Role Description The Medical Claims Auditor manages the process by which claims failing established clinical-related adjudication parameters are evaluated for payment, leveraging clinical and/or coding expertise. - Analyzes claims that have failed established clinical-related adjudication parameters by applying knowledge of CPT, HCPCS, and ICD 10. - Establishes root cause of claims failure and applies Plan benefit, reimbursement and/or medical policies, contract terms, etc. to determine the appropriate resolution. - Prioritizes claims/cases based on urgency. - Consults staff in the Office of Affairs (OCA), Business Integration, Claims, Legal, Benefits, Payment Policy, and other departments, as necessary, to resolve atypical issues. - Acts as internal consultant to various internal departments, such as Customer Care and Provider Relations, regarding clinical/coding-related adjudication parameters and their application in specific cases. - Applies knowledge of CPT, HCPCS, ICD10, provider contract terms, and Plan clinical and reimbursement policies to the validation of services in the medical record, and the accuracy of payment during assigned clinical audits. - Documents clinical audit findings and communicates them to providers; records final audit findings and, where appropriate, processes recoveries or payments. - Identifies potential deficiencies in the delivery of care during the analysis of failed claims or clinical audits and refers to the appropriate department. - Identifies opportunities to improve or streamline clinical/coding-related adjudication parameters and/or their effect on claims processing and escalates to management for review and communication. - Maintains established productivity and quality metrics. - Other duties as assigned. Qualifications - Bachelor's degree in Nursing with certification in coding either through AAPC or AHIMA or the equivalent combination of Coding Certification through AAPC or AHIMA, education, training, and experience. - If a Registered Nurse: - Minimum one year medical claim auditing or medical record review and Coding certification in AAPC or AHIMA. - Minimum two years RN experience in a clinical setting. - If a Certified Coder: - Minimum seven years direct coding experience. - Preferred/Desirable: Two years’ experience in health care insurance, or provider coding or claims processing settings. Requirements - Successful completion of pre-employment background check. - Valid MA or NH Registered Nurse license or eligible OR valid AAPC or AHIMA coding certification. - Valid MA or NH Motor Vehicle Operator’s license and dependable transportation. Benefits - Full-time remote work. - Competitive salaries. - Excellent benefits. Working Conditions and Physical Effort - Regular and reliable attendance is an essential function of the position. - Work is normally performed in a typical interior/office work environment. - Ability to travel to providers, as assigned. - Ability to work during peak periods. - No or very limited physical effort required. No or very limited exposure to physical risk. - Occasional bending and lifting up to 30 lbs. may be required. Compensation Range $57,500 - $83,500. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.

Role Description Intertek is searching for an entry level Modular Inspector to join our Building & Construction team. This is a fantastic opportunity to grow a versatile career in Intertek Modular Building Solutions! The Modular Inspector is responsible for inspections of residential and commercial buildings, modular components, and perform other related QA/QC tasks in general accordance with set forth standards and regulations to ensure compliance with city, state and federal laws and regulations. This is a remote position; however, applicants must reside in and be able to legally work in the United States. What you’ll do: - Examine modular building plans and specifications for compliance with current codes (building, electrical, fire protection, accessibility, energy conservation, etc.) as required of third-party agencies. - Inspect modular buildings for compliance with current codes (building, electrical, fire protection, accessibility, energy conservation, etc.) as required of third-party agencies. - Consult with manufacturers, consultants, engineers, and others in matters related to plans, specifications, materials, equipment, and the methods. - Perform related work as assigned. Qualifications - State of California HCD Certifications - State of California QAI License - State of California FBH License - International Code Council Certifications - Residential Building Inspector - Residential Mechanical Inspector - Residential Electrical Inspector - Residential Plumbing Inspector - Residential Combination Inspector - Residential Energy Inspector/Plans Examiner - Commercial Energy Inspector - Commercial Electrical Inspector - Electrical Inspector - Commercial Mechanical Inspector - Mechanical Inspector - Commercial Plumbing Inspector - Plumbing Inspector - Commercial Building Inspector - Building Inspector - Commercial Combination Inspector - Combination Inspector - Accessibility Inspector/Plans Examiner - Fire Inspector I Requirements - Fluent in English - Willing to travel out of country - High School Diploma or GED - Technical knowledge of building construction - Field experience or strong interest in working onsite - Ability to read and understand architectural drawings and specifications - Ability to perform office tasks and physical labor tasks - Ability to perform work from ladders, boom-lifts, scaffolds, roofs, etc. - Ability to efficiently work on projects independently and in a team environment - Excellent organizational and project management skills - Demonstrated ability to meet deadlines - Strong technical writing and communication skills - Consistent and professional interaction and communication with clients and project team - Ability to travel outside local area, depending on local work load and project locations - Valid driver’s license and reliable driving record (required) - Ability to pass a pre-employment physical and drug screening - Fluent in English for the safe and effective performance of the job. - Weekly travel throughout the US Benefits - Competitive compensation packages - Paid time off - Paid holidays - Paid parental leave - Medical plan options - Dental and vision insurance - Life and disability insurance - 401(k) plan with company matching - Tuition reimbursement - And more

• Review and audit files, records, and documentation for accuracy and completeness • Identify discrepancies, errors, or missing information and ensure timely resolution • Maintain organized and up-to-date records in internal systems • Collaborate with team members to ensure compliance with company standards and procedures • Assist with reporting and tracking audit findings • Support process improvements to increase efficiency and accuracy

• Work closely with BSI clients to help them improve their performance by assessing their systems and processes against BSI standards • Compile a business report and present this to the client at the end of each assessment • Recommend the issue, re-issue or withdrawal of certificates and report recommendations in accordance with BSI policy, procedures and prescribed time frame • Prepare assessment reports and deliver findings to clients to ensure client understanding of the assessment decision • Ensure that value is added to customers and their business/organisation through the assessment of their systems and processes against BSI requirements • Continually enhance & uphold the reputation and perception of BSI through excellent planning, delivery, report writing and day-to-day interactions with customers and other key stakeholders • Demonstrate commercial acumen and real added value when feeding back to clients • Lead assessment teams as required ensuring that team members are adequately briefed so that quality of service is maintained and effective working relationships are sustained both with Clients and within the team • Establish and develop an effective partnership which secures the commercial relationship and encourages opportunities for business development and increased client satisfaction with clients in your portfolio.