Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Develop and track performance related to claims accuracy, turnaround time, and dispute resolution ...
Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Develop and track performance related to claims accuracy, turnaround time, and dispute resolution ...
... dispute resolution including representation in various types of claims, controversies and ... This position is also open to partner candidates that will work remote but are based in Florida.
... dispute resolution including representation in various types of claims, controversies and ... This position is also open to partner candidates that will work remote but are based in Florida.
Attorney - Employment and Labor Partner (remote) (Miami, FL; Orlando, FL; ...)
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... dispute resolution including representation in various types of claims, controversies and ... This position is also open to partner candidates that will work remote but are based in Florida.
Attorney - Employment and Labor Partner (remote) (Miami, FL; Orlando, FL; ...)
Miami, FL · On-site +1
... dispute resolution including representation in various types of claims, controversies and ... This position is also open to partner candidates that will work remote but are based in Florida.
340B - Lawyer/Paralegal
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... dispute resolution processes. Why Join Us? - Fully remote position with flexible hours. - Opportunity to work on impactful projects within the healthcare and pharmaceutical industries ...
340B - Lawyer/Paralegal
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$67K - $90K/yr
... dispute resolution processes. Why Join Us? - Fully remote position with flexible hours. - Opportunity to work on impactful projects within the healthcare and pharmaceutical industries ...
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Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...
Claims Examiner - Remote
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Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...
Claims Examiner - Remote
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Experience processing Provider Dispute Resolution (PDR), appeals, reconsiderations, or claim ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...
Claims Examiner - Remote
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Attorney-Workers Compensation Partner
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... assessment and dispute resolution including representation in various types of claims ... This position can be remote. THE QUALIFICATIONS The ideal candidate is licensed to practice in ...
... dispute resolution including representation in various types of claims, controversies and ... This position can be nearly fully remote. THE QUALIFICATIONS Qualified candidates will have at ...
... dispute resolution including representation in various types of claims, controversies and ... This position can be nearly fully remote. THE QUALIFICATIONS Qualified candidates will have at ...
... dispute resolution including representation in various types of claims, controversies and ... This position can be nearly fully remote. THE QUALIFICATIONS Qualified candidates will have at ...
... dispute resolution including representation in various types of claims, controversies and ... This position can be nearly fully remote. THE QUALIFICATIONS Qualified candidates will have at ...
... dispute resolution including representation in various types of claims, controversies and ... This position offers the potential for a remote arrangement. Goldberg Segalla is one of the premier ...
... dispute resolution including representation in various types of claims, controversies and ... This position offers the potential for a remote arrangement. Goldberg Segalla is one of the premier ...
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Flexible remote working arrangements * Competitive compensation * Growth Opportunities ... and dispute resolution. Interested in hearing more? Easy Apply now by clicking the "Apply Now ...
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USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Dispute resolution experience: Liability Investigation/Comparative Negligence, Unrelated Prior ...
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Provide guidance on dispute resolution, settlements, and enforcement matters as needed. * Ensure ... Remote Work Requirements * Stable, reliable internet connection. * Professional and dedicated ...
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USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Leads complex negotiations and dispute resolution, navigating high-impact, high-visibility ...
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USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Leads complex negotiations and dispute resolution, navigating high-impact, high-visibility ...
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USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Leads complex negotiations and dispute resolution, navigating high-impact, high-visibility ...
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Remote Dispute Resolution information
Is there a demand for mediators?
How to make 25 an hour online?
What jobs pay 4000 a week without a degree?
What is a Remote Dispute Resolution job?
A Remote Dispute Resolution job involves mediating conflicts, handling claims, or resolving disputes between parties through online platforms, emails, or virtual meetings. Professionals in this role may work in legal, financial, or customer service settings, helping clients settle disagreements without in-person interaction. The job requires strong communication, negotiation, and problem-solving skills. Many roles involve working for companies, legal firms, or independent mediation services.
What are some typical challenges faced by professionals in remote dispute resolution roles?
Professionals in remote dispute resolution often face challenges related to building rapport and trust between parties in a virtual setting, as non-verbal cues can be harder to interpret online. Technical issues, such as unstable internet connections and unfamiliarity with digital mediation tools, may also arise. Additionally, maintaining confidentiality and ensuring all parties feel heard and respected can require extra attention when working remotely. However, with strong communication strategies and technical preparedness, these challenges are manageable and can even lead to more flexible, widely accessible resolution processes.
What are the key skills and qualifications needed to thrive in the Remote Dispute Resolution position, and why are they important?
To thrive in Remote Dispute Resolution, you need strong analytical abilities, negotiation skills, and a background in conflict management or law, often supported by a degree or relevant certification such as ADR (Alternative Dispute Resolution). Familiarity with mediation software, secure virtual meeting platforms (like Zoom or Microsoft Teams), and case management systems is typical in this role. Excellent written and verbal communication, impartiality, and active listening are essential soft skills for effective dispute resolution. These competencies ensure fair and efficient handling of disputes in virtual environments, maintaining professionalism and productive outcomes for all parties involved.
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Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 17 days ago
Job description
Claims Quality Auditor| Remote
Job Type: Full time
Work Setup: Remote
Reports to: Claims Supervisor
Position Summary:
TheClaims Quality Auditor plays a key role in ensuring the accuracy, compliance, and effectiveness of claims processing and provider dispute resolution. The ideal candidatehas hands on experience withEZCap,auditing claims, analyzing dispute claims and evaluating internal policies and regulatory requirements, with a particular focus on Medi-Cal and commercial health plans.This role is responsible to partners closely with cross-functional teams to drive continuous improvement and operational excellence.
Key Duties:
- Perform detailed audits of denied, underpaid, and processed claims using EZCap to assess accuracy and compliance with provider contracts and regulatory guidelines.
- Analyze provider disputes for patterns or recurring issues.
- Identify root causes and work with relevant teams to implement corrective actions and process improvements.
- Develop and track performance related to claims accuracy, turnaround time, and dispute resolution efficiency.
- Conduct thorough root cause analyses on high-impact errors or escalations.
- Support training initiatives by identifying knowledge gaps and assisting in the development of updated procedures and documentation based on audit results.
- Ensure all reviewed processes align with applicable regulatory requirements. Participate in internal and external audits as needed.
Qualifications:
- High school diploma or equivalent
- At least 3-5 years of Quality Analyst in healthcare,TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
- Hands-on experience with EZCap (strongly preferred)
- Familiarity with Medi-Cal and Commercial insurance claim
- Strong analytical and problem-solving skills
- Excellent verbal and written communication
- Attention to detail in documentation and compliance
- Ability to manage multiple tasks and meet deadlines
- Experience with other claim adjudication platforms and provider systems.
- Familiarity with DHCS, DMHC, CMS dispute handling regulations.
What We Offer
- Remote work offered
- Equipment provided
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
COMPANY OVERVIEW:
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.