claim auditor

Hoag Health System

<div><p><b>Primary Duties and Responsibilities
</b></p><p>The Claims Auditor is responsible for performing pre-payment and post-payment audits ensuring financial and processing accuracy, compliance with regulatory and health plan requirements of claims processed.
</p><p>The Claims Auditor is responsible for auditing and confirming accuracy of the loading of:
</p><ul><li>Fee schedules
</li><li>Provider contracts
</li><li>Payor contracts
</li><li>Benefits
</li><li>Code changes
</li><li>System enhancements</li></ul></div>
<br><div><p><b>Education and Experience
</b></p><ul><li>High School Diploma or equivalent
</li><li>5 years of experience in a medical claims processing environment
</li><li>Knowledge of HMO/managed care regulatory guidelines
</li></ul><p><b>Preferred:
</b></p><ul><li>Experience with Epic Tapestry system
</li><li>3 years experience in claim audits, revenue recovery, or claims system configuration
</li></ul><p><b>License Required
</b></p><p>N/A
</p><p><b>License Preferred
</b></p><p>N/A
</p><p><b>Certifications Required
</b></p><p>N/A
</p><p><b>Certifications Preferred
</b></p><p>N/A</p></div>

Claims Auditor: Hoag Clinic Claims & Enrollment

ARMStrong Insurance Services

<div><p>ARMStrong Insurance Services is the leading and most trusted name in the world of debt recovery and financial solutions. With a track record of excellence and reliability, we have proudly served businesses across various industries for decades, ensuring efficient B2B collections and tailored debt recovery solutions. As the parent company, ARMStrong is proud to own and operate Brown &amp; Joseph, Paragon, SubroIQ, and NEIS, each a powerhouse in their own right, providing specialized expertise in debt management and financial services.<br>
<br>
NEIS, LLC has been a leader in the insurance audit and loss control prevention industry since 1945 and seeking a Premium Auditor as we continue to grow our team. Premium Auditors examine the financial records of businesses insured by commercial property and casualty insurers to make sure they are following laws and regulations. As a premium auditor, looking for evidence of fraud and checking that insured businesses adhere to these regulations are your primary responsibilities. Your job will be based from home with required daily travel to each audit location. Car travel will be on average of 2-4 days per week within your assigned territory.</p><p><b>
Job Responsibilities:</b></p><ul><li>
Conduct insurance premium audits for Workers Compensation, General Liability, and Automobile policies by auditing policyholder&rsquo;s records, and applying manual rules and company standards.
</li><li>Prepare for the audit by identifying the necessary information and type of records needed</li><li>
Prepare schedule to maximize optimal use of time</li><li>
Correspond with insured via phone, email and mail to setup audit appointments.</li><li>
Examine the policyholder&rsquo;s records, gather data to determine correct classifications for business activities and write an effective description of operations</li><li>
Prepare complete audit document, explain results to insured and communicate the results to the home office</li><li>
Travel to multiple audit locations</li><li>
Hybrid position - work from home and complete remote audits 2-3 days per week</li></ul><p><b>
Job Requirements:</b></p><ul><li>
Associate&rsquo;s Degree or equivalent plus two years&rsquo; performing premium audits or equivalent combination of education and experience highly desired</li><li>
Ability to read, analyze and interpret financial documents</li><li>
General PC knowledge including Microsoft Excel and Word. Knowledge of Visual Audit is a plus.</li><li>
Ability to communicate well with customers and staff.</li><li>
Valid driver&rsquo;s license and satisfactory driving record
</li><li>Maintain automobile insurance while employed with bodily injury limits equal to or greater than $100,000 per person and $300,000 per accident or $300,000 combined</li></ul><p><b>
Compensation and Benefits:
</b></p><ul><li>$44-$46 per billable hour</li><li>
Weekly pay</li><li>
Part-Time or Full-Time Hours - flexible work days and schedule</li></ul><p>
We look forward to you joining the team!</p><p>
ARMStrong Insurance Services is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.</p><p>
</p><p>EqdpugGXhH</p></div>

Premium Auditor (Hybrid)

DINERS

<p><b>Job Title: Inventory Auditor</b></p><p><b>Location:</b> Lahore</p><p><b>Key Responsibilities:</b></p><ul><li>Conduct physical inventory audits at stores and warehouses.</li><li>Compare system inventory records with actual stock levels.</li><li>Identify, investigate, and report discrepancies in stock counts.</li><li>Ensure compliance with company inventory policies and procedures.</li><li>Generate and analyze inventory reports to detect patterns of shrinkage or overstock.</li><li>Work with store managers and warehouse teams to address inventory variances.</li><li>Collaborate with operations and supply chain teams to improve inventory accuracy.</li><li>Support implementation of new inventory control procedures.</li><li>Ensure all stock transactions follow company SOPs and retail compliance guidelines.</li><li>Maintain audit records and ensure proper documentation of stock adjustments.</li></ul><p><b>Qualifications &amp; Skills:</b></p><ul><li>01 to 2+ years of experience in inventory auditing, retail operations.</li><li>Strong knowledge of inventory management systems.</li><li>Proficiency in Microsoft Excel and data analysis tools.</li><li>Excellent attention to detail and problem-solving skills.</li><li>Strong communication and reporting skills.</li><li>Ability to travel to different retail locations as required.</li><li>Experience in the fashion retail industry.</li></ul><p>Job Type: Full-time</p><p>Pay: Rs40,000.00 - Rs60,000.00 per month</p><p>Work Location: In person</p>

