24 quality assurance analyst i ii iii jobs found

JOB SUMMARY: The Payment Integrity Analyst (Team Lead) assists with leading the Policy and Payment Integrity (PPI) team while maintaining the regular duties and responsibilities of this role which is accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   The Team Lead must also be knowledgeable of the application of client policy and industry standards within reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient; trend analysis of internal auditing, appeals of pre and post payment claims, and any other claim or record that requires quality review to determine claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews; assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching...

CorVel has proprietary software to provide claims, bill review and case management services to our customers.  Both CorVel employees and customer users must be set up to use our software.  There are multiple roles in our application that define what a user has access to in our systems.  The expectation of this position is to become a subject matter expert in this area of our support model. The Jr. Business Analyst /User Subject Matter Expert performs diverse user and user setup support responsibilities. They will spend approximately 70% of their time on User operation tasks, and 30% on business analyst tasks. Qualified candidates must have experience with business requirements analysis acting as the intermediary for the end users.  They must have the ability to solve complex technical problems with innovative solutions. Work effectively on user issues and provide analysis where needed.  Build relationships via phone, email, and other mediums.  The employee will work independently...

The Treasury Product Systems Analyst supports and enhances our treasury operations through the administration and optimization of both proprietary and third-party software platforms. This role requires a unique combination of technical proficiency, financial literacy, and design sensibility. The ideal candidate will support daily operations, assist with financial review, serve as a backup for production systems (including Impress), and work across a variety of internal tools and hardware—including specialty printers. This is a hybrid role blending finance, systems management, programming, and creative software skills, aimed at supporting product output, reporting, and overall treasury workflows. This is a remote role.   ESSENTIAL DUTIES & RESPONSIBILITIES:         System Support & Operations Operate, maintain, and troubleshoot proprietary and third-party treasury and product-related software. Serve as a backup operator for our Impress production software...

This role serves as the primary client facing contact point for assigned accounts and represents a source of subject matter expertise, guidance, and accountability for providing an outstanding client and customer experience.  The Client Account Manager-II will be the account service expert for the plan, processes, and services being provided to their assigned accounts. This individual will have the responsibility to work closely with all AHP departments, carriers, and other benefit providers to ensure the organization provides prompt quality services to assigned schools, in a proactive manner whenever possible. The Client Account Manager-II is responsible for driving continuous quality and performance improvements through monitoring, extensive data analytics, process analysis, and delivery of performance and quality improvements to ensure timely, efficient, and effective high-quality services are sustained and that target service and productivity goals are achieved. The...

The Guardian Life Insurance Company of America (Guardian) is seeking an Advertising Compliance Analyst to join our team. Guided by our company Purpose of “Inspiring well-being for our colleagues, consumers, and communities,” we are committed to building a best-in-class Law Department. We drive a high-performance culture across our Legal, Compliance, and Government Affairs functions, aligned to “what” we deliver (i.e., our goals and objectives) and “how” we demonstrate our values and behaviors while focusing on the customer. We do this through leveraging a series of core capabilities, which includes accountability, interpersonal effectiveness, ability to demonstrate business savvy, being a subject matter expert, all while supporting the Law Department’s Mission to be a trusted advocate and advisor to drive strategic solutions that advance Guardian’s purpose, priorities, and values. Do you want to be part of a collaborative Compliance Legal Team? The Compliance team...

This role serves as the primary contact point for assigned accounts and represents a source of subject matter expertise, guidance, and accountability for providing an outstanding client and customer experience.  The Client Account Manager-I will be the account service expert for the plan, processes, and services being provided to their assigned accounts. This individual will have the responsibility to work closely with all AHP departments, carriers, and other benefit providers to ensure the organization provides prompt quality services to assigned schools, in a proactive manner whenever possible. The Client Account Manager-I is responsible for driving continuous quality and performance improvements through monitoring, analysis, and delivery to ensure timely, efficient, and effective high-quality services are sustained and that target service and productivity goals are achieved. Primary Duties & Responsibilities: Work with Client Account Manager-II, management,...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   * Sign On Bonus of $2,500.   How you will benefit: Will earn a competitive salary of $65,728.- $85,000 annually with annual bonus potential based on performance. Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include: 401k Match Medical Dental Vision PTO Paid Holidays Tuition Reimbursement   ****This position is currently able to work remotely from a home office location for day-to-day operations,   "TRAVELING TO FIELD LOCATIONS AS NECESSARY TO COMPLETE JOB RESPONSIBILITIES",  unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy....

Assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent, timely delivery of our quality services. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate clearly and professionally with callers and via email. Understand Workers Compensation guidelines and various client contract language to interpret and support our bill review. Maneuver in the bill review application to obtain accurate information for the callers. Understand CorVel EORs as well as client-specific nuances. Answer basic to complex State WC fee schedule and/or billing questions on processed medical bills covering regular as well as facility bill types Understand and be able to properly explain provider...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Hourly Job Description:   Reports to (job title): Retail Sales Leader                                                 I.  Position Description Primary Duties and Responsibilities (details of the basic job functions): Provide a high level of support to the Insurance Agency and members, by servicing existing Insurance accounts: performing retention calls, processing applications, renewals, amendments, resolving customer problems, as well as selling membership and financial products (credit cards).   Provide price quotes on all insurance products and factor in all applicable rules (underwriting, business, etc.) and discounts to complete the sale.  Takes insurance payments (initial, installment, lapse, or reinstatement).  Responds to customers’ insurance inquiries and explains...

