3 results for Insurance Verification Remote jobs

Medical Claims Auditor

Emeryville, CA
remote
Temporary
39.5865 - 45.837 USD / Hourly
We are looking for an experienced Medical Claims Auditor to join our team in Emeryville, California. In this long-term contract position, you will play a pivotal role in ensuring the accuracy and compliance of medical claims while also serving as a trainer to enhance team knowledge and performance. If you have a strong background in medical coding, auditing, and training, this opportunity is ideal for you. Responsibilities:• Conduct detailed audits of paid, pending, and denied medical claims to ensure proper coding, adherence to benefit rules, and compliance with state and federal regulations, including the California Knox-Keene Act and Medi-Cal.• Design and deliver comprehensive training programs for Claims Examiners, focusing on workflows, updated policies, and emerging technologies.• Investigate complex claim issues, including provider disputes and appeals, and identify trends to propose effective corrective actions.• Compile and maintain detailed statistical and quality reports, presenting audit findings and staff performance metrics to management.• Stay informed about federal and state billing laws, including Medicare guidelines, to ensure compliance during health plan audits.• Collaborate with team members to resolve discrepancies and implement efficient claims processing practices.• Assist in the development of new audit procedures and quality control measures to continuously improve operations.• Provide subject matter expertise in medical coding standards, including ICD-10 and CPT codes, to support organizational goals.• Contribute to special projects and initiatives as needed to enhance claims auditing and training functions. If you are interested in this role please apply Now for immediate consideration.
2026-03-24T00:00:00Z

Medical Insurance Claims Specialist

Boise, ID
remote
Temporary
15 - 16 USD / Hourly
We are looking for a detail-oriented Medical Insurance Claims Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of claims processing within the healthcare industry. Working remotely but closely with the team based in San Diego, California, you will help support better financial and member outcomes while contributing to a collaborative and fast-paced environment. NOTE: (Only for Idaho Residents) Responsibilities:• Conduct audits of pre-lag reports to verify accuracy, completeness, and compliance with established turnaround times.• Investigate and resolve member out-of-pocket concerns to ensure proper claims adjustments.• Monitor daily pre-lag reports for assigned regions and escalate compliance issues as needed.• Analyze daily, weekly, and check-run reports for assigned IPAs to identify potential errors or inconsistencies.• Notify management promptly about compliance concerns related to claims payment timelines.• Perform quality reviews of claims processes to ensure adherence to organizational standards.• Collaborate with team members to identify trends and root causes of recurring issues.• Assist with benefit interpretation and claims adjustments using EZCap or similar platforms.• Maintain documentation and provide detailed audit reports to support continuous improvement initiatives.• Support the implementation of quality measures and compliance protocols within claims operations.
2026-03-25T00:00:00Z

Medical Insurance Claims Specialist

Albuquerque, NM
remote
Temporary
15 - 16 USD / Hourly
We are looking for a detail-oriented Medical Insurance Claims Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of claims processing within the healthcare industry. Working remotely but closely with the team based in San Diego, California, you will help support better financial and member outcomes while contributing to a collaborative and fast-paced environment. NOTE: (Only for New Mexico Residents) Responsibilities:• Conduct audits of pre-lag reports to verify accuracy, completeness, and compliance with established turnaround times.• Investigate and resolve member out-of-pocket concerns to ensure proper claims adjustments.• Monitor daily pre-lag reports for assigned regions and escalate compliance issues as needed.• Analyze daily, weekly, and check-run reports for assigned IPAs to identify potential errors or inconsistencies.• Notify management promptly about compliance concerns related to claims payment timelines.• Perform quality reviews of claims processes to ensure adherence to organizational standards.• Collaborate with team members to identify trends and root causes of recurring issues.• Assist with benefit interpretation and claims adjustments using EZCap or similar platforms.• Maintain documentation and provide detailed audit reports to support continuous improvement initiatives.• Support the implementation of quality measures and compliance protocols within claims operations.
2026-03-26T00:00:00Z