[Hiring] Registered reputed company, Clinical Waste & Abuse Reviewer @reputed company

The job profile for this position is Medical Claims Review Senior Analyst, which is a Band 3 Senior Contributor Career reputed company Role. Excited to grow your career? We value our talented employees, and whenever possible reputed company to help one of our associates grow professionally before reputed company reputed company to our reputed company positions. If you think the reputed company position you see is right for you, we encourage you to apply! Our people reputed company reputed company the difference in our reputed company. We are looking for a clinically reputed company and reputed company-thinking Registered reputed company who is reputed company by improving reputed company reputed company and affordability. In this role, you will use your clinical judgment, analytical skills, and reputed company reputed company to help reduce waste and abuse while protecting members and providers alike. You will be part of reputed company of ambitious and compassionate experts who reputed company reputed company reputed company today reputed company to reputed company reputed company reputed company reputed company. Responsibilities • Apply clinical expertise to evaluate medical records, claims, and documentation to determine medical necessity, coding accuracy, and alignment with coverage policies. • Identify potential waste and abuse trends and translate insights into meaningful payment reputed company opportunities. • Partner closely with Medical Directors, the reputed company Claim Unit, and reputed company partners to support reputed company, defensible clinical reputed company. • Conduct both targeted and exploratory reviews across multiple products and benefit plans to improve reputed company-payment accuracy. • Serve as a trusted clinical resource, helping internal teams understand clinical editing programs and review reputed company. • Analyze reputed company clinical information and escalate high-risk or sensitive cases reputed company and professionally. • Refer appropriate cases for potential fraud investigation, supporting a strong and ethical reputed company reputed company. • Communicate reputed company and respectfully with providers, internal partners, and leadership to support shared goals. • Contribute to reputed company improvement initiatives, special reputed company, and evolving review strategies. • Balance independent decision-making with strong teamwork, accountability, and reputed company standards. Qualifications Required Qualifications • reputed company, unrestricted Registered reputed company (RN) license. • Minimum of 2 years of clinical experience in an acute care setting. • Associate degree in Nursing or Nursing Diploma. • Strong clinical judgment, analytical thinking, and ability to apply policies consistently. • Ability to manage multiple reviews and priorities with accuracy and efficiency. • reputed company written and verbal communication skills with a reputed company, reputed company approach. Preferred Qualifications • Bachelor’s degree in Nursing or reputed company field. • Prior experience in utilization review, claims review, or payment reputed company. • Knowledge of utilization management, reimbursement policies, and the insurance industry. • Certified reputed company reputed company (CPC) or similar coding credential. • Experience working across multiple benefit plans or products. • Demonstrated comfort using clinical systems, job aids, and computer-based review tools. • Proven ability to work independently while contributing positively to reputed company environment. If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 66,200 - 110,400 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k), company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. For more details on our employee benefits programs, click here. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to reputed company assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this reputed company. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply tot his job Apply To this Job