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clinical review auditor

305 clinical review auditor jobs found

CorVel
11/11/2025  
Clinical Review 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. 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. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through...
CorVel Fort Worth, TX, USA Full Time
CorVel
10/27/2025  
Clinical Review 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. 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. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing...
CorVel Fort Worth, TX, USA Full Time
CorVel
10/09/2025  
Clinical Review 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. 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. This is a remote position.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing...
CorVel Fort Worth, TX, USA Full Time
CorVel
07/25/2025  
Clinical Review Auditor
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...
CorVel Fort Worth, TX, USA Full Time
CorVel
07/25/2025  
Clinical Review 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 determine accuracy of billing through...
CorVel Fort Worth, TX, USA Full Time
CorVel
11/11/2025  
Clinical Review QC Auditor
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...
CorVel Fort Worth, TX, USA Full Time
CorVel
09/08/2025  
Hospital Bill Audit Supervisor
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...
CorVel Fort Worth, TX, USA Full Time
EMC Insurance
11/19/2025  
Underwriting Assistant Manager-CL Featured
At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.    **This position can be performed remotely for candidates who reside in Lansing, Michigan.** Essential Functions: Supervises assigned underwriting team. Enforces guidelines and procedures established by Corporate Office Underwriting.  Enforces underwriting guidelines and procedures specific to their branch territory.  Models smart and effective underwriting practices for individual accounts, all lines of business, and different classes.  Implements strategies to address challenges to profit and drive that message throughout the underwriting unit.  Answers questions, shares recommendations for complex situations, such as...
EMC Insurance MI, USA Full Time
Encova Insurance
11/19/2025  
Associate Internal Auditor Featured
The salary range for this job posting is $61,742.00 - $98,788.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. Encova Insurance has an opening for an Associate Internal Auditor. In this role, you will work a hybrid schedule from the Columbus, Ohio corporate office with days in office each week. This role will report to the Assistant Vice President, Internal Audit. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting...
Encova Insurance Columbus, OH, USA Full Time
FCCI Insurance Group
10/23/2025  
Internal Auditor - IT/Ops Featured
Creating connections is our focus at FCCI. Are you a dedicated team-player who thrives in a culture of accountability, have strong team working skills, possess technical excellence, have a desire for continuous learning and have compassion and respect for others? This is the company for you! Ready to join a dynamic team where your independent insights drive real impact? We're seeking an Internal Auditor with sharp critical thinking skills to focus on information technology audits and data analytics, as well as operational and compliance audits and reviews. If you're passionate about identifying risks, improving controls and being a trusted voice, this is your opportunity to contribute to organizational success. In this role, you will add value through the execution of audit and advisory projects, with a focus on information technology assurance.  You will manage individual projects, partner with team members, and engage with IT and other business units to identify and address...
FCCI Insurance Group Sarasota, FL, USA Full Time
EMC Insurance
10/23/2025  
Statistical Compliance Manager Featured
At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.    **This role can be performed remotely in the Des Moines, Iowa area, with ability to work on site twice per quarter** Essential Functions: Manages a team responsible for accurate and timely reporting to regulatory authorities and reporting bureaus. Leads the analysis of regulatory texts, official guidance documents, regulatory updates, and industry publications to understand the nuances of reporting requirements. Maintains a deep understanding of the regulations and reporting requirements impacting assigned lines of business. Collaborates closely with Compliance, legal counsel, and regulatory affairs teams to ensure a comprehensive...
EMC Insurance Des Moines, IA, USA Full Time
EMC Insurance
09/30/2025  
Underwriting Director Featured
At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.    **Position is eligible for candidates who reside in or around the greater Lansing area** Essential Functions: Leads and directs the branch underwriting process. Enforces guidelines and procedures established by Corporate Office Underwriting.  Develops and enforces underwriting guidelines and procedures specific to their branch territory.  Models smart and effective underwriting practices for individual accounts, all lines of business, and different classes.   Sets and implements strategies to address challenges to profit and communicates strategies throughout the underwriting department.  Answers questions, shares...
EMC Insurance Lansing, MI, USA Full Time
EMC Insurance
09/19/2025  
Agency Compensation Consultant Featured
At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.    **This position is eligible to work from home anywhere in the United States** Serves as a high level technical resource on agency compensation programs. Responsible for designing, implementing, and maintaining competitive compensation and incentive plans for agency distribution, ensuring strict compliance with all agency compensation contracts, agreements, and regulatory requirements. Provides regular analysis of compensation programs, including agent tiering strategies, to ensure alignment with EMC’s business objectives. Acts as a key partner to regional and field leadership, including Sales Directors and RVPs, delivering insights, training,...
