Claims Auditor Job at Robert Half (Omaha)

Medical Claims Auditor

We are looking for an experienced Medical Claims Auditor to join our team in Eme...

Location

United States , Emeryville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

A minimum of 7 years of experience in medical coding, auditing, and claims processing
Strong knowledge of ICD-10 and CPT codes, along with certified coding credentials
Expertise in auditing insurance claims and ensuring compliance with state and federal regulations
Proven ability to conduct training sessions and develop educational resources for team members
Familiarity with Medi-Cal and the California Knox-Keene Act
Exceptional analytical skills to identify trends and resolve complex claim issues
Proficiency in preparing statistical reports and presenting findings to stakeholders
Strong communication skills and the ability to collaborate effectively with diverse teams

Job Responsibility

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

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Director of Project Accounting

Robert Half Management Resources is partnering with a San Diego-based, project-d...

Location

United States , San Diego

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor's degree in Accounting or Finance
10+ years of progressive accounting experience
Strong project-based accounting experience within construction or similar industries
Expertise in revenue recognition (ASC 606), change orders, contracts, cost-to-complete estimates, WIP accounting, reserves, claims, and settlements
Experience in multi-entity and consolidated environments
Ability to manage multiple complex projects (Lump Sum, GMP, T&M)
Experience overseeing audits and working with external auditors
CPA strongly preferred

Job Responsibility

Lead and enhance project accounting operations, driving efficiency, accuracy, and cross-functional alignment
Strong focus on projects around Sales & Use tax, Inventory, tariff compliance, unique project considerations (cancellations, customer bankruptcies)
Partner cross-functionally with Project Controls, Construction, and Operations to design and optimize accounting processes while ensuring strong internal controls
Lead month-end close for project accounting, including WIP, job cost accruals, reserves, underbillings, deferred revenue, and joint ventures
Support quarter-end flux / variance analysis tied to project performance
Oversee complex balance sheet reconciliations and non-standard journal entries
Manage, mentor, and review the work of the project accounting team
Assist in the preparation of financial statements in accordance with US GAAP
Identify issues proactively and implement process improvements and operational efficiencies
Support audit readiness and coordination with external auditors

What we offer

medical, vision, dental, and life and disability insurance
401(k) plan

Fulltime

New

Accountant

Are you ready to take your accounting career to the next level? Join our dynamic...

Location

United Kingdom , Kettering

Salary:

33000.00 GBP / Year

Office Angels

Expiration Date

Until further notice

Requirements

Proven experience in an accounts department, including monthly management accounts production
Ideally AAT Qualified, or part qualified CIMA/ACCA or an equivalent qualification
A collaborative team player with excellent communication skills
Meticulous attention to detail and strong influencing/persuasion skills
The ability to develop others and enhance departmental skills
Proficiency in intermediate-level Excel spreadsheets

Job Responsibility

Preparation of management accounts and forecasts
Assisting with year-end audits, providing documentation and answering auditor queries
Maintaining monthly balance sheet reconciliations
Overseeing VAT reporting
Supporting monthly and annual stock takes
Managing the fixed asset register
Conducting analysis and reporting
Implementing standard costing for Test Equipment products
Setting up new customer accounts and amending existing ones
Handling sales invoicing for our Irish entity

What we offer

Full training provided
A supportive team atmosphere
Opportunities for personal and professional development

Fulltime

Clinical Specialist, Quality Management I

Who We Are: Because health is personal. That's why Personify Health created the ...

