305 clinical review auditor jobs found

The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding and clinically supported as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures.  The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through...

CERIS in Fort Worth, Texas is seeking a DRG Coder/Clinical Auditor. The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using, ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. This is a remote role.   Job Duties and Responsibilities: The Clinical Auditor will look at individual medical records to check for missing documentation; The Clinical Auditor will check for physician's notes supporting the DRGs...

CERIS is seeking a DRG Coder/Clinical Auditor. The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding and clinically supported as defined by review methodologies specific to the type of review. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. Experience using ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures.  The ideal DRG Clinical Auditor candidate will have strong oral and written communication skills, clinical knowledge of disease process, and knowledge of medical necessity rules. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to...

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Administrative/Clerical, Operations Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors,...

Primary Details Time Type: Full time Worker Type: Employee Title: Senior Claims Adjuster - Crop  The Opportunity: The purpose of this role is to provide efficient and precise claims services to policyholders and agents through field inspections, communication with stakeholders, investigations, adjustments, and policy administration while ensuring adherence to regulatory requirements. Location: Work Remotely Illinois, USA Work Arrangement: This role is fully remote {M-F 37.5 hours}   The salary range for this role is between $64,000-$96,000   Your new role    Complete field inspections, reviews and adjustments accurately and efficiently to administer crop insurance policies.  Ensure compliance with insurance statutes and regulations to apply crop policies cost-effectively.  Build and maintain customer relationships through timely and accurate policy service.  Document and transmit loss information accurately to assess potential...

Primary Details Time Type: Full time Worker Type: Employee Title: Claims Adjuster - Crop     The Opportunity: The purpose of this role is to investigate and process crop claims, conduct field inspections, communicate with stakeholders, and ensure compliance with insurance policies and regulations.   Location: Work Remotely North Carolina, South Carolina or Virginia USA Work Arrangement: This role is fully remote for candidates located in North Carolina, South Carolina or Virginia ONLY {M-F 37.5 hours}    The salary range for this role is between $53,000-$79,000       Your new role    Complete field inspections, reviews and adjustments accurately and efficiently to administer crop insurance policies.   Ensure compliance with insurance statutes and regulations to apply crop policies cost-effectively.   Build and maintain customer...

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's Risk Solutions team, formerly known as Beecher Carlson, is looking for a Senior Accountant & Captive Manager to join the Captive practice in Colchester, VT, Honolulu, HI, or remotely. The Senior Accountant & Captive Manager will manage the day-to-day accounting and financial activities of a portfolio of captive insurance companies, acting as focal contact person with senior management and our clients, developing strategic and consulting skills. Responsibilities will include but are not limited to: Provide advice on compliance requirements, investment regulations and current accounting developments that affect clients. Give presentations at client, shareholder, and/or Board of Director meetings to review financial information.  Prepare and/or review monthly financial statement package and management review...

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 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 payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims,...

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...

The Doctors Company Patient Safety team has an opportunity for a Vice President, Patient Safety. This is a hybrid or telecommuter opportunity depending on the final candidate’s location from the company's office. The final candidate must reside within one of the company's Region II states, which includes the mid-west and east coast states. Position Mission: The VP, Patient Safety is responsible for leading and advancing the organization’s patient safety and risk management initiatives through strategic business development, exceptional member service, and operational excellence.   Qualifications: Bachelor’s degree in a healthcare-related field (e.g., Nursing, Public Health, Healthcare Administration, or a related discipline) required; advanced degree preferred (e.g., MSN, MHA, MPH) Must possess a valid state driver’s license and be able to travel locally and regionally as required Current and unrestricted license (e.g., RN, MD, DO) 10 years of progressive...

Job Description: We are looking to add an Information Security Officer to join our Information Technology team in Waukee, IA . This role will lead and manage the day-to-day operations of the Information Security Team while developing and maintaining a strong security program. They will be expected to write and enforce security rules and regulations across the Holmes Murphy enterprise. Offering a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Holmes! Essential Responsibilities: Provide security leadership and critical insight to develop and implement the organization's security strategy. Recommend and oversee the selection and acquisition of hardware and software for information security and privacy. Promote and advocate for security within the company to build customer trust. Enable the Information Security team to collaborate with other departments to enforce...

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...

