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Claims Auditor Ii Jobs

Quality Auditor Ii - Rn/Sw
By Horizon Blue Cross Blue Shield of New Jersey At , Newark, 07105 $75,300 - $100,800 a year
Completes other assigned functions, including special projects, as requested by management.
HEDIS experience is highly preferred in this role.
Prefers knowledge of audit methodologies and procedures.
Requires excellent verbal and written communication skills.
Prefers a Bachelor's degree. In lieu of degree, relevant work experience required.
Requires a minimum of three (3) years clinical nursing experience.
Qa Auditor Ii Jobs
By Thermo Fisher Scientific At ,

Conductscomplex internal and/or external audits to ensure compliance with established quality assurance processes, standards, global regulatory guidelines and/or client ...

Field Auditor Ii Jobs
By North Carolina Dept of Revenue At , $65,876 - $115,283 a year
Knowledge, Skills and Abilities / Competencies
Minimum Education and Experience Requirements
Comprehensive knowledge of state and federal tax issues, auditing and accounting theories and principles.
Experience performing complex, specialized audits.
Experience justifying and defending audit findings.
Perform complex and specialized audits
Claims Qa Auditor - Claims - Paramount
By ProMedica At , Toledo, 43606, Oh
Experience or strong working knowledge of benefit/pricing configuration, provider database maintenance, or related configuration experience desired.
Associates degree in Finance/auditing strongly preferred
Spreadsheet and database skills required. Demonstrated Excel at least level 2
Excellent written, verbal, and interpersonal communication skills required
Quality assurance program experience highly desirable
Good working knowledge of HCFA, State of Ohio and Michigan compliance regulations, and institutional/professional ECS submission formats highly desirable.
Claims Analyst Ii (Calhoun, Ga, Us, 30701)
By Mohawk Industries At Calhoun, GA, United States
Accurate data entry skills and the ability to calculate figures and amounts, such as discounts, interest, commissions and percentages
Communicating effectively with a wide range of individuals including members of management and other internal and external business contacts
Minimum of 2 years of Customer Service experience required. Internal candidates with at least 1 year of Claims experience preferred
Working knowledge of computers required, including AS400, SAP, Power BI, Microsoft Word, Excel and PowerPoint
Using good listening skills so that customer needs and problems are heard and addressed or resolved.
Negotiate claims and provide resolutions that satisfy our dealers/end users while creating the most favorable financial impact to our company.
Claims Specialist Ii Jobs
By Everest Re Group, Ltd. At , Township Of Warren, 07059, Nj $90,000 - $135,000 a year
Management and direction of outside counsel as well as reviewing and approving legal and/or expense budgets and bills
Determine and resolve workload and assignment issues to ensure effective claims processing, expense management and claims disposition
Vendor oversight and management, including auditing of same
The ideal candidate will have 5+ years of Commercial Property claims experience and current, working knowledge of jurisdictional laws and regulations.
Ability to and willingness to present to senior management and other group settings
Execution: Delivering outstanding support to the organization through strong day-to-day business operations, effective project management, and careful oversight of vendors.
Dental Claims Auditor- Remote (Ak, Az, Fl, Id, Or, & Wa)
By Moda Health At United States
Strong reading, writing, and verbal communication skills.
Good analytical, problem solving, decision making, organizational and detail-oriented skills with ability to shift priorities.
Good organizational skills, ability to work well under pressure and ability to handle a variety of functions to meet timelines.
Proficiency in Facets claims processing applications and Benefit Tracker.
Knowledge of Power BI Report Server (PBIRS) is helpful.
Knowledge and understanding of Delta Dental’s administrative policies affecting claims and customer service.
Claims Auditor Jobs
By Morgan Stephens At Spokane, WA, United States

Our client is a great hospital system located in Spokane, WA

The compensation package includes a base pay of $60,000-$70,000 plus bonus potential!

Claims Analyst/Claims Consultant I, Ii, Or Sr.
By National General At Washington, United States
Time management skills from a global case management and pending perspective (vs. transactional)
Identifies customer needs and works to meet those needs using appropriate customer service skills
Bachelor’s degree preferred or equivalent experience
0-2 years of related experience
Effective verbal and written communication skills
Problem solving and analytical skills; ability to detect differences and issue recognition from multiple sources
Claims Auditor & Appeals Processor
By Planstin Administration At St George, UT, United States
Provide regular feedback to Claims Management concerning process improvement and/or training opportunities.
Provide regular feedback to Finance.
Knowledge and understanding of medical terminology, anatomy and both ICD-10 and CPT coding.
One or more years of experience working with insurance plans or self-funded options.
Two years' experience in medical claims processing.
Read and interpret Planstin plans to ensure payment accuracy.
Quality Control Auditor Ii
By Lennar Homes At , Miami, 33126, Fl $36 an hour
Minimum of six years’ experience in mortgage lending
Minimum of three years underwriting experience or equivalent with Conventional, FHA and VA loan products preferred
Previous experience with loan closings and regulatory compliance
Experience in ACES, BlitzDocs & Destiny preferred
This position will be eligible for the benefits listed above in accordance with Company policy.
Become a subject matter expert in certain aspects of loan origination, such as regulatory compliance or credit underwriting
Auditor Ii Jobs
By Transocean At , Houston, Tx
Assist the Engagement Lead with the preparation of draft issues for presentation to Audit and Company management.
Minimum Required: Good communication and organizational skills. Self-motivated to perform responsibilities with limited supervision.
Preferred Level: Strong communication and organizational skills. Self-motivated to perform responsibilities with limited supervision.
Minimum Required: Bachelor's Degree in Accounting, Finance, IT or related disciplines.
Minimum Required: 2 years professional experience.
Transocean is focused on being the employer of choice for the drilling industry.
Claims Auditor I Jobs
By State of Oklahoma At Oklahoma City, OK, United States
Demonstrate strong analytical interpersonal, problem solving, time management and negotiation skills.
If education, certification, or licensure is required to meet qualifications, applicants must provide documentation with application.
Complexity Of Knowledge, Skills, and Abilities
Principles and practices of business organization and management.
1-year of qualifying experience in business, accounting, finance, or public administration.
Initiate and maintain cooperative relationships with co-workers, managers and supervisors, claimants, and members of the public.
It Auditor Ii - Remote
By Windstream Communications At , Remote
Collaborate with management and external auditors to ensure internal controls effectively mitigate risks.
Experience in assisting with audits, with a focus on both business processes and ITGCs
Understanding or experience with internal controls, including all phases of planning, evaluation, walkthroughs, documentation, sampling, testing and remediation is highly preferred.
Knowledge of Generally Accepted Accounting Principles (GAAP) is highly preferred.
Previous experience with audit and/or Sarbanes-Oxley compliance procedures desirable
Strong written, verbal, and analytical skills
Quality Control Auditor Ii
By DHI Mortgage At , Austin, Tx
Document findings to provide management with an accurate and detailed picture of the issue
Perform Quality Control Pre-Funding Status Audits as assigned and directed by DHIM Quality Control Management
Knowledge of or experience in mortgage loan processing and underwriting
Maintain a knowledge of all underwriting guidelines
Five to eight years of underwriting experience required
Meet department audit and reporting guidelines
Claims Processor Ii Jobs
By BlueCross BlueShield of South Carolina At Columbia, SC, United States
2 years of experience processing, researching, and adjudicating claims
Strong organizational, analytical and judgment skills
Strong oral and written communication skills
Examine and process complex or specialty claims according to business/contract regulations, internal standards and examining guidelines
Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes
Verify that claims have been keyed correctly
Claims Auditor- Remote Jobs
By Prime Therapeutics At , Remote $18.50 - $27.75 an hour
Completes special focused audits as assigned by management.
Knowledge of coordination of benefit guidelines.
Requires ability to read and understand benefit plans.
Experience with multiple claim processing systems.
Must function independently with strong organizational skills.
Strong verbal and written communication skills.
Claims Representative Ii - Remote
By Ryder System At , Frankfort, 40621, Ky $48,300 - $72,450 a year
Interacts, on an on-going basis, with field and operations management, legal counsel, safety managers, customers, insurance carriers, and third party claimants
data/ranges; applicant’s skills; prior relevant experience; certain degrees or
Ryder offers comprehensive health and welfare benefits, to include medical,
Manages litigation to ensure claims are handled appropriately, according to the applicable jurisdiction
Assists Claim Manager in the identification of exposures and recommends solutions
Manages indemnity and expense costs properly
Claims Manager Ii, Excess Coverage And Specialized Claims
By Liberty Mutual At , Remote $117,501 - $150,000 a year
Prior Management experience with P&C Claims is desired!
Advanced knowledge of Commercial Casualty insurance, claims investigation, coverage evaluation, loss assessment, reserving, insurance legal & regulatory environment and claims processes
Umbrella and Excess experience a plus!
Actively attracts, develops, and engages talented claims employees while simultaneously addressing employees who are not meeting expectations.
Monitors and evaluates the claims reserve practices within the office and ensures that actual reserves are accurate and established promptly.
Quality Associate Ii (Auditor)
By BAXTER At , Jayuya, Pr
Identifies possible Regulatory Risks within the Baxter Jayuya operations and notified to management.
Perform and support Quality Management System activities required or assigned to assure the facility compliance.
Coordinate, manage and follow up the Internal Audit program.
Support and perform the plant annual FDA 483’s Certification.
Performs changes to procedures for areas of responsibilities.
Manage and use the applicable software application (Trackwise).

