Claims Quality Auditor is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State a

of Job Ensure prompt, efficient, accurate and timely claims adjudication of high dollar claims in accordance with the current policy benefits, limitations or exclusions. Provide resolution of provider inquiries and collaborate with internal departments. Provide feedback or suggestions to enhance current processes and/or systems. Responsibilities Research and adjudicate hig

Overview Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day to day operations according to defined processes and proc

We have an exciting opportunity to join our team as a Assistant Director Reimbursement. In this role, the successful candidate is responsible for assisting in the overall planning, organization, direction, and control of the Reimbursement department. Interfaces with various hospital personnel regarding financial issues and analysis. The position will require the individua

JOB DESCRIPTION Position Type Full time Type Of Hire Experienced (relevant combo of work and education) Travel Percentage 1 5% FIS is a leading provider of technology solutions for merchants, banks and capital markets firms globally. FIS stays ahead of how the world is evolving to power businesses in today's fast changing competitive landscape and help our clients run, gr

The Settlements Specialist (Associate) will be immersed in a fast paced environment supporting daily settlements processes for Capital Markets derivative trading business as well as provide support for the derivative business conducted by group companies in New York, London and Hong Kong. Covered products FX, OTC Derivatives, Cleared Derivatives, Margin, and USD and CAD T

Construction Safety & Risk Control Consultant Are you ready to bring top tier innovation to clients nationwide? Can you become the difference maker that leads to our client's success stories? If you answered yes to both of those questions Aon is looking for you to become part of setting the gold standard in client servicing! This opportunity is a virtual position with exp

When you join Verizon Verizon is one of the world's leading providers of technology and communications services, transforming the way we connect around the world. We're a human network that reaches across the globe and works behind the scenes. We anticipate, lead, and believe that listening is where learning begins. In crisis and in celebration, we come together lifting u

When you join Verizon Verizon is one of the world's leading providers of technology and communications services, transforming the way we connect around the world. We're a human network that reaches across the globe and works behind the scenes. We anticipate, lead, and believe that listening is where learning begins. In crisis and in celebration, we come together lifting u

When you join Verizon Verizon is one of the world's leading providers of technology and communications services, transforming the way we connect around the world. We're a human network that reaches across the globe and works behind the scenes. We anticipate, lead, and believe that listening is where learning begins. In crisis and in celebration, we come together lifting u