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Quality Assurance Reviewer
Previous SC DDSN, Medicaid, Utilization Review, Case Management, Quality Assurance, Claims Auditing or Fraud/Abuse experience required....
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Project Cost Specialist I
Flatwater Inc. a subsidiary of Ho-Chunk, Inc.
Bellevue, NE
Reviewer of contracts accounts payable including subcontractors and vendors invoices. Interface with internal departments (HCSS Accounting/Program & Project...
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Clinical Nurse Educator
Jacksonville, FL 32202 (Downtown area)
$61,200 - $91,800 a year
Knowledgeable of Medicare claims processing systems (FISS, MCS). Evaluate issues impacting quality/consistency of MR decision making and work with management to...

Third Party Reviewer

Somerville, MA
 Process rejected claims through trac and Onbase correspondence. The Reviewer functions under the general supervision of the Unit Manager....

Relocation Reviewer/Department of Justice Liaison (ODOT18-26...

Salem, OR
$59,340 - $87,636 a year
As a relocation reviewer, this position reviews all types of relocation benefit studies, cost findings, relocation moving claims for personal property, people,...

INSURANCE CO NURSE REVIEWER/SNR CUSTOMER SERVICE REP

NOITU Insurance Trust Fund
Queens, NY
$56,000 - $70,000 a year
Catastrophic Claims Monitoring. Claims Clinical Data Coordinator. Develop and maintain the tools necessary to keep the Claims Director abreast of all high...
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Disability Claims Nurse

Remote
As a Disability Nurse Claims Reviewer, You Are Responsible for:. You will need the knowledge and skills to conduct thorough investigations of disability claims....

PT/OT Peer Reviewer-Contract Opportunity Only

United States
Participation in group reviewer meetings as scheduled. (we aren’t looking for evening and weekend reviewers). Perform post-service clinical peer reviews of out...

Medical Claims QA Reviewer

Irving, TX 75039
Knowledge of claim payment and process preferred. To perform daily audits of work performed in assigned operational areas to ensure work adheres to processes as...

Nurse Reviewer

Oriskany, NY 13424
In this role you will investigates life insurance claims and makes determination on claims settlement within authorized guidelines....

Compliance Specialist 3 (Medical Reviewer)

Salem, OR
$55,548 - $81,300 a year
Knowledge of workers' compensation claim processing. The reviewer often resolves disputes through alternative dispute resolution processes using mediation and...

NY National -Utilization Management Representative I - Midla...

Georgia
Refers cases requiring clinical review to a Nurse reviewer. Managing incoming calls or incoming post services claims work....

Claims Reviewer (Medical and Behavioral Health Claims Review...

Phoenix, AZ
Provides clinical and coding-related information to medical director, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management...
Utilization Management Specialist
Charlestown, MA 02129 (Fenway-Kenmore area)
Enters authorizations into CCA’s data system to ensure timely review of and downstream claims processing. Communicates results of reviews in the centralized...
Licensed Utilization Review II, RN Preferred (PS10997)
Virginia Beach, VA 23464
May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost...
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