Location

United States

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

Active, unrestricted Registered Nurse (RN) license required
Basic computer literacy
The ability to work on multiple screens, and proficient typing skills
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Ability to work independently and utilize written resources to problem solve
After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in: Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Excellent verbal and written communication skills for upward and downward conversations
Level I: In-depth knowledge of applicable regulations and accreditation standards (HIPAA, CMS requirements as applicable, NCQA, URAC)

Job Responsibility

Ensure compliance with state, federal, and accreditation requirements (e.g., HIPAA, CMS, NCQA, URAC, ERISA, as applicable)
Conduct internal and external audits of UM/CM/CDM processes and documentation
prepare audit files, findings, and corrective action recommendations
Identify quality and compliance risks and collaborate with cross-functional partners on mitigation and resolution
Review and support SOPs and workflows to ensure regulatory alignment and operational clarity
Support external audit readiness activities, including NCQA and URAC evidence preparation and maintenance
Develop, maintain, and deliver role-based training curriculum aligned to compliance standards, quality goals, and operational workflows
Conduct onboarding and orientation to prepare staff for assigned UM/CM/CDM functions
Deliver training using multiple modalities (virtual, self-paced, and one-on-one coaching) tailored to adult learners
Ensure training covers applicable processes such as case initiation and closure, documentation standards, high-dollar case monitoring, stop-loss notification, administrative support, customer service, and productivity expectations

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Unlimited PTO—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Director of Technology

Our Client is seeking a Director of Technology who will lead their overall techn...

Location

United States , New York

Salary:

180000.00 - 200000.00 USD / Year

Solomon Page

Expiration Date

Until further notice

Requirements

Bachelor's degree in Computer Science, Information Technology, Engineering, or related field
8+ years of progressive technology and IT leadership experience
Experience within commercial finance, specialty lending, banking, fintech, or other regulated financial services environments preferred
Strong understanding of cybersecurity, infrastructure management, cloud technologies, and enterprise systems
Experience managing software implementations, systems integrations, reporting platforms, and operational technology projects
Strong knowledge of Microsoft environments, Excel-based operational tools, Power BI, and ERP systems
Experience supporting customer-facing SaaS platforms and teams preferred
Demonstrable understanding of AI/ML concepts, capabilities, and limitations, with the ability to evaluate tools, assess vendor claims, and guide technology decisions
Working knowledge of AI-related data privacy, security, and regulatory frameworks (e.g. GDPR, CCPA, SOC 2, ISO42001), with experience establishing or maintaining governance policies that manage risk across client-facing data environments
Strong communication, organizational, and stakeholder management skills

Job Responsibility

Develop and execute the company's technology roadmap aligned with business objectives and growth initiatives
Serve as a strategic partner to executive leadership on technology planning, systems optimization, cybersecurity, AI governance, and operational scalability
Define and implement the company's AI usage policies, governance standards, and technology initiatives
Identify opportunities to automate workflows, improve reporting, and enhance operational efficiency across the organization
Evaluate and implement new technologies that support business growth and operational resilience
Effectively communicate strategies, opportunities, risks, project/program updates, issues, and go-forward options to senior management
Oversee company-wide laptop, mobile device, and end-user technology setup, administration, and lifecycle management
Provide and manage first-level technology support for all employees across the organization
Escalate and manage technology issues with external managed service providers, including primary oversight of the relationship with the company's MSP
Establish IT operational standards, documentation, and support procedures

Fulltime

Financial Transaction Specialist

Reporting to the Group Operations Financial Controller, the Financial Transactio...

Location

United Kingdom , London

Salary:

Not provided

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Minimum 2 years of experience in Accounts Payable and/or Accounts Receivable, or a similar finance role
Proficiency in using multiple financial systems, banking platforms, and transaction-processing software
Strong Microsoft Excel skills, including data analysis and reconciliation functions

Job Responsibility

Process supplier invoices, credit notes, and employee expense claims accurately and within agreed timelines
Match invoices to purchase orders and ensure all appropriate approvals are obtained prior to payment
Prepare and process weekly and monthly payment runs
Reconcile supplier statements
Investigate and resolve billing discrepancies, payment issues, and supplier disputes in a timely manner
Maintain accurate supplier records and ensure supporting documentation is up to date
Process corporate credit card transactions and employee reimbursements
Monitor customer accounts and track outstanding balances
Apply and reconcile incoming payments and refund
Investigate and resolve payment discrepancies, short payments, and unapplied cash

What we offer

£450 Gross Refer-a-friend scheme (unlimited referrals!)
50% discount on F&B onsite
Reward and discounts platform
SmartTech and CycleToWork schemes
Access to delicious on shift meals
Great and fun local business partnership discounts

Fulltime

Staff Accountant

We are looking for a detail-oriented Staff Accountant to support daily accountin...

