354 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. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding and...

CERiS in Fort Worth, Texas is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic Related Groups (DRG) QC Clinical Auditor will be responsible for performing quality control DRG validation (clinical/coding) reviews of internal audit team 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, as well as communicating missed or incorrect information to the auditors in a professional manner. Experience using, ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. This is a remote position. Job Duties and Responsibilities: The Quality Control...

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...

The hospital bill audit nurse supervisor will maintain a positive team building approach with emphasis on overseeing the day to day functions of hospital bill audit nurses, reporting, leadership and professional communication with all CERiS departments.  This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Utilize nursing education, experience and industry best practices to lead a team of registered nurses to plan, execute and deliver timely and accurate hospital bill audits Ensure accuracy of audits through acquired knowledge of client policies, provider contract information, and other standard guidelines Assist in the development and support of auditors to meet and exceed productivity requirements based on CERiS productivity standards Act as a point of contact to answer and resolve auditor issues with the goal of providing excellent customer service and relationship management  Perform audits as necessary Keep manager informed of any issues...

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 Claims Assistant PRIMARY PURPOSE : To provide support to the claims staff and to perform other office tasks on a commercial automobile liability PIP department ESSENTIAL FUNCTIONS and RESPONSIBILITIES Annotate Mail and Medical bills Download and organize documents for adjusters Assist adjusters and supervisor with voicemails Sets up and enters new claims into claims management system when requested. Inputs and reviews notes/diaries in claims management system...

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....

Job Description: Job Title: SEC Reporting Supervisor Location: Wichita, Topeka, or Overland Park Kansas Employment Type : Full-Time About Capitol Federal At Capitol Federal Savings Bank , we are committed to helping individuals, families, and communities achieve financial success. With a long-standing tradition of integrity, service, and financial stewardship, we strive to deliver exceptional banking experiences to every customer we serve. Our team members are the foundation of our success. We believe in fostering a supportive environment where employees can grow professionally, contribute meaningfully, and build rewarding careers. Position Summary We’re hiring a SEC Reporting Supervisor.  This position is responsible for managing the preparation and submission of all SEC filings for the Company, ensuring compliance with U.S. GAAP, SEC regulations, and internal policies. This role ensures the accuracy, completeness, and timeliness of all public...

Grow With Us!  At Hilb Group, we recognize that our associates are our greatest asset. We promote a service-driven culture of high performance that encourages career and professional development. The Hilb Group is currently seeking a motivated and ambitious Employee Benefits Account Executive to join our team. This position will report to our agency located in Canton, MA. The ideal candidate will be motivated to succeed, is well organized, able to prioritize, and able to work well with a team. This is an in-office position. Responsibilities: Develop and implement benefit strategies that are both innovative and compliant, leveraging creative thinking to address client needs Partner with producers to lead client meetings, presentations, and onboarding of new clients Actively participate in strategic discussions, providing out-of-the-box solutions and consulting expertise to enhance clients’ benefit programs Manage benefit program implementations and oversee annual...

Job Description NewLane Finance is a commercial equipment finance company, serving small and mid-size businesses nationwide. Our mantra is “business lending done right,” and our strategy is to revolutionize small business lending by employing the latest technology and a motivated workforce to deliver fair and transparent financing solutions to businesses with unmatched levels of speed, convenience and customer service. We offer products and services to the business community primarily through financing programs with equipment manufacturers, distributors, and dealers. The Vice President of Credit is a senior leadership role responsible for overseeing the organization’s credit policy, risk management, and lending strategy. This role provides strategic direction and hands-on oversight of underwriting, portfolio management, and credit policy, ensuring timely and sound credit decisions in a fast-paced, client-focused environment.  The VP of Credit plays a highly visible and...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Manager, Benefit Design & Requirements (PBM) will be the founding individual contributor of this function, establishing the processes, standards, and institutional knowledge from the ground up. As the function matures, this Manager will have the opportunity to scale the team, hiring and developing analysts beneath them who will carry out the work they defined. In the near term, this person serves as AffirmedRx’s resident...

Role: Sr. Manager, Insurance Product Management (Forms & Compliance)   Department:  Insurance Product   Reports To:  VP, Product Management (Insurance)   About Hippo:     Hippo was built on a promise: make homeownership effortless. Nearly a decade later, that mission still drives us. We use technology and data to help our customers stay ahead of problems and protect what matters most.     Today, that same tech-native approach powers our work beyond homeowners. Hippo operates as a diversified carrier platform, partnering with MGAs to deliver tailored program solutions that help them grow and deliver better customer experiences. Behind that work is a team that values ownership, curiosity, collaboration, and continuous improvement.    If you're energized by building what's next, we'd love to meet you.   About the Role   We're looking for a Product Compliance & Forms Management Lead to serve as a critical first line of defense...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Job Description Summary In this role, you will leverage your expertise in auto damage assessment to inspect vehicles, evaluate losses, and prepare accurate, comprehensive estimates for both first- and third-party material damage claims across auto or specialty lines. The ideal candidate brings proficiency in CCC ONE estimating software, strong negotiation and time management skills, and a customer-focused approach to delivering an exceptional claims experience. National General Insurance is seeking a Field Auto Claims Estimator to support our Kentucky region. Join our high-performing auto claims team...

WHO WE ARE Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.   WHAT WE’RE LOOKING FOR The Senior Accountant is primarily responsible for complex accounting activities relating to the maintenance of a complete and accurate general ledger and the subsequent managerial reports and financial statements for assigned business units. The person in this position is also responsible for ensuring the integrity of account information by recording verifying, consolidating, and entering accounting transactions. A GLIMPSE INTO YOUR DAY Prepares and records asset, liability,...

Job Description Sompo has a unique opportunity for a VP, Audit Director, to join our North America Internal Audit team. The VP, Audit Director is the assurance leader responsible for the oversight, execution, and continuous evolution of Internal Audit coverage across the North America Insurance business, aligned with Sompo International’s global Internal Audit strategy, standards, and methodology. This role plays a critical leadership position within the Internal Audit function, with accountability for risk assessment, audit planning, execution quality, stakeholder engagement, and Audit Committee reporting across U.S.-based insurance operations. The Audit Director partners closely with business leadership, risk and compliance functions, and global Internal Audit peers to deliver risk-based, forward-looking assurance over governance, risk management, and internal controls. This role is instrumental in ensuring Internal Audit remains independent, value-added,...

Reporting to the Head of Client Solutions and Wealth Management, the Head of Distribution will build, lead and execute a sales and distribution vision and strategy to accelerate the growth of Guardian’s individual financial protection business. The successful candidate will assess current capabilities, distribution model, and strategy, and will drive transformation to elevate performance results. This executive will lead a highly experienced team of leaders accountable for accelerating and expanding sales growth in key-growth markets. KEY RESPONSIBILITIES ▪ Lead the sales and distribution vision and strategy for Guardian Life’s individual businesses in new and existing channels, including general agency, third-party and multi-life channels. ▪ Build and expand third-party distribution capabilities across life, annuity, disability, multi-life (life and disability) and investment products and solutions. ▪ Assess distribution organizational structure and teams to determine...

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,...

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 ADA Accommodation Coordinator PRIMARY PURPOSE :   To process claims and determine accommodation options following written guidelines and procedures pursuant to ADA, state and/or client requirements; to make timely referrals for appropriate disability and federal/state leave of absence eligibility review; and to ensure the ongoing processing of claims. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Informs claimants of documentation required to process claims, required...

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 Clinical Specialist PRIMARY PURPOSE : Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, and/or complexity. Consults with providers and employees by providing case direction and ensures medical information substantiates the need for employee absence from work.  ESSENTIAL FUNCTIONS and RESPONSIBILITIES Performs standard clinical reviews of referred medical claims based on client...

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,...