Are you looking for an exciting opportunity to use your auditing skills to help protect the financial interests of a company? If so, then we have the perfect job for you! We are looking for a Claims Auditor II to join our team and help us ensure that all claims are accurate and compliant with regulations. You will be responsible for reviewing and analyzing claims data, identifying discrepancies, and making recommendations for corrective action. If you are detail-oriented, have excellent problem-solving skills, and are passionate about protecting the financial interests of a company, then this is the job for you!

Overview:

Claims Auditor II is responsible for auditing and verifying insurance claims to ensure accuracy and compliance with applicable laws and regulations. They review claims for accuracy and completeness, investigate discrepancies, and recommend corrective action. They also provide guidance and advice to claims adjusters and other staff on claims processing and related matters.

Detailed Job Description:

Claims Auditor II is responsible for auditing and verifying insurance claims to ensure accuracy and compliance with applicable laws and regulations. They review claims for accuracy and completeness, investigate discrepancies, and recommend corrective action. They also provide guidance and advice to claims adjusters and other staff on claims processing and related matters. They may also be responsible for preparing reports, analyzing data, and making recommendations for improvement.

What is Claims Auditor Ii Job Skills Required?

• Knowledge of insurance claims processing and related regulations
• Excellent analytical and problem-solving skills
• Ability to work independently and as part of a team
• Excellent communication and interpersonal skills
• Proficiency in Microsoft Office Suite
• Ability to work with large amounts of data
• Ability to work under pressure and meet deadlines

What is Claims Auditor Ii Job Qualifications?

• Bachelor’s degree in accounting, finance, or related field
• At least two years of experience in insurance claims auditing
• Certified Public Accountant (CPA) or Certified Internal Auditor (CIA) certification preferred

What is Claims Auditor Ii Job Knowledge?

• Knowledge of insurance claims processing and related regulations
• Knowledge of auditing principles and practices
• Knowledge of accounting principles and practices

What is Claims Auditor Ii Job Experience?

• At least two years of experience in insurance claims auditing

What is Claims Auditor Ii Job Responsibilities?

• Review and audit insurance claims for accuracy and completeness
• Investigate discrepancies and recommend corrective action
• Provide guidance and advice to claims adjusters and other staff on claims processing and related matters
• Prepare reports, analyze data, and make recommendations for improvement
• Monitor claims processing activities to ensure compliance with applicable laws and regulations
• Maintain accurate records and documentation of audit findings and recommendations