Location

United States , Mount Kisco

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bachelor's degree in accounting or a related field with a strong foundation in general accounting principles
At least 3 years of relevant accounting experience, including journal entries, general ledger activity, accruals, and revenue-related accounting
Practical experience with payroll accounting, paid time off accruals, accounts payable, receivables, and cash flow monitoring
Familiarity with HR administration such as employee benefits, retirement plans, leave processing, workers compensation, and related compliance support
Proficiency in QuickBooks Desktop and Microsoft Office, especially Excel for reporting, analysis, and pivot tables
Ability to manage deadlines effectively, including participation in a fast-paced month-end close process
Strong communication and interpersonal skills with the ability to work effectively with employees, families, vendors, financial partners, and leadership

Job Responsibility

Maintain accurate financial records by posting journal entries and processing transactions across payroll, accounts payable, accounts receivable, cash receipts, credit cards, investments, fixed assets, and depreciation
Manage tuition and related billing activities, including entering and updating account data, supporting registration-related payment setup, answering billing questions, and following up on overdue balances
Prepare supporting schedules and submissions for applicable government funding, subsidy claims, and other receivables in a timely and accurate manner
Administer employee-related processes such as benefits coordination, retirement plan support, payroll questions, tax and deduction follow-up, leave administration, and unemployment documentation
Reconcile bank, investment, credit card, and other balance sheet accounts, and investigate variances, aging items, and unusual account activity
Partner with internal teams to track and reconcile fundraising and donation-related financial activity, including contributed goods and event-based transactions
Complete the monthly close within established deadlines and review financial results, budget-to-actual performance, and key account activity with finance leadership during the first week of each month
Support the annual financial statement audit by organizing documentation, responding to requests, and coordinating with external auditors and internal stakeholders
Contribute to special projects and additional accounting or administrative assignments as business needs arise

What we offer

Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance
Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan

Fraud Operations Senior Professional

In this role at Citizens, you’re made ready for a fulfilling career with excitin...

Location

United States , Johnston; Pittsburgh; Irving

Salary:

Not provided

Citizens Bank

Expiration Date

Until further notice

Requirements

8+ years fraud prevention or fraud risk management experience working in the financial services industry
Deep understanding of bank products and operations
current fraud prevention and detection techniques
and key processes, controls, and exposure areas
Effective influencing and conflict resolution skills
Strong problem solving and analytical skills, attention to detail, and the ability to work independently and as part of a team
Excellent communication skills (oral and written), interpersonal / business partnering, and organizational skills
Bachelor’s degree in relevant field required
Certified Fraud Examiner, Certified Internal Auditor, Certified Public Accountant and/or Risk Management certifications preferred

Job Responsibility

Oversee fraud prevention activities for assigned enterprise-level business units
Provide guidance on fraud policies, standards, processes, and tools
Conduct, where appropriate, fraud risk assessments
Act as a fraud prevention subject matter expert to ensure projects, programs, processes, and product initiatives align with fraud policies and standards
Challenge and advise on new products or services, issues, key fraud risk indicators, and vendor engagements
Assist business unit managers in establishing a proactive fraud prevention posture, led by evolving data-driven intelligence and solutions, to ensure losses remain within risk appetites
Review and analyze fraud cases to identify trends and mitigation opportunities
Partner with Fraud and Claims colleagues and Corporate Security and Resilience to ensure the results and learnings from fraud incidents and investigations are effectively leveraged to prevent future fraud incidents
Identify emerging fraud prevention risks and control issues in the operating environment, while working with the business line to implement action plans to mitigate business impact
Collaborate with business lines to ensure appropriate alerting mechanisms and effective requirements for proper authentication are implemented

What we offer

competitive pay
comprehensive medical, dental and vision coverage
retirement benefits
maternity/paternity leave
flexible work arrangements
education reimbursement
wellness programs

Fulltime

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Claims Auditor

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