12 clinical review auditor jobs found

Accident & Health Operations Manager Position Overview The Accident and Health Operations Manager is responsible for the onboarding, operational integration, and ongoing management of external program managers, administrators, intermediaries and fronting insurance companies (collectively, “MGUs”). This role ensures that MGUs are effectively integrated into company systems, processes, and compliance frameworks to support efficient policy issuance, regulatory adherence, and operational excellence. In addition to execution, this role owns the MGU onboarding strategy, defining scalable frameworks, standards, and best practices for integrating new partners and programs. This position serves as the primary day-to-day liaison between the company and its MGU partners, coordinating across underwriting, licensing, compliance, and operational teams.  The Operations Manager plays a critical role in enabling business growth by ensuring new programs are launched efficiently and...

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℠. Job Summary The Senior Vice President, Ceded Reinsurance Accounting is a critical contributor to Arch Insurance North America’s (AINA) ceded reinsurance strategy.   This role is responsible for the end‑to‑end controllership and financial operations of the corporate Ceded Reinsurance function at AINA.  Overall, the Ceded Reinsurance Accounting function coordinates the settlement and financial recording of over $1B in annual Treaty and Facultative premium. This role will report to the Chief Financial Officer of AINA and be a key member of the AINA Finance leadership team.    The SVP will be integral to successfully executing the financial commitments of the reinsurance treaties...

This role sits at the intersection of hands-on incident response, cyber defense and threat mitigation. You will be part of a highly collaborative cyber defense and incident response organization, responding to and investigating high-impact security incidents. The ideal candidate is an analytical, curious, and resilient technical leader with a strong investigative mindset and a desire to reduce risk through decisive action. You bring deep knowledge of modern attack techniques and frameworks, communicate clearly under pressure, and naturally step in to respond to and lead incidents during critical situations. You thrive in partnership working closely with security, IT, legal, HR, communications, and business teams to drive effective identification, containment, investigation, response, and recovery. You Have 5-7 years of overall cybersecurity experience, with a focus in digital forensics, incident response, SOC, or threat mitigation. Broad and deep technical expertise...

Who we are AIG, Inc. is a leading provider of insurance products and services for commercial and personal insurance customers.  It includes one of the world’s most far-reaching property casualty networks.  AIG, Inc. (“AIG”) offers a broad range of products to customers through a diversified, multichannel distribution network.  Customers value AIG’s strong capital position, extensive risk management and claims experience and its ability to be a market leader in critical lines of the insurance business. Corporate Finance - Investment Accounting The Investment Accounting group at AIG is responsible for the accounting and reporting for AIG's Invested Assets of over $95 billion a comprised primarily of fixed maturity securities and includes private equity, hedge funds, commercial/residential loans and equity securities.  In addition, AIG’s derivative portfolio consists primarily of foreign exchange derivatives but also includes interest rate and other derivative instruments....

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℠. Job Summary The Assistant Vice President of Enterprise Reporting and Data leads enterprise reporting and data strategy across critical functions, including data engineering, data governance, agentic AI, business intelligence and reporting, actuarial data support, and specialized areas such as Ceded Reinsurance. This role owns end-to-end data and reporting platforms, ensuring scalable architecture, efficient operations, and business-aligned delivery across agile teams and vendor partners. The AVP also drives cross-functional collaboration, business value, compliance, and modernization across the data ecosystem, including Snowflake, Azure services, Databricks, Sigma, Python, Airflow,...

This is your opportunity to join AXIS Capital – a trusted global provider of specialty lines insurance and reinsurance.  We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture.  As a member of AXIS, you join a team that is among the best in the industry. At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.  All qualified applicants will receive consideration for employment without regard to any protected characteristic, including age, color, disability, ethnicity, gender identity, marital status, national origin, pregnancy, race, religion, sex, sexual orientation, veteran status, or...

Crum & Forster Company Overview Crum & Forster (C&F) , with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+"(Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work® Award  for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.   For more information about Crum & Forster, please...

The Primary objective of the Firm Technology Representative, Program Reporting & Analytics is to take responsibility for maintaining, enhancing and developing applications, reports & GOL publications for Distribution Sales Compensation (DSC) management, Guardian firms, and Guardian advisors to monitor results in the context of key production/performance thresholds and awards & recognition programs.  Specifically, this role will work on the ACS Clubs application, Agency Paid-For system, various reporting platforms and data sources, and other functions as required, including specialized recurring/ad-hoc reports.  This position involves design and development of automated/streamlined reporting and tracking of results, requiring analytical skills and technical problem-solving skills. An additional objective is to act as liaison between DSC, other user teams and IT.  The role will focus on ensuring that reporting & technology needs of DSC and its customers within the...

This is an opportunity to join Ascot Group - one of the world’s preeminent specialty risk underwriting organizations. Designed as a modern-era company operating through an ecosystem of interconnected global operating platforms, we’re bound by a common mission and purpose. Our greatest strength is a talented team who flourish in a collaborative, inclusive, and entrepreneurial culture, steeped in underwriting excellence, integrity, and a passion to find a better way, The Ascot Way.   The Ascot Way guides our people and our organization. Our underwriting platforms collaborate to find creative ways to deploy our capital in a true cross-product and cross-platform approach. These platforms work as one, deploying our capital creatively through our Client Centric, Risk Centric and Technology Centric strategies.   Built to be resilient, Ascot offers clients leading financial security while delivering bespoke products and world class service — both pre- and post-claims. Ascot exists to...

Overview AmTrust Financial Services, a  fast growing  commercial insurance company, has a need for a Complex Care Case Manager, RN for Workers Compensation managed care team.     PRIMARY PURPOSE :   The  complex care case manager will provide comprehensive and quality telephonic case management for our injured employees with complex diagnoses and often catastrophic injuries. Our nurses will  be responsible for  proactively applying clinical  expertise  ensuring our injured employees receive medically  appropriate healthcare  to achieve a safe return to work or best  optimal  level of function 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...

NJM Insurance Group, is a leading mid-sized U.S. property and casualty insurance company with 90 consecutive years of A+ financial strength ratings by AM BEST. Due to exceptional employee experience, NJM has been included on the latest Forbes List of Best Employers in New Jersey for the fourth year in a row. The NJM reputation for being a top provider of outstanding customer service was reaffirmed by the most recent J.D. Power Auto Insurance Claims Survey. Over the last five years, the Company has focused on a strategic plan that calls for it to become a regional property & casualty insurer and has transitioned away from its affinity-based membership model. To that end, the Company has added an independent agency model for new lines of middle and large commercial and has more than doubled its product offerings. NJM now offers its various products to businesses across New Jersey, Pennsylvania, New York, Maryland, Delaware, and Connecticut. Celebrating its 110-year...

Crum & Forster Company Overview Crum & Forster (C&F) , with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+"(Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work® Award  for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.   For more information about Crum & Forster, please...