharmacy solutions, disability/absence management strategies and claims audit services. Product based solutions such as our pharmacy purchasing coalition round out our broad-based suite of offerings.    The Role   This role will support the growth of voluntary insurance consulting opportunities across the U.S. Southeast region. The position will partner closely with the Senior Director, serving as a subject matter expert across new...

Primary Details Time Type: Full time Worker Type: Employee The Opportunity: Vice President, Workers' Compensation Programs will execute business strategy for assigned Workers’ Compensation (WC) programs by underwriting business, evaluating risk, and ensuring decisions contribute to a profitable portfolio. This role involves developing strategy, directing operations, mentoring team members, and fostering cross-functional knowledge sharing. Additionally, the role is responsible for delivering profitable growth and overseeing the P&L for designated programs. Location: New York, NY, Chicago, IL, Atlanta, GA, Boston, MA, Madison, WI, Irvine, CA, or Los Angeles, CA Work Arrangement: This role will be on a hybrid schedule with expectations of being in office 8-12 days a month The salary range for this role is: $176,000 - $330,000 Your New Role: Deliver on the long-term programs strategy and business plan to drive continued profitable growth of assigned programs....

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 Sourcing Director PRIMARY PURPOSE :  To lead the strategic sourcing team and the contract administration team including strategic sourcing initiatives, supplier management, categorization, risk mitigation evaluation of indirect corporate suppliers, and review, evaluation, and recommendations to the corporate vendor programs. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Leads strategic sourcing initiatives acting as a trusted adviser to business partners in the...

Together we fight for everyone’s opportunity for a better financial future. We will do this together — with customers, partners and colleagues. We will fight for others, not against: We will stand up for and champion everyone’s access to opportunities. The status quo is not good enough … we believe every individual and every community deserves access to financial opportunities. We are determined to support both individuals and communities in reaching a better financial future.  We know that reaching this future depends on our actions today. Like our Purpose Statement, Voya believes in being bold and committed to action.  We are committed to a work environment where the differences that we are born with — and those we acquire throughout our lives — are understood, valued and intentionally pursued. We believe that our employees own our culture and have a responsibility to foster an environment where we all feel comfortable bringing our whole selves to work. Purposefully...

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 Alpharetta, GA or Dallas, TX 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 prospectively,...

Primary Details Time Type: Full time Worker Type: Employee The Opportunity: Support Specialty Casualty Team strategy by utilizing established guidelines and communicating with agents to evaluate risk, apply sound decision-making and underwrite profitable business within authorized limits. Location: Atlanta, GA; 3340 Peachtree Road, Tower Place 100 Atlanta GA 30326 Work Arrangement: This role is hybrid, where you will be expected to be in the office 2-3 days per week. The salary range for this role is between $80,000-$120,000. Your New Role: Review, evaluate and price business by applying sound underwriting judgment and adhering to company policy and state regulations within established authority Underwrite insurance risks in accordance with the business plan and the personal authority to meet business objectives including negotiating rates, terms and conditions for existing and new business, managing production and issue of contract...

About Specialty Program Group: Specialty Program Group (SPG) is the wholesale & MGA division of HUB International (7th Largest Global Broker). SPG acts in a holding company capacity acquiring best in class underwriting businesses to operate independently under discrete brands (portfolio companies). Responsibilities Accuracy & Compliance Management Process surplus lines tax transactions and filings for all states within state-mandated deadlines Review comparative late filing reports, improve accuracy, and request refunds of erroneous charges where applicable Run reports and verification of state surplus lines tax data to ensure accuracy of information and correct errors where necessary Customer Service & Communication Respond promptly to inquiries from surplus lines team, divisions, and third-party vendors Resolve transactions in question (TIQs, TAGs, flagged transactions) and escalate complex issues to Surplus Lines Tax Manager when...

Position Summary Velocity Risk provides insurance solutions for small to mid sized businesses and middle market properties in coastal and catastrophe prone areas. We specialize in risks involving hurricanes, windstorms, and other natural disasters. Our team uses advanced modeling, strong technology, and a fast and responsive claims process to deliver high quality E&S property solutions. What will your job entail? Job Responsibilities Underwriting and Risk Assessment Review new and renewal submissions for property risks. Evaluate risk quality, pricing, terms, and conditions. Analyze coastal and CAT exposures such as wind, storms, and hurricanes. Apply underwriting guidelines and rating tools accurately. Data and Documentation Maintain accurate policy data throughout the policy lifecycle. Prepare and organize underwriting documentation, quotes, and bind orders. Support audits by providing complete and accurate underwriting files. Build and maintain...

What part will you play? If you’re looking for a place where you can make a meaningful difference, you’ve found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you’ll find your fit amongst our global community of optimists and problem-solvers. We’re always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! The position encompasses Property underwriting for the Markel Specialty Southeast Region. Specific focus for this role will to be to establish and grow the Property book of wholesale business in the Southeast territory. The primary purpose of this position is to underwrite new business and renewals in a profitable manner and according to authority level and established guidelines. The appropriate candidate will utilize underwriting tools to determine accurate classifications, rates, and premium charges....