Inventory Auditor

<div><p>ARMStrong Insurance Services is the leading and most trusted name in the world of debt recovery and financial solutions. With a track record of excellence and reliability, we have proudly served businesses across various industries for decades, ensuring efficient B2B collections and tailored debt recovery solutions. As the parent company, ARMStrong is proud to own and operate Brown &amp; Joseph, Paragon, SubroIQ, and NEIS each a powerhouse in their own right, providing specialized expertise in debt management and financial services.<br>
<br>
NEIS, LLC has been a leader in the insurance audit and loss control prevention industry since 1945 and seeking a Premium Auditor as we continue to grow our team. Premium Auditors examine the financial records of businesses insured by commercial property and casualty insurers to make sure they are following laws and regulations. As a premium auditor, looking for evidence of fraud and checking that insured businesses adhere to these regulations are your primary responsibilities. Your job will be based from home with required daily travel to each audit location. Car travel will be on average of 2-4 days per week within your assigned territory.<br>
<br>
<b>Job Responsibilities:</b></p><ul><li>
Conduct insurance premium audits for Workers Compensation, General Liability, and Automobile policies by auditing policyholder&rsquo;s records, and applying manual rules and company standards.
</li><li>Prepare for the audit by identifying the necessary information and type of records needed</li><li>
Prepare schedule to maximize optimal use of time</li><li>
Correspond with insured via phone, email and mail to setup audit appointments.</li><li>
Examine the policyholder&rsquo;s records, gather data to determine correct classifications for business activities and write an effective description of operations</li><li>
Prepare complete audit document, explain results to insured and communicate the results to the home office</li><li>
Travel to multiple audit locations</li><li>
Hybrid position - work from home and complete remote audits 2-3 days per week</li></ul><p><b>
Job Requirements:</b></p><ul><li>
Associate&rsquo;s Degree or equivalent plus two years&rsquo; performing premium audits or equivalent combination of education and experience highly desired</li><li>
Ability to read, analyze and interpret financial documents</li><li>
General PC knowledge including Microsoft Excel and Word. Knowledge of Visual Audit is a plus.</li><li>
Ability to communicate well with customers and staff.</li><li>
Valid driver&rsquo;s license and satisfactory driving record
</li><li>Maintain automobile insurance while employed with bodily injury limits equal to or greater than $100,000 per person and $300,000 per accident or $300,000 combined</li></ul><p><b>
Compensation and Benefits:
</b></p><ul><li>Benefit package with health, dental, vision, life and disability coverage options</li><li>
401(k) retirement plan option with company matching</li><li>
Generous paid time off policy and 7 paid holidays</li><li>
Salary is $45.00 - $53.00 per billable hour</li><li>
Weekly pay</li><li>
401(k) plan with company matching and immediate vesting</li></ul><p>
We look forward to you joining the team!</p><p><br>
ARMStrong Insurance Services is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.</p><p>
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Premium Insurance Auditor (Hybrid)

Interstate Auditing, LLC

<p>At Interstate Audit LLC, we are dedicated to exceeding our customers&rsquo; expectations with every audit. This is achieved by our team of independent auditors who bring their high-level of experience, professionalism and integrity to each and every audit they perform, resulting in our continued growth and success.</p><p>As a contracted Premium Auditor, you will perform physical workers compensation, general liability, garage liability, and dealer insurance audits traveling throughout Buffalo, NY. Your ability to work independently will be essential as you examine policyholders&rsquo; operations and financial records to obtain actual exposures, as well as interpret and apply manual rules and regulations. When not traveling to physical locations, you will work out of your home effectively scheduling audit appointments within your assigned territory, and performing routine administrative tasks, such as status updates, time tracking, etc., in a timely manner.</p><p><b>Requirements:</b></p><ul><li>A High School diploma or GED is required; an Associate's or a Bachelor's degree in Accounting, Finance or a related area is strongly preferred</li><li>A minimum of 1-3 years of experience in premium auditing, accounting and/or bookkeeping is required</li><li>Exceptional time management, analytical, communication and interpersonal skills are required</li><li>PC literate, including Microsoft Office products is required</li><li>Reliable vehicle/transportation is required</li></ul><p>Job Types: Full-time, Contract</p><p>Pay: $40.00 - $50.00 per hour</p><p>Work Location: On the road</p>

