Support management of internal MGA programs, optimizing multiple areas.
Use data analyses to identify opportunities impact instant price and written premium.
Make recommendations on pricing through profitability analyses and market trends.
Zensurance is redefining commercial insurance for Canadian businesses by making getting the right coverage simple, fast, and accessible through a digital-first experience. They are a leading InsurTech that values ownership, collaboration, and innovation and has been recognized by Deloitte’s Technology Fast 50.
Conducts audits of highly complex accounts substantiating accuracy of policy classifications.
Develops proper premium basis on risks adhering to strict time deadlines.
Conducts interviews with the insured to obtain information regarding the insured's operations and business model.
CNA strives to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. They are focused on success, individually and collectively and pride themselves on promoting a culture that challenges and engages people.
Prepare documentation, review claim history, and investigate requests.
Utilize available resources to investigate claim situations for cases.
Follow-up with responsible departments and delegated entities to ensure compliance.
Centivo is an innovative health plan for self-funded employers, aiming to provide affordable, high-quality healthcare. They work with employers ranging in size from 51 employees to Fortune 500 companies and are headquartered in Buffalo, NY with offices in New York City and Buffalo.
Conduct audits of payer processed claims to verify accurate reimbursement.
Conduct post-implementation Care Center audits following the audit policy.
Assist the Manager, RI, in leading initiatives that drive efficiency.
Privia Health is a technology-driven physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices. Their platform consists of scalable operations and cloud-based technology to reduce healthcare costs and improve patient outcomes.
Utilizing healthcare experience to perform audit recovery procedures.
Identifying and validating incorrect claim payments.
Researching reimbursement regulations for claim payment compliance reviews and documentation to support current audit findings.
Cotiviti Healthcare is the payment accuracy expert, working with healthcare organizations to recover money, improve processes, strengthen relationships, and maximize their value. They are a well-established company with competitive pay, opportunities to develop professionally, and excellent benefits.
Support internal and external audits by helping coordinate documentation, timelines, and follow up items
Collaborate with cross functional partners to gather information and support compliance reviews
Monitor daily, weekly, and monthly quality and oversight reports to ensure regulatory and internal deadlines are met
Spring Health is on a mission to revolutionize mental healthcare by removing every barrier. They partner with over 450 companies and brands you use and know like Microsoft, Target, and Delta Airlines, providing care for 10 million people.
Assists in handling coverage applications and claims processes.
Helps share complex information about life and accident benefits.
Operates professionally while helping with sensitive situations.
PEHP Health & Benefits, a division of the Utah Retirement Systems, provides medical, dental, life, and long-term disability insurance plans. They are a government entity committed to customer value, market excellence, and healthcare improvement, offering competitive salaries, generous benefits, and work-life balance.
Provide insights and recommendations to support internal customers and state partners.
Evaluate performance, identify trends, and make recommendations for improvements.
Lead workstreams on projects and present analyses to Product Managers.
Liberty Mutual strives to create a workplace where everyone feels valued and supported. They foster an inclusive environment with comprehensive benefits, flexibility, and professional development opportunities. They value hard work, integrity, and commitment.
Manage personal auto product forms and contract initiatives.
Complete competitive intelligence research for specific states.
Analyze information from various resources to develop recommendations.
Liberty Mutual's Personal Lines Auto Product team builds and rolls out auto insurance solutions. They focus on auto, bringing expertise and data to deliver results while modernizing how they price policies and the technology that supports them.
Conduct in-depth analysis of claim payments, identifying trends and patterns for cost avoidance through internal and external collaboration.
Ensure medical claims comply with guidelines, contracts, and standards while detecting billing inefficiencies and recommending corrective actions.
Provide data-driven recommendations to management on payment-affecting issues, supporting necessary system and policy updates and provider education.
BCBSRI is dedicated to serving Rhode Islanders by providing access to high-quality, affordable, and equitable care. They actively support associate well-being and work/life balance, fostering a culture of belonging where diverse perspectives are valued and employees are equipped for success.
Investigate and determine whether medical insurance claims are recoverable from a liable third party.
Communicate and negotiate with healthcare plan members, insurance adjusters, and attorneys.
Utilize computer systems to accurately document collected information.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. With over 85 health plans and 270 million lives represented, we bring together a configurable, AI-powered platform along with expertise.
Oversee a team of Claims Analysts and outsourced vendor staff.
Ensure team meets quality, production, and service expectations.
Address complex claims and customer service inquiries.
Jobgether is a platform that uses AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify top-fitting candidates and share the shortlist with the hiring company, while not replacing human judgement in the final hiring decisions.
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Works collaboratively as part of a project team(s).
Actively communicates time availability, constraints and progress on deliverables to project manager(s).
Keeps detailed and accurate track of time spent on project work and other responsibilities daily using our shared tools.
Brown & Brown is one of the world’s largest insurance brokerages. They have a team that is as connected locally as it is globally; their high-performing, highly collaborative team delivers innovative risk and insurance solutions.
Design engaging training, lead coders through evolving standards, perform high level audits, and shape best practices across multiple specialties.
Conduct detailed audits to identify under coding, over coding, documentation gaps, and compliance risks.
Spot trends in documentation and coding performance and collaborate on workflow improvements.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Responsible for Clinical Chart Validation (CCV) audit operation and talent management.
Oversee process improvement initiatives and the Natural Language Processing program.
Provide supervision and direction to audit Team Leads.
Cotiviti is focused on payment accuracy, helping clients avoid unwarranted payments in the complex healthcare environment. They offer a competitive benefits package and are an equal opportunity employer that values diversity and inclusion.
Interpret and apply CMS, Medicare, Medicaid, and AMA policies to define claims editing logic.
Analyze claims and edit performance data to confirm accuracy and prioritize enhancements.
Monitor regulatory updates and coding changes to keep edits current and compliant.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. They use an AI-powered platform with expertise across the payment continuum, serving over 85 health plans and 270 million lives.
Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims.
Liberty Mutual provides insurance products and services. They aim to create a workplace where everyone feels valued and supported, offering comprehensive benefits and professional development opportunities to foster an inclusive culture where employees can thrive.
Develop of dashboards and analytical reports that help monitor, maintain, and improve quality standards
Analyze key performance data and identify levers that impact patient service and trial delivery
Drive ad hoc and regular cadence analytics and reporting that supports current goals and business initiatives
Care Access works to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, they bring world-class research and health services directly to communities that often face barriers to care.
Monitor client volume trends and identify changes or anomalies affecting performance.
Resolve client issues, including inquiries and escalations.
Participate in scheduled client calls to support issue resolution, solution agreement, and relationship management.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. They have a team of 25,500 people across 32 countries and are listed on the London Stock Exchange (EXPN).