Conducts internal and external audits to evaluate financial, operational, and compliance controls.
Analyzes data to detect deficient controls, fraud, or non-compliance and drafts recommendations for improvement.
Communicates audit findings to corporate executive management through detailed reports.
Palmetto GBA is a healthcare service administrator providing technology solutions for healthcare administration. It is one of the nation's largest providers of medical claims processing and offers training and development programs for its associates.
Handle provider inquiries through multiple channels with accuracy and precision.
Establish and maintain positive relationships with providers on behalf of the company.
Complete ongoing training to stay abreast of products, services, and policy changes.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association offering health insurance. It is consistently voted one of the "Best Places to Work in PA" and values employee growth and community involvement.
Investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis and interviews.
Analyze information, report findings, and recommend settlements or denials while supporting legal proceedings.
Conduct training on fraud detection and maintain knowledge of relevant laws and regulations.
Cotiviti is a healthcare analytics company that helps clients reduce costs and improve outcomes through data-driven insights. As a global leader in payment accuracy and network performance, Cotiviti fosters a collaborative and inclusive culture.
Initiate investigation of new claims and evaluate coverage to make appropriate policy decisions.
Evaluate and negotiate settlements of property, collision, and transportation losses while managing outside adjusters.
Ensure compliance with state laws, maintain licenses, and handle small claim suits as needed.
ClaimsPro LP, part of SCM Insurance Services, is a Third Party Administrator handling claims across the US and Puerto Rico. SCM is Canada's largest privately owned insurance services provider, known for a culture of continuous learning and recently winning a Culture Innovator Award.
Respond to premium audit inquiries via phone and email, providing accurate information to clients.
Coordinate communication between clients and the audit team to ensure smooth audit processes.
Maintain accurate records of communications and prepare audit reports and summaries.
Crum & Forster (C&F) provides specialty and standard commercial lines insurance products through admitted and surplus lines insurance companies. With over 2000 employees in the United States, C&F has earned a Great Place to Work Award and is committed to diversity, equity, and inclusion.
Conduct research and structured reviews of documentation to evaluate program performance.
Support day-to-day program execution and maintain project artifacts and workplans.
Present findings and proposed solutions in client-facing meetings and working sessions.
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations, and enhanced service delivery. Founded in 2012, they have over 300 employees nationwide and focus on human-centered services to optimize mission delivery.
Perform pre-invoice validation, post-invoice audits, and investigate billing discrepancies.
Partner cross-functionally to resolve issues and improve billing quality standards.
Track KPIs, build dashboards, and lead process improvement initiatives.
NWN is an AI-powered technology solutions provider for North America's innovative organizations. The company employs over 1,000 experts and fosters a customer-obsessed culture, earning recognition as a 'Best Place to Work' with high employee satisfaction.
Perform monthly billing audits, fee calculations, and adjustment processing.
Maintain client accounts and billing instructions to ensure accurate fee schedule assignments.
Collaborate with advisors and teams to resolve billing discrepancies and facilitate fee collections.
Mercer Advisors helps families simplify and amplify their financial lives through comprehensive financial planning, investment management, and related services. The firm serves over 31,300 families across 90+ U.S. cities, with a diverse team where more than half of employees and client-facing professionals are women.
Support quality assurance and audit planning for the WTC Health Program
Analyze claims data to identify trends and recommend improvements
Maintain health plan codebook and ensure accurate medical coding standards
Advanced Technologies & Laboratories International, Inc. (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. The company offers a competitive total compensation package and invests in professional growth through tuition reimbursement and certification programs.
Coordinates data collection from multiple sources to audit and monitor compliance with regulations.
Investigates and resolves compliance matters and monitors corrective action plans.
Develops training materials and publications to educate organization stakeholders.
UnityPoint Health is a healthcare system serving Iowa, Illinois, and Wisconsin. It is recognized as a Top 150 Place to Work in Healthcare, with a culture focused on belonging and support for its team members.
Support PBA account teams with day-to-day client requirements and benefit management.
Analyze client requests and coordinate with internal and external teams to execute plan documentation.
Lead quality assurance testing, claim reviews, and resolve sponsor and member issues.
Judi Health is an enterprise health technology company providing a comprehensive suite of PBM and health benefit management solutions for employers and health plans. They value diversity and are committed to rebuilding trust in healthcare in the U.S.
Analyze insurance portfolio performance and competitor products to drive business decisions.
Develop recommendations for product, pricing, and underwriting improvements based on data insights.
Create reporting tools, dashboards, and ROI calculators to support stakeholder decision-making.
RealPage is a property management software company that provides solutions for rental housing. It is a large, data-driven organization with a culture focused on innovation and analytical insights.
Defines project strategy and manages moderate to high complexity analysis with minimal direction.
Queries data for ad hoc analysis and builds tools and queries for others.
Leads workstreams on projects, conducts competitive intelligence, and mentors less experienced analysts.
Liberty Mutual is an insurance company focused on delivering underwriting solutions for profitable growth. It seeks to create an inclusive workplace with comprehensive benefits and professional development opportunities for a large, national workforce.
Assemble and summarize data to structure loss analysis and identify financial risks.
Analyze past claims for recoverability and report on trends.
Consult with management to guide strategic decision making and reduce costs.
LoanCare is a leading national full-service mortgage loan subservicer that delivers excellence to banks, credit unions, and independent mortgage companies. Backed by Fidelity National Financial (NYSE: FNF), a Fortune 500 company, we offer a culture built on integrity and collaboration.
Serve as the main point of contact for providers, resolving escalated issues and maintaining positive relationships.
Manage internal projects to improve provider experience, including education on best practices and policies.
Use data analysis and tools like Excel and Salesforce to investigate issues and reduce provider abrasion.
Clover Health provides high-quality, affordable healthcare plans for America's seniors by leveraging data and technology through the Clover Assistant. The company is a mission-driven, remote-first organization with a focus on diversity and inclusion, employing a team of passionate professionals.
Drive collaboration and coordination with cross-functional teams including programmers, engineers, and management.
Conduct root cause analyses, track progress, and deliver detailed status reports with KPIs.
Audit call and email communications to assess quality and compile feedback for improvement.
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. The team consists of highly dedicated professionals from world-class institutions who care deeply for their work and each other.
Monitor merchant processing activity to identify suspicious transactions and potential fraud.
Investigate alerts and review reports to mitigate company losses and ensure compliance.
Collaborate with cross-functional teams to design risk strategies and maintain SOPs.
Xplor provides cloud-based technology solutions for small and medium-sized businesses to manage payments and operations, processing over $47 billion annually for 130,000+ businesses in 72+ countries. The company is backed by investors Advent International, Battery Ventures, and Silver Lake, and fosters a culture guided by values of simplicity, purpose, community, and people-first.
Administer fraud, waste, and abuse (FWA) duties, including investigations, audits, and corrective actions.
Prepare reports, correspondence, and data analysis for internal and external stakeholders.
Assist in policy development, training, and regulatory compliance for FWA programs.
CareOregon is a nonprofit, mission-driven health plan focused on providing care to low-income Oregonians. With around 1,000 employees, it fosters a culture of equity, diversity, and inclusion, and offers comprehensive benefits.
Prepare and submit mortgage insurance and agency claims in accordance with applicable guidelines.
Conduct monthly audits and review exception reports to ensure data integrity and identify trends.
Support resolution of escalated issues, maintain process documentation, and assist training efforts.
Jobgether uses AI-powered matching to connect candidates with hiring companies. They process applications based on legitimate interest and offer remote work flexibility.
Participate in complex client and system implementations, ensuring compliance with prompt pay laws and analyzing liquidity impacts.
Perform issue management triage, collaborating with stakeholders to identify root causes and resolve payment issues.
Conduct in-depth analysis on payment compliance with federal and state prompt pay laws and contractual requirements.
Prime Therapeutics is a different kind of pharmacy benefit manager (PBM) with a purpose beyond profits, focused on connecting care for those we serve. The company is a large organization that fosters a purpose-driven culture and offers opportunities to make a difference in simplifying healthcare.