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Remote Risk Adjustment Auditor Jobs in Tennessee

This role will be a Remote role but must be based within the United States. The Manager, compliance ... risk-based healthcare compliance and privacy auditing programs to detect and remediate violations.

Schedule and perform external and/or remote assessments of LabConnect critical vendors on a risk-based schedule. * Update and maintain QRS Key Performance Indicators and other metrics as necessary ...

WBL has a fully remote, multinational workforce of ~200 and a proven, seasoned leadership team ... Build succession planning and cross-training practices to reduce key-person risk within the ...

$130K - $135K/yr

The ability to balance security principles with business realities as part of a risk-managed ... LI-MP1 LI-REMOTE

$130K - $135K/yr

The ability to balance security principles with business realities as part of a risk-managed ... LI-MP1 LI-REMOTE

$130K - $135K/yr

The ability to balance security principles with business realities as part of a risk-managed ... LI-MP1 LI-REMOTE

$130K - $135K/yr

The ability to balance security principles with business realities as part of a risk-managed ... LI-MP1 LI-REMOTE

$130K - $135K/yr

The ability to balance security principles with business realities as part of a risk-managed ... LI-MP1 LI-REMOTE

Showing results 41-60

Remote Risk Adjustment Auditor information

What are the key skills and qualifications needed to thrive as a remote risk adjustment auditor?

To thrive as a Remote Risk Adjustment Auditor, you need strong knowledge of medical coding (CPT, ICD-10), healthcare compliance, and experience with risk adjustment methodologies, typically supported by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic health record (EHR) systems, coding audit software, and secure remote work platforms is essential. Attention to detail, analytical thinking, and effective written communication are important soft skills for interpreting complex medical records and collaborating with healthcare providers. These skills ensure accurate risk adjustment coding, regulatory compliance, and optimized reimbursement processes in a remote work environment.

What are some common challenges remote risk adjustment auditors face, and how can they overcome them?

Remote Risk Adjustment Auditors often encounter challenges such as interpreting complex medical records, staying current with changing coding guidelines, and effectively communicating with team members in a virtual environment. To overcome these, auditors should prioritize ongoing education on coding standards, utilize secure collaboration tools to stay connected with colleagues, and develop strong organizational skills to manage multiple assignments efficiently. Proactively seeking feedback and participating in team meetings can also help maintain accuracy and a sense of community while working remotely.

What is a remote risk adjustment auditor?

A Remote Risk Adjustment Auditor is a healthcare professional who reviews medical records and documentation from a remote location to ensure accurate coding for risk adjustment purposes. Their work helps health plans and providers comply with government regulations and receive appropriate reimbursement for patient care. They analyze clinical documents to validate diagnoses, identify coding errors, and ensure data integrity. Remote auditors use specialized software and follow strict confidentiality guidelines while working from home or another offsite location.

What is the difference between Remote Risk Adjustment Auditor vs Remote Medical Coder?

AspectRemote Risk Adjustment AuditorRemote Medical Coder
CertificationsCPMA, RAC, or RHITAAPC CPC, CCS, or RHIT
Work EnvironmentInsurance, healthcare auditing firmsHospitals, clinics, insurance companies
Job FocusReviewing documentation for risk adjustment accuracyAssigning medical codes to patient records

Remote Risk Adjustment Auditors and Remote Medical Coders often share certifications and work in healthcare settings. However, auditors focus on reviewing documentation for risk adjustment purposes, while coders assign medical codes directly to patient records. Both roles require healthcare knowledge but serve different functions within the industry.

What are the most commonly searched types of Risk Adjustment Auditor jobs in Tennessee? The most popular types of Risk Adjustment Auditor jobs in Tennessee are:
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What cities in Tennessee are hiring for Remote Risk Adjustment Auditor jobs? Cities in Tennessee with the most Remote Risk Adjustment Auditor job openings:

Multi-Line Claims Adjuster - General Liability / Bodily Injury

CCMSI

Nashville, TN โ€ข On-site, Remote

$75K - $80K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

This job post hasย expired today.ย Applications are no longer accepted.


Job description

OverviewMulti-Line Claim Consultant - General Liability & Bodily InjuryLocation: Dallas, TX (Remote or Hybrid)ย Compensation: $75,000-$80,000 annually (based on experience)Schedule: Monday-FridayWork Model: Fully Remoteย 

Build Your Career With Purpose at CCMSI

At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.

We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.

Job Summaryย 

The Multi-Line Claim Consultant is responsible for the investigation and adjustment of assigned general liability, premises liability, and bodily injury claims within a national account environment. This role manages claims from assignment through resolution (cradle to grave), including files with significant litigation exposure, while ensuring compliance with CCMSI claim handling standards, client-specific instructions, and applicable state laws.

This position supports a highly engaged national client and requires exceptional responsiveness, thorough documentation, and consistent communication. While claims may be handled nationwide, the portfolio includes a significant concentration of claims in Missouri, Pennsylvania, Kentucky, and Tennessee, making experience with those jurisdictions highly desirable.

This position is designed for experienced liability adjusters with 5+ years of claim handling experience who can independently manage complex liability claims and provide exceptional client service in a fast-paced environment. The successful candidate will be comfortable handling bodily injury and premises liability exposures while balancing competing priorities across multiple accounts.

Approximately 30% of the caseload may involve litigated claims, making litigation management experience and the ability to effectively manage defense counsel critical to success.

This is a true liability adjuster role responsible for cradle-to-grave claim handling and is not an HR or consulting position.

ResponsibilitiesWhen we hire adjusters, we look for professionals who take ownership of their work, navigate complex claims with confidence, and deliver exceptional service with integrity. In this role, you'll manage your files independently while contributing to a collaborative, highperforming team.What You'll Do
  • Investigate, evaluate, and adjust general liability, premises liability, and bodily injury claims in accordance with corporate standards and jurisdictional requirements
  • Manage claims from assignment through resolution, including litigated files
  • Conduct detailed liability investigations and evaluate coverage, negligence, damages, and exposure
  • Establish and maintain appropriate reserves based on claim development and exposure analysis
  • Review medical records, bills, legal documentation, and investigative materials to support claim strategy
  • Negotiate settlements with claimants, attorneys, and authorized representatives
  • Coordinate and manage defense counsel and other external vendors as appropriate
  • Maintain proactive communication with clients, claimants, attorneys, and other involved parties
  • Prepare claim reports, reserve recommendations, and status updates as required
  • Identify and pursue subrogation opportunities when applicable
  • Maintain accurate claim documentation, diary management, and financial controls
  • Provide timely excess and carrier reporting when required
  • Ensure compliance with Corporate Claim Handling Standards and client-specific requirements
Qualifications

What You Bring

Required
  • 5+ years of multi-line liability claim handling experience
  • Experience and confidence handling attorney-represented, complex, and litigated files.

  • Strong experience handling general liability, premises liability, and bodily injury claims
  • Demonstrated litigation management experience, including working directly with defense counsel and managing litigated files
  • Experience handling claims in one or more of the following jurisdictions:
    • Missouri
    • Pennsylvania
    • Kentucky
    • Tennessee
  • Active adjuster license in Missouri, Pennsylvania, Kentucky, or Tennessee required (one or more required)
  • Ability to independently manage a moderate to complex caseload
  • Strong investigative, analytical, negotiation, and decision-making skills
  • Demonstrated ability to provide detailed, responsive client service
  • Excellent written and verbal communication skills
  • Strong organizational skills and diary management practices
  • Ability to work independently in a remote environment
  • Proficiency with Microsoft Office applications
  • Reliable, predictable attendance during business hours

Preferred

ย 
  • Familiarity with hospitality, entertainment, recreation, tourism, amusement, or similar guest-facing operations is a plus.

  • Exposure to significant injury claims involving fractures, surgeries, traumatic brain injuries, or other serious bodily injury allegations is preferred.

  • Active licenses in multiple states, particularly MO, PA, KY, and TN
  • Prior Third Party Administrator (TPA) experience
  • Experience handling high-touch national account programs
  • Experience conducting coverage evaluations and coverage position analysis
  • Experience preparing and issuing tender letters
  • NY Adjusters license is a huge plusย 

Why You'll Love Working Here

  • 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year
  • Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
  • Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
  • Career growth: Internal training and advancement opportunities
  • Culture: A supportive, team-based work environment

ย 

How We Measure Successย 

ย At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:ย ย 

  • Quality claim handling - thorough investigations, strong documentation, well-supported decisions
  • Compliance & audit performance - adherence to jurisdictional and client standards
  • Timeliness & accuracy - purposeful file movement and dependable execution
  • Client partnership - proactive communication and strong follow-through
  • Professional judgment - owning outcomes and solving problems with integrity
  • Cultural alignment - believing every claim represents a real person and acting accordingly

This is where we shine, and we hire adjusters who want to shine with us.

Compensation & Compliance

The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.

CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance.

Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.

Visa Sponsorship:ย CCMSI does not provide visa sponsorship for this position.ADA Accommodations:ย CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.Equal Opportunity Employer:ย CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.

Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.

Our Core Values

At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:

  • Lead with transparency We build trust by being open and listening intently in every interaction.
  • Perform with integrity We choose the right path, even when it is hard.
  • Chase excellence We set the bar high and measure our success. What gets measured gets done.
  • Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
  • Win together Our greatest victories come when our clients succeed.ย 

We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.

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Employment Type: OTHER