Description Summary: The Functional Coordinator provides Simply the Best customer service at all times. Responsibilities include providing advanced clerical/administrative support to a functional area by coordinating a variety of complex tasks. We're looking for a self-starter who wants to grow with us!   Duties & Responsibilities: Prepares, maintains and sends various reports including Property Tax, delinquency and other ad hoc reports using a variety of reporting tools including Tableau, Power BI, Business Objects and Excel. Assists Collections Managers with service provider invoice intake, tracking and payment processing Acts as a liaison between service providers, Collections and the Financial Recovery group to resolve billing questions or issues.  In conjunction with functional Managers and Leads, the position is responsible for the maintenance and updating of all Portfolio Management related...

Objective: Heffernan's Irvine, CA branch is looking for an experienced Executive Account Manager to add to their team. The Executive Account Manager position is a lead role that will train, mentor, and assist an assigned account management service team. The Executive Account Manager will provide technical support and education for the service and sales team and assist where necessary in new business sales. Accounts may be fully insured, partially self-funded, or self-insured.   Responsibilities Include: Support Account Management Service Team: Assist with workflow and workload balance for service team Assist in training for new and existing team members Provide service team with guidance in handling difficult and complex service issues Manage HIB internal policies and procedures to safeguard against potential Errors and Omissions issues Assist in education to clients. Account Management Responsibilities for Assigned Accounts: Marketing and...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Staff Auditor- IT/IS , you will execute technology and information/cyber security (IT/IS) audit assignments . Performs technology and information/cyber security (IT/IS) audit assignments. Identifies problems for resolution in support of risk-based assurance and advisory engagements across the IT/IS organization. Applies learning knowledge of large financial services regulations to audit assignments. Performs IT/IS risk and control identification and evaluation, increasingly complex audit...

Overview   As experts in protecting what matters most to businesses and individuals, we’re looking to bring on our next High Net Worth Account Executive to support our Personal Lines department and deliver exceptional risk management solutions to our growing cli ent base .  We are looking for a strong critical thinker who enjoys working with a team and looking for an opportunity to growth their career in Personal Lines.    Our Account Executive will partner with our sales team, as well as work independently on sales opportunities, to lead day-to-day management of current clients' insurance programs. You will also be provided with administrative help to assist with answering phones, billing, processing, endorsements, certificates, and ID cards.    As one of the fastest growing insurance brokers in the U.S., we are excited to bring on those interested in continuing to grow their career in the insurance industry. Opportunity awaits you...

As a team member in the Finance department at Nationwide, the opportunities are endless! You can grow and learn in diverse areas across many disciplines such as Advanced Analytics, Investments, Actuarial, Accounting, Risk Management, Critical Business Advisor, Internal Audit, and so much more. Let Nationwide help create your career journey! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. As a Senior Professional on the Enterprise Risk Asset/Liability Management (ALM) Team, you will be an important contributor to the development of investment strategy and risk targets across the organization to help the company grow the funds necessary to serve our customers in their greatest times of need.   You’ll be a subject matter expert on the asset models (ALFA, GGY AXIS) used to support new business pricing, ALM, Corporate Risk Model, and...

If you're passionate about being part of a diverse organization that enables a Fortune 100 company to deliver innovative business solutions with excellence, then Nationwide's Legal team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. Job Description:  This position will be a critical member of a Reinsurance / Insurance Claims and Alternative Risk center of excellence within Nationwide’s Office the Chief Legal Officer (OCLO) and will support such matters throughout the Nationwide enterprise. This position involves providing specialized legal and regulatory expertise to support (re)insurance coverage analysis and (re)insurance claims / litigation, manuscript drafting of insurance policies, and external audit matters. This position will also provide significant support for reinsurance transactions, and...

As a team member in the Finance department at Nationwide, the opportunities are endless! You can grow and learn in diverse areas across many disciplines such as Advanced Analytics, Investments, Actuarial, Accounting, Risk Management, Critical Business Advisor, Internal Audit, and so much more. Let Nationwide help create your career journey! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. Sr. Actuary – Annuities Valuation – Remote In this role, you will have the opportunity to: Work with all valuation types (US Stat, GAAP - Pre/Post LDTI, and Tax). Engage with various annuity products (PRT, SPIA, FIA, RILA, Traditional VA, In Plan Guarantees, and Traditional Fixed). Assess and prepare for emerging regulation/guidance. Evaluate and advise on the valuation impacts of new products. Provide proactive thought leadership...