The Claims Quality Assurance serves as the claim technical expert for the Claims Operations by auditing compliance with established CorVel, Industry and Carrier claim handling standards. The primary responsibility will be to evaluate claim handling quality, accuracy and timeliness in categories including but not limited to: Coverage analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. The successful candidate will have the ability to interpret results and trends in order to deliver operational reporting, participate in the development and presentation of training.    This is a hybrid position. ESSENTIAL FUNCTIONS AND 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 various departments within assigned offices as needed. Lead QA projects and serve as...

The Policy and Payment Integrity Manager oversees the PPI team and assists with implementation of policies to perform reviews conducted by CERIS including but not limited to itemized bill review, professional review, hospital outpatient and DRG validation. In this position, you will be managing members of the PPI team including developing team strengths and improving weaknesses, identifying team goals, and evaluating team progress. The manager in this role provides trend analysis of internal auditing of claims for claim accuracy related to pre and post payment claims, targeted claims, high dollar claims, and any other claim or record that requires quality review to determine the claim accuracy; assist with development of internal quality assurance measures based on client policy and industry guidelines; perform quality assurance reviews (as needed); assist in researching and implementing best practices related to payment policy, and/or policy initiatives; researching various...

The Procurement Supervisor is responsible for managing daily production (file flow) of designated department, which may include one or more of the following functions: human resources, customer service, and promoting positive influence over Procurement Analysts. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised Requires regular and consistent attendance Responsible for training of new employees and/or implementing protocols as they change and sending those changes out to the units Comply with all safety rules and regulations during work hours in conjunction with the Injury Illness Prevention Program (IIPP) Additional duties as required Must be willing and able to work overtime as required May be required to travel overnight...

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 Technology 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, including the scope,...

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.    *The preferred candidate will reside within 1 hour of Des Moines Iowa* As a Software Engineering Manager for Agile Delivery technology teams, you will lead and mentor a team of talented software engineers to deliver high-quality, scalable, and innovative software solutions. You will be responsible for managing the development process, ensuring alignment with Agile methodologies, and fostering a collaborative and dynamic work environment. Your role will involve coordinating with cross-functional teams, defining project goals, and driving continuous improvement and plan upskilling for team members. ESSENTIAL FUNCTIONS Technical Leadership...

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 Technology 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, including the scope,...

To ensure the consistent delivery of CorVel’s total Ohio MCO workers’ compensation solution through the development, implementation and ongoing utilization of specific quality assurance tools and training leading to consistency and satisfied/loyal customers. Primary source of quality assurance and information for MCO’s Claims team. Supports management by handling quality assurance and escalated issues, monitoring representatives and completing quality assurance emails for team members. Provides informational documents such as Standard Operating Procedures, PowerPoints, emails, and departmental newsletter to assist team members in daily tasks. Assists team members in performing daily job duties. Tracks quality assurance for individuals and the department and reports quality assurance trends.     ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Conduct quality reviews/audits to ensure appropriate management of the claims and office, score the office performance, and make...

As our business growth continues we have an established need for data intensive cloud development. We need the aid of a highly motivated problem solver. An engineer who enjoys the challenge of resolving complex problems with innovative solutions. We desire an engineer with a proven track record of delivering high quality results. An individual who is a self-driver with the ability to work across multiple facets of a project while juggling multiple responsibilities seamlessly. We are looking to add a key contributor to our talented stable. If you are ready for a challenge we are eager to hear from you. This is a remote role within the US.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Develop and maintain complex Software system. Acquire extensive business and system knowledge. Apply system knowledge to diagnose and fix complex problems. Perform requirements analysis, design, peer reviews and documentation. Provide reliable estimates of effort and good...

We are seeking a Full-Stack Developer with experience in modern front-end technologies to join our software engineering team to design, develop and maintain modern software applications. The ideal candidate will possess a keen attention to detail, a strong creative drive and a thorough understanding of industry standards. You must have the ability to work on multiple projects simultaneously and prioritize properly. You will have the patience to listen and understand but the conviction to speak up and explain your decisions. This is a remote role within the US.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Design, develop and maintain complex web applications. Perform requirements analysis, design, peer reviews and documentation. Provide documentation for implementation, deployment and QA teams. Apply sound software engineering processes, including iterative development, unit testing, source code control, inspections and reviews. Adhere to the goal of...

CorVel is seeking a Quality Assurance Nurse with experience in Case Management and Worker’s Compensation to conduct case management quality assurance audits. The Quality Assurance Nurse Auditor (QA Auditor) will serve a key role in ensuring patient and department records and processes are in compliance with policies, quality standards, workflow procedures, and regulatory and accreditation requirements. The QA Auditor will perform quality assurance audits for quality documentation and appropriate management of processes, maintain detailed auditing records, prepare trending reports, and monitor auditing results to support continuous innovation and compliance.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Develop, implement and provide ongoing quality assurance audit of processes 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....

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This position will be in our Hartford, CT office during training, and once fully trained transition to a hybrid work arrangement.    ESSENTIAL...