EMC Insurance USA Full Time
Core Specialty
12/05/2025  
Underwriting Assistant
- The position will be part of the Healthcare team and will ensure the efficient and effective management of all information necessary to support the underwriting activities of the organization.   The underwriting assistant will perform a variety of complex administration tasks within established process and quality guidelines. Key Accountabilities/Deliverables:   Process incoming submissions, including clearance, review of information received and data entry into the system to prepare account for rating and quoting. Assist Underwriter with confirming new/renewal business conditions and subjectivities including review of applications, supplements, loss runs and other requested underwriting information and advising Underwriter of any discrepancies. Process Requests to Bind including electronic delivery of Binder Confirmations and invoices to agents; perform follow-up and resolve information discrepancies between agent requests and Underwriter prior to updating the...
Core Specialty Atlanta, GA, USA Full Time
Pie Insurance
12/05/2025  
Senior Product Manager - Finance
Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.   Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by  core values and operating principles  that guide every decision we make. As a Senior Product Manager for Finance, you will leverage your deep knowledge of product management to drive the transformation of Pie's financial technology infrastructure. You'll own the delivery of innovative fintech capabilities that modernize our billing, collections, and payment operations - ensuring we can scale efficiently while maintaining the precision required in financial services. You will consistently question why insurance has done things the way they have, and deliver innovative How You’ll Do It Finance Journey Our finance flows are the...
Pie Insurance USA
Nationwide
12/05/2025  
Specialist, Risk Analytics & Capital Management
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. Internal Comp Grade is F4 This role sits within the Rating Agency Management and Capital Forecasting team in Enterprise Risk Management. Specifically, this role is responsible for the production of P&C Return on Capital (RoC) and Capital Sources & Uses metrics, as well as enterprise capital reporting. This role also assists with establishing a consistent and robust P&C capital monitoring and reporting framework used to make capital...
Nationwide OH, USA Full Time
Nationwide
12/05/2025  
Financial Business Director
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. Do you thrive on curiosity and enjoy challenging assumptions to uncover new insights? Are you passionate about modernizing how Finance partners with Technology and shaping forward-looking strategies? If you’re energized by influencing decisions and empowering teams to deliver clarity and strategic value, we want to know more about you! As the Technology Finance Director, you’ll lead a team of Financial Business Analysts to transform...
Nationwide Columbus, OH, USA Full Time
National Life Group
12/05/2025  
Associate Director - Annuity Operations
Come join one of America’s fastest-growing insurance companies. Since 1848, National Life Group has aimed to keep our promises, providing families with stability in good times and in bad. Throughout that history, we have provided peace of mind to those families as they plan their futures. Our mission extends beyond the insurance and annuities policies that we offer. We strive to make the world a better place through our grants from our charitable foundation, paid volunteer time for our employees, environmentally sustainable and healthy workplaces, and events that promote the work of nonprofits in our own backyard. We foster a collaborative environment with opportunities for growth and encourage our associates to live our values: Do good. Be good. Make good. Role Summary We are seeking a dynamic and experienced leader to join our leadership team. This leadership position is of utmost importance in leading and developing the Case Managers responsible for our Individual...
National Life Group Addison, TX, USA
Capitol Federal
12/05/2025  
IT Disaster Recovery Coordinator
Job Description: Are you passionate about ensuring business resilience and safeguarding critical IT operations? We’re seeking an IT Disaster Recovery Coordinator to lead the development, implementation, and ongoing management of our disaster recovery (DR) strategies. In this role, you’ll ensure rapid recovery of essential systems, partner with technical and business teams, and support regulatory compliance frameworks essential to our organization’s stability. Key Responsibilities Develop and maintain IT disaster recovery plans aligned with BCP, FFIEC, and GLBA standards. Coordinate DR testing, documentation, and ongoing updates across systems and applications. Partner with Business Continuity, Infrastructure, Cybersecurity, and Application teams on risk assessments, BIAs, RPO/RTO requirements, and remediation work. Lead DR drills and table-top exercises and manage response efforts during real incidents. Validate backup systems, replication processes, and...
Capitol Federal Topeka, KS, USA Full Time
BP&C, Shared Services Inc. (American National & Argo Group)
12/05/2025  
Manager, Premium Tax
Argo Group International Holdings, Inc .  and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description The Premium Tax Manager will be responsible for managing premium tax compliance, reporting, and strategic planning specifically for insurance companies. The role will also provide oversight of surcharge and assessment compliance levied on insurers. The role interacts with senior level executives, so strong business and financial acumen are necessary and the capability to articulate strategy is critical. The role will be responsible for delivery and improvement on all processes and system...
BP&C, Shared Services Inc. (American National & Argo Group) San Antonio, TX, USA Full Time

 

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