Top 218 Fraud Detection Specialist Jobs

Medical Reimbursement Specialist
CH Revenue Management Solutions —Red Bank, NJ
- From $27 an hour
- Full-time
- Microsoft Word
- Background check
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
Medical Claims Specialist
CH Revenue Management Solutions —Tinton Falls, NJ
- From $24 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Medical Billing Appeals Specialist
CH Revenue Management Solutions(CHRMS) —Eatontown, NJ
- From $26 an hour
- 8 hour shift
- Microsoft Outlook
- Customer service
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Wireless Intrusion Detection Specialist Level III
General Dynamics Information Technology —Aurora, CO
- $147,292 - $199,278 a year
- Up to 50% travel
- Research
- High school diploma or GED
13d
Compliance AML & Responsible Gaming Specialist
Aristocrat Interactive —Lansing, MI
- $77,000 - $166,734 a year
- Full-time
- Hybrid work
- Background check
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Fraud Specialist
AppleOne —Rochester, NY
- $21 - $22 an hour
- Temporary
- Research
- Finance
- Fair chance
- Dental insurance
- 401(k)
Quick Apply
Cash and Collection Specialist
Bucar Group —Pittsburgh, PA
- $18 - $20 an hour
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- GAAP
- Paid time off
Quick Apply
Post Closing QC Specialist
UNION HOME MORTGAGE CORP —Remote
- Remote
- Microsoft Excel
- Microsoft Outlook
- Data analysis skills
Quick Apply
Fraud Analytics Subject Matter Expert
Elder Research —Arlington, VA
- Email
- Hybrid work
- 5 years
- Bachelor of Science
- Analysis skills
Quick Apply
Specialist, Cyber Enabled Fraud Analyst
Prudential —Newark, NJ
- $96,200 - $158,800 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- SQL
- Employee stock purchase plan
- Disability insurance
Role: Alloy Expert (Identity & Fraud / Risk Integration Specialist)
Vytwo Technologies Inc —Prosper, TX
- $60 - $70 an hour
- Full-time
- Hybrid work
- 7 years
- Senior level
- Banking
- Work from home
Quick Apply
Pre-Funding QC Specialist
UNION HOME MORTGAGE CORP —Remote
- Remote
- Microsoft Excel
- Data analysis skills
- Mid-level
Quick Apply
Senior Fraud Specialist
Netspend —Austin, TX
- Full-time
- 5 years
- Finance
- High school diploma or GED
10d
Principal Specialist, Fraud
Sallie Mae —New Castle, DE
- Full-time
- Hybrid work
- Finance
- Analysis skills
- Business Administration
- Wellness program
- Paid parental leave
Fraud Abuse Specialist, Digital Fraud & Abuse
GEICO —Bethesda, MD
- $100,000 - $215,000 a year
- Full-time
- Computer science
- Computer Science
- 5 years
Trust & Safety Senior Specialist
G2 —Remote
- $75,000 - $90,000 a year
- Full-time
- Remote
- 3 years
- SQL
- Analysis skills
- Parental leave
Risk Investigations Specialist - Trust & Safety
Control Risks —San Francisco, CA
- $100,000 - $110,000 a year
- Weekends as needed
- Remote
- SQL
- US work authorization
- Organizational skills
- AD&D insurance
- Health insurance
Quick Apply
Fraud Detection Specialist I
City National Bank —Phoenix, AZ
- $22.27 - $33.43 an hour
- Full-time
- Microsoft Word
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Senior Compliance and Fraud Risk Specialist
Universal Service Administrative Company —Washington, DC
- $85,000 - $115,000 a year
- Bachelor's degree
- Training & development
- 1 year
- Commuter assistance
- Paid holidays
Quick Apply
Card Payments Specialist
Fidelity Bank —Fuquay-Varina, NC
- Full-time
- Mid-level
- Office
- High school diploma or GED
Quick Apply

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Medical Reimbursement Specialist

CH Revenue Management Solutions
Red Bank, NJ

Quick Apply

Job Details

Full-time
From $27 an hour

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Microsoft Word
Appeals
Microsoft Excel
Microsoft Outlook
Employee relationship building
Microsoft Office
High school diploma or GED
ICD-9
ICD-10
Medical insurance appeals management
CPT coding
Alternative dispute resolution
Insurance claims appeal handling

Full Job Description

CH Revenue Management Solutions (CHRMS) is seeking a Medical Reimbursement Specialist to join its growing team. CHRMS represents out-of-network surgeons throughout the United States in the claim reimbursement cycle, from medical billing through appeals, including claims through the arbitration process under Federal and State laws. Our team is comprised of more than 50 professional medical billers, coders, insurance industry professionals, medical practice managers and ERISA and state regulatory experts. This opportunity is for the right individual looking to be part of an entrepreneurial work environment with a good work/life balance.

The Medical Reimbursement Specialist is responsible for analyzing claim data, preparing arbitration statements and appeals and ensuring compliance by payors with contractual obligations, and the independent dispute resolution process.

If you are looking for a change to a more claim specific appeals process based on pursuing medical and legal strategies, this opportunity is for you.

MUST be a strong writer.

FULL TIME IN OFFICE IS REQUIRED.

Key Responsibilities

Review explanation of benefits (EOB) and ensure coding is accurate and reflects the procedures performed.
Analyze all coding adjustments made on EOB to ascertain accuracy and valid support.
Review client claim information and related insurance documents.
Determine and execute best approach for claim pathway, whether through appeals, IDR or other means.
Preparing documents in a timely manner to comply with filings, Federal, State and plan guidelines.
Maintain knowledge of Company’s strategies, processes and policies in preparing appeals, IDR statements and other documents.
Document all actions taken in the Company’s database and any follow-up required.
Request and obtain medical records, notes and/or copy of claim as appropriate.

Knowledge, Skills and Abilities

Proficiency in Microsoft Office programs, especially Excel, Word and Outlook.
Comprehensive knowledge of health care customer service, regulatory requirements and Provider Dispute and/or Member Appeal process.
Working knowledge and a thorough understanding of denial resolution strategies and payer reimbursement specifics.
Knowledge of CPT/HCPC, ICD9/10 coding, procedures and guidelines
Comprehensive analytical skills.
Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) and fraud and abuse prevention detection policies and procedures.
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Knowledge and experience in the out-of-network insurance world.

Minimum Requirements

High school diploma or equivalency
At least 3 years of medical coding/billing/appeals experience

Salary and Benefits

Starting at $27/hour
We offer our team paid time off, medical, dental, vision, 401(k) with match, LTD, STD, FSA, Pet Wellness Plans, and supplemental insurance plans.

EOE/DFWP

Job Type: Full-time

Pay: From $27.00 per hour

Expected hours: 40 per week

Benefits:

401(k) matching
Dental insurance
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance

Experience:

medical coding/billing/appeals: 3 years (Required)

Ability to Commute:

Red Bank, NJ 07701 (Required)

Work Location: In person

Quick Apply

Refine Your Search

Fraud Detection Specialist jobs

Medical Reimbursement Specialist

Medical Claims Specialist

Medical Billing Appeals Specialist

Wireless Intrusion Detection Specialist Level III

Compliance AML & Responsible Gaming Specialist

Fraud Specialist

Cash and Collection Specialist

Post Closing QC Specialist

Fraud Analytics Subject Matter Expert

Specialist, Cyber Enabled Fraud Analyst

Role: Alloy Expert (Identity & Fraud / Risk Integration Specialist)

Pre-Funding QC Specialist

Senior Fraud Specialist

Principal Specialist, Fraud

Fraud Abuse Specialist, Digital Fraud & Abuse

Trust & Safety Senior Specialist

Risk Investigations Specialist - Trust & Safety

Fraud Detection Specialist I

Senior Compliance and Fraud Risk Specialist

Card Payments Specialist

I want to receive the latest job alert for Fraud Detection Specialist

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