32 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...

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...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, is looking for a Background & Data Intelligence Analyst to join its Special Investigations Unit! This individual will aid the SIU team in the investigation of insurance fraud by performing research on a person or entity's background through subscription-based and publicly-available forums, as well as perform data mining of internal systems and subsequent analysis pertinent to Claimant, Premium, and Provider investigations.   Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status.   ESSENTIAL RESPONSIBILITIES Perform data mining of internal systems to detect claims and billing patterns relevant to specific investigations. Collect and organize data for timely submission to regulatory and law enforcement authorities. Conduct research using publicly available and subscription-based databases; maximize the...

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more...

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more...

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more...

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...

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more...

We are looking for an HR Analyst to play a critical role in enabling data-driven People decisions across the employee lifecycle. This role sits at the intersection of HR systems, analytics, compensation, workforce planning, and operational execution, and partners closely with People Ops, Compensation, Payroll, Finance, and HRBPs. This is not a reporting-only role. You will be responsible for building trusted data foundations, translating complex people data into actionable insights, and supporting high-impact initiatives such as compensation cycles, workforce planning, HRIS transformation, and compliance reporting. There will be a lot of opportunities to learn along the way, so the ideal candidate should have the confidence, curiosity, and executive presence to engage with senior stakeholders, be a trusted SME, and drive meaningful change. You're excited to adapt and grow alongside a fast-paced, high-growth business that's scaling globally. If you're ready to roll up your...

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 OPPORTUNITY: HUB’s Customer Service professionals provide critical support to our customers through account management, claims management, day-to-day client oversight, and underwriting services that make us a leading sales and service organization in the insurance industry. Through a robust network of resources, you will be amongst some of the industry’s top talent to help guide and support our customer’s needs and provide them with innovative solutions. The Employee Benefits Account Representative works collaboratively with the Producer and Account Team managing a book of business. Coordinates and provides day-to-day service for employee benefits clients by maintaining client relationships, supporting client retention, maintaining strong carrier relationships and understanding client needs. Serves as day-to-day contact and provides resolution for client questions and issues. The Employee Benefits Account Representative I role is focused on the mid to large...

Company Details Berkley Speciality Property is a leading Lloyd's Syndicate underwriting Property, Crisis Management, Engineering & Construction, Asset Protection and Specialty Casualty.   The company is an equal employment opportunity employer. Responsibilities The AVP, Commercial Property Binding Authority Broker is responsible for the development and implementation of the account evaluation and binding strategy at WRB Specialty.  The position reports to the Director of Specialty Property and works with both Field and Staff functional areas.  S/he executes, binds, and monitors accounts for WRB Specialty business and is in regular contact and communication with WRB Underwriting based in London.  Key functions include but are not limited to: Daily management of the workload to ensure the effective solicitation, selection, pricing, and retention of profitable business. Helps to develop and implement best...

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...

Objective: Heffernan Insurance Brokers is seeking a Manager of Financial Planning & Analysis to join our growing Finance team. This role is ideal for a strong analytical leader who enjoys building scalable processes and operating in a fast-paced, growth-oriented environment where adaptability and personal ownership are critical to success. The Manager of FP&A will play a key role in leading the company’s budgeting, forecasting, and financial reporting processes while partnering closely with operational teams. This position offers meaningful exposure to senior leaders and the opportunity to help shape the evolution of the Finance function. We are looking for someone who brings strong financial acumen, intellectual curiosity, and a hands-on ownership-driven approach to problem solving in a collaborative environment with the ability to independently drive work to completion and operate confidently in executive-facing settings.   Core Responsibilities Include:...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world's largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a-kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. WHY CHOOSE HUB? Throughout our network of more than 450 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees, and provide continuous opportunities for growth and development.  Our entrepreneurial culture fosters an...

At Cotality, we are driven by a single mission—to make the property industry faster, smarter, and more people-centric. Cotality is the trusted source for property intelligence, with unmatched precision, depth, breadth, and insights across the entire ecosystem. Our talented team of 5,000 employees globally uses our network, scale, connectivity and technology to drive the largest asset class in the world. Join us as we work toward our vision of fueling a thriving global property ecosystem and a more resilient society. Cotality is committed to cultivating a diverse and inclusive work culture that inspires innovation and bold thinking; it's a place where you can collaborate, feel valued, develop skills and directly impact the real estate economy. We know our people are our greatest asset. At Cotality, you can be yourself, lift people up and make an impact. By putting clients first and continuously innovating, we're working together to set the pace for unlocking new possibilities...

What We Do Ascend is transforming the $10T global insurance industry by combining AI automation with embedded fintech.  While insurance represents 7.2% of global GDP, outdated financial infrastructure like PDFs, emails, and manual reconciliation continues to slow the industry down. Ascend is the first and market-leading finance automation platform built specifically for insurance, driving the industry’s rapid digital transformation. In just five years: Trusted by thousands of insurance businesses nationwide Processes billions in transactions annually, growing 200%+ YoY Built a world-class team of 70+ across San Francisco and Columbus How We Do It Ascend automates the insurance financial lifecycle, from collections to disbursements. We streamline operations and drive real profitability. AI is rapidly driving the cost of software down, opening the door to faster innovation and broader access. At the same time, it is shifting where...

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...

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 Disability Representative Sr Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:       West Hills, CA   : 8521 Fallbrook Ave West Hills, CA 91304    PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining...

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 Sr. Disability Representative Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near this Center of Excellence:   West Hills, CA : 8521 Fallbrook Ave West Hills, CA 91304  PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely...