16 clinical review auditor jobs found

This role is a highly managerial position focused on leading the Help Desk, overseeing day to day operations, and ensuring that all support activities are executed with consistency, quality, and accountability. The position requires a confident leader who can manage people, processes, and performance at a high standard.   Minimum Qulifications: Minimum of five years of hands-on help desk support experience. Minimum of three years of experience in a managerial role overseeing Help Desk or IT operations, with five years preferred. ServiceNow ITSM and ServiceNow platform experience preferred. Experience working within ITIL frameworks and applying IT service management best practices in a Help Desk or IT operations environment.   Primary Job Functions: Leadership and Operational Oversight Provides full management and oversight of daily ticket volume, including prioritization, assignment, distribution of work, and overall workflow coordination. Serves...

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.  T his is an office-based position in our Salt Lake City, UT office.   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...

Job Description: Title:   Operations Technical Specialist – Training & Development   Work Mode:   Fully Remote   | Location/Supporting:   Longwood, FL office   | Experience:  Previous commercial or personal lines experience. Licensing and experience with Applied Products are strong preferred.   Please note: If this position is posted as either fully remote and/or hybrid, in accordance with company policy, individuals residing within a 50-mile radius of a branch location may be required to work onsite in a hybrid capacity as there may be occasions when on-site presence is necessary to meet specific business needs. Additionally, our remote work policy includes having a dedicated, distraction-free workspace. Remote work is not a substitute for childcare, elder care, or other personal responsibilities during working hours. To view our branch locations, please visit: ioausa.com/locations     About the Role :...

WTW is a leading global advisory, broking and solutions company that helps clients around the world turn risk into a path for growth. With roots dating to 1828, WTW has 40,000 employees serving more than 140 countries. We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand the power of capital to protect and strengthen institutions and individuals. Our unique perspective allows us to see the critical intersections between talent, assets and ideas – the dynamic formula that drives business performance. Together, we unlock potential. Learn more at  wtwco.com . Note: Employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity.    Role Overview – Incoming Specialty Client Manager – U.S. Broker   This mission-critical, mid-level hybrid role sits at the intersection of client delivery, market execution, and global collaboration. The Incoming Specialty Client Manager – U.S. Broker...

WTW is a leading global advisory, broking and solutions company that helps clients around the world turn risk into a path for growth. With roots dating to 1828, WTW has 40,000 employees serving more than 140 countries. We design and deliver solutions that manage risk, optimize benefits, cultivate talent, and expand the power of capital to protect and strengthen institutions and individuals. Our unique perspective allows us to see the critical intersections between talent, assets and ideas – the dynamic formula that drives business performance. Together, we unlock potential. Learn more at  wtwco.com .   Note: Employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity.    Role Overview – Senior Incoming Specialty Client Manager – Lead U.S. Broker   This senior‑level hybrid role sits at the intersection of advanced U.S. broking execution, market leadership, and strategic client advisory within global insurance 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 Disability Representative Sr Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of these Centers of Excellence:   Orlando, FL (Preferred) : 12650 Ingenuity Dr Orlando FL 32826  Dubuque, IA   : 4141 Westmark Drive, Dubuque, IA 52002  Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604  PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on 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 Advocacy Coordination Team Specialist Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence: Orlando, FL : 12650 Ingenuity Dr Orlando FL 32826 Eden Prairie, MN  : 11000 Prairie Lakes Drive Eden Prairie, MN 55344  Dublin, OH : 5500 Glendon Court Dublin OH 43016 New Albany, OH : 7795 Walton Parkway New Albany, OH 43054 Memphis, TN : 8125 Sedgwick Way,...

The Baldwin Group is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses take them throughout the U.S. and abroad. The Baldwin Group has award-winning industry expertise, colleagues, competencies, insurers, and most importantly, a highly differentiated culture that our clients consider an invaluable expansion of their business. The Baldwin Group (NASDAQ: BWIN), takes a holistic and tailored approach to insurance and risk management. Directly supervises and leads a high-functioning team of risk placement professionals. Responsible for the overall function of marketing, underwriting, and placement of new business accounts submitted by the Sales Team and the consistent quality output of the Risk Placement...

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 Utilization Review Coordinator PRIMARY PURPOSE : To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Accesses, triages and assigns cases for utilization review (UR). Responds to telephone inquiries proving accurate information and triage as necessary. Enters demographics and UR information into claims or clinical...

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 Advocacy Coordination Team Specialist PRIMARY PURPOSE :   Actively researches, resolves, and administers escalated inquires for all lines of business, including but not limited to Family Medical Leave (FMLA), complex paid and unpaid state, military, and company-specific leaves, accommodations, disability and statutory claims. Provides excellent customer service displaying care and empathy to callers regarding claims and executes technical and jurisdictional requirements...

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 Maitland, FL or Boca Raton, FL 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,...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking a Small/Middle Market Business Account Manager to join our growing team in Daytona Beach, and Maitland, FL! This role provides commercial lines support in maintaining, expanding, and servicing assigned accounts. How You Will Contribute:   Develop and maintain strong technical knowledge of commercial lines coverages and rating including the license as required by law and all continuing education required Independently manage large book with larger and/or more complex accounts Maintain favorable relationship with customers and producers Enter all required data into agency management system to maintain current file data on all assigned accounts, and properly document all conversations and confirm to insured all actions taken at their request Prepare renewal submissions including all...

At FCCI, we focus on creating connections and building lasting relationships.  Our people truly make the difference.  Are you a dedicated team player who thrives in a diverse, innovative and upbeat culture?  Do you have strong team working skills, possess technical excellence, have a desire for continuous learning and have compassion and respect for others?  If so, FCCI Insurance Group is the company for you! Currently seeking an experienced professional to provide customer service for billing inquiries and handle other administrative and system related tasks in support of billing functions. This role focuses on managing billing operations related to property and casualty (P&C) insurance policies. The ideal candidate will ensure accurate and timely billing, maintain compliance with industry standards, and provide excellent service to both internal teams and external clients, including policyholders and agency partners. The  Billing Coordinator  will serve as front line...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking a Commercial Lines Account Manager to join our growing team in Jacksonville, FL!   The Commercial Lines Account Manager is responsible for servicing commercial insurance accounts by reviewing renewals, processing policy documents, responding to client requests, ensuring compliance with underwriting guidelines, and maintaining strong relationships with clients, carriers, and internal teams. How You Will Contribute:   Process daily mail, including faxes and e-mail, for assigned accounts Answer and process all telephone requests for assigned accounts Enter all required data into system to maintain current file data on all assigned accounts Review commercial applications, renewal requests and endorsements for adherence to underwriting authority and guidelines as established by the company’s...

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:   Orlando, FL :   12650 Ingenuity Dr Orlando FL 32826   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...

Job Summary This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department’s performance on meeting regulatory standards. Job Responsibilities · Review home office casualty files, provide direction as required to ensure that handling is within best practice guidelines and local jurisdiction regulations. · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation. · Provide authority and guidance on all bodily injury claims regarding coverage, liability and damages, as required. · Provide feedback to leadership and adjusting...