Claims Specialist II Blue Cross and Blue Shield AssociationClaims Specialist IILos Angeles, CANecessary Contacts: In order to effectively fulfill this position, the Claims Specialist II must be in contact with personnel in other Units: Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Enrollment and Billing, Administrative Services, and District Offices. Reviews, researches, and makes necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction.
Director Complex Claims and Counsel Banner HealthDirector Complex Claims and CounselCA$65.70–$109.50 / hourResponsible for obtaining, entering data into claim file and monitoring such data in order to comply with deadlines for meeting Medicare, Medicaid, Ship Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medical expense claims. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
Senior Manager, Claims Adjustments L.A. Care Health PlanSenior Manager, Claims AdjustmentsLos Angeles, CAThe Senior Manager, Claims Adjustments manages all adjustment-related operational workflows, including provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support. Ensures all provider adjustments meet Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and contractual (TAT) requirements.
Claims Examiner Career AdvocatesClaims ExaminerLos Angeles, