California Licensed Health Plans Auditor
VirtualVocationsPasadena, Texas, United Statesjob_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_description
A company is looking for a Specialty Health Plans Auditor III, Claims.
Key Responsibilities
Lead planning, execution, reporting, and corrective action monitoring for claims processing compliance across specialized health programs
Conduct annual claims audits and ensure compliance with regulatory and contractual requirements
Act as a Subject Matter Expert, mentoring staff and shaping best practices for continuous improvement
Qualifications
Bachelor's Degree in Accounting, Finance, or a related field, or equivalent education and / or experience
Minimum 5 years of experience in claims audits or claims processing related to managed care product lines
Demonstrated background in managed care, healthcare, or health insurance
Proven experience in healthcare claims audit and financial compliance
Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint)
serp_jobs.job_alerts.create_a_job
Health Plans Auditor • Pasadena, Texas, United States
Job_description.internal_linking.related_jobs A company is looking for a UM Nurse, RN for the Weekend Shift.Key Responsibilities Conduct prospective and concurrent / retrospective reviews of referrals to ensure compliance with regulatory requi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Project Manager, Associate to support the Hospitality team in coordinating and implementing Hospitality Management Solutions for customers.
Key Responsibilities Assist i...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community.
When we say every member of our comm...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Financial Operations - Internal Auditor II.Calpine Corporation is America's largest generator of electricity from natural gas and geothermal resources with operations in competitive power markets.I...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
At Corebridge Financial, we believe action is everything.That's why every day we partner with financial professionals and institutions to make it possible for more people to take action in their fi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.The work you do with our team will directly improve health outcomes by connect...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Director of Underwriting for Life, Disability, and Supplemental Health.Key Responsibilities Manage a team of underwriters and provide leadership to meet financial and m...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day 
The Health System Administrator acts as the full Associate Medical Center Director / Chief Operations Officer in the direction and coordination of designated administrative services of the Medical Ce...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
Gig Workers Wanted! Are you tired of working for someone else? Have you thought about building a business for yourself? If you answered yes to either question – Welcom...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Dean's Professional Services is now hiring a qualified.EOB Follow-up / Insurance Specialist.We are on a mission to create care that is more convenient and professional, with solutions that are v...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Commercial Underwriter III (Healthcare).At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve.
We are all united in delivering the best experience for ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Case Manager RN.Key Responsibilities Assess member health status and coordinate care needs, including inpatient review and discharge planning Develop and implement tre...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Remote Medical Benefits Representative.Key Responsibilities Perform inbound and outbound calls assisting patients with prescription benefits Verify insurance, billing,...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours Director Of ACO Population Health.At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community.Wh...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 
APPLICATIONS ARE REVIEWED DAILY.YOU CAN EXPECT A RESPONSE WITHIN 24 HOURS.Our Patients : an intentional focus on small caseloads with a compassionate care approach.
Our Culture : Our Core Values are m...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
Rockwall National Public Adjusters is one of the most established public adjusting firms in the region.For more than 15 years, we have successfully advocated for property owners, supported by leade...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives.The work you do with our team will directly improve health outcomes by connect...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 
Focus on the core content of the job post, removing all extra metadata, navigation mentions, and redundant headers.Keep the formatting beautiful and high signal to noise ratio.serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Director Managed Care Contracting.At Houston Methodist, the Director Managed Care Contracting position is responsible for the development, negotiation, maintenance and payer relations of the Housto...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
This job is responsible for providing comprehensive advice and customized solutions to clients to help them achieve their financial goals.
Key responsibilities include triaging client leads, making ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
- serp_jobs.job_card.promoted
California Licensed Utilization Management Nurse
VirtualVocationsSugar Land, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Texas Licensed Project Manager
VirtualVocationsHouston, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Director, Revenue Cycle - Claims Follow-Up (Hybrid)
Memorial HermannHouston, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Financial Operations - Internal Auditor II
CalpineHouston, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Retirement Plan Consultant II - Houston, TX
Corebridge FinancialHouston, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Medical Director - Post-Acute Care Management - Care Transitions - Remote anywhere in US
UnitedHealth GroupHouston, TX, United Statesserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Director of Underwriting - Life & Disability
VirtualVocationsHumble, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Health System Administrator (Associate Medical Center Director)
US Government JobsHouston, TX, USserp_jobs.job_card.full_time
Premium Auditor
Davies Risk ServicesThe Woodlands, TX, USserp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
- serp_jobs.job_card.promoted
EOB Follow-up / Insurance Specialist - Houston, TX
Dean's Professional ServicesHouston, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Commercial Underwriter III (Healthcare)
PNCHouston, TX, USserp_jobs.job_card.full_time +1
- serp_jobs.job_card.promoted
Texas Licensed RN Case Manager
VirtualVocationsSugar Land, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Texas Licensed Medical Benefits Rep
VirtualVocationsHumble, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Director, ACO Population Health
Memorial HermannHouston, TX, USserp_jobs.job_card.temporary
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
BCBA Clinical Director
Action Behavior CentersAtascocita, TX, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Licensed Public Adjuster Houston, Texas
Rockwall National Public AdjustersHouston, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Medical Director - Post-Acute Care Management - Care Transitions - Remote
UnitedHealth GroupHouston, TX, United Statesserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Licensed Health Insurance Agent-Temp Position
AloricaHumble, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Director Managed Care Contracting
Houston MethodistHouston, TX, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Financial Solutions Advisor - South Houston Area
Bank of AmericaDickinson, TX, USserp_jobs.job_card.full_time