Premium Auditor

Western Growers Family of Companies

<div><div>If you&rsquo;re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we&rsquo;re looking for you.</div><div>
At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.</div><div>
As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn&rsquo;t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee&rsquo;s life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.</div><div>
With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees&rsquo; job satisfaction and success.</div><div><b>
Compensation: $45,091 - $63,617 with a rich benefits package that includes profit-sharing</b></div><div></div><div><h1 class="jobSectionHeader"><b>
Job Description Summary</b></h1><div>
Position reports to the Supervisor, Benefit Installation &amp; Distribution and performs in-depth plan coding and testing of new and existing business accounts. This position will ensure that all new and existing health (medical/dental) insurance plans underwritten by the Western Growers Assurance Trust (WGAT) and those of Pinnacle, Inc. (PCMI) are in compliance with the respective employers&rsquo; summary plan descriptions.
</div><h1 class="jobSectionHeader"><b>Qualifications</b></h1><ul><li>
BS/BA degree in Business or related field and a minimum of three (3) to (5) five years of recent experience as a medical/dental claims auditor or plan testing experience, preferred.
</li><li>Exceptional understanding and ability to interpret summary plan descriptions of employee medical/dental benefits.
</li><li>Strong ability to work efficiently and effectively in a multiple task, multi-project, and multi-demandingenvironment to meet expected goals, dates, and milestones.</li></ul><ul><li>
 Ability to anticipate problems, recommend solutions, and exercise best judgement.</li><li>
Excellent writing, editing, and proofreading skills to compose and edit correspondence, reports, emails, and other written materials.</li><li>
Proficient ability to analyze and interpret group health benefits provisions, administrative policies, and provider contracts.
</li><li>Previous experience with conducting research and presenting complex information.</li><li>
Excellent communication and interpersonal skills.</li><li>
Superior organization skills and high attention to detail.</li><li>
Ability to learn complex business processes and appropriately apply knowledge to make informed decisions.</li><li>
Advanced skills in Microsoft Office applications.</li><li>
Knowledge of medical terminology. Familiar with ICD10, CPT, HCPC, and CDT codes.</li><li>
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.</li><li>
Home router with wired Ethernet (wireless connections and hotspots are not permitted).</li><li>
A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)</li><li>
A functioning smoke detector, fire extinguisher, and first aid kit on site.</li></ul><div>
 Duties And Responsibilities</div><div>
Testing</div><ul><li>
Using close and comprehensive analyses, verify new and existing plans loaded on the Company&rsquo;s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.
</li><li>Test all new plans prior to loading them into production (medical, dental and vision plans).
</li><li>Work with programmers to test claims and related system programs to verify impact within the HCPS.</li><li>
System analysis and testing of mass system updates.</li><li>
Plan coding of new business and plan changes for medical, dental, and vision plans.</li><li>
Communicate with other operational departments, as necessary, to ensure smooth integration of new plans for both WGAT and PCMI moving into production.</li></ul><div>
Reporting</div><ul><li>
Provide monthly reporting of all requested plan issues submitted from the Claims department.</li><li>
Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
</li><li>Create and document Standard Operating Procedures (SOP).</li><li>
Identify, initiate and implement process improvements and/or innovation.</li></ul><div>
Other</div><ul><li>
Utilize all capabilities to satisfy one mission &mdash; to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.</li><li>
Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.</li><li>
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.</li><li>
Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)</li><li>
All other duties as assigned.</li></ul><p>
Physical Demands/Work Environment</p><div>
The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.</div></div></div>

Implementation Auditor

<p>At Interstate Audit LLC, we are dedicated to exceeding our customers&rsquo; expectations with every audit. This is achieved by our team of independent auditors who bring their high-level of experience, professionalism and integrity to each and every audit they perform, resulting in our continued growth and success.</p><p>As a contracted Premium Auditor, you will perform physical workers compensation, general liability, garage liability, and dealer insurance audits traveling throughout Worcester, MA and its surrounding areas. Your ability to work independently will be essential as you examine policyholders&rsquo; operations and financial records to obtain actual exposures, as well as interpret and apply manual rules and regulations. When not traveling to physical locations, you will work out of your home effectively scheduling audit appointments within your assigned territory, and performing routine administrative tasks, such as status updates, time tracking, etc., in a timely manner.</p><p><b>Requirements:</b></p><ul><li>An Associate' or Bachelor's degree in Accounting, Finance or a related area is required</li><li>Minimum of 1-3 years of experience in premium auditing, accounting and/or bookkeeping is required</li><li>Exceptional time management, analytical, communication and interpersonal skills are required</li><li>PC literacy, including Microsoft Office products is required</li><li>Reliable vehicle/transportation is required</li></ul><p>Job Types: Full-time, Contract</p><p>Pay: $40.00 - $50.00 per hour</p><p>Ability to Relocate:</p><ul><li>Worcester, MA: Relocate before starting work (Required)</li></ul><p>Work Location: On the road</p>

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1929 claim auditor jobs Near Me

Claims Auditor: Hoag Clinic Claims & Enrollment

Premium Auditor (Hybrid)

Inventory Auditor

Premium Insurance Auditor (Hybrid)

Premium Auditor

Implementation Auditor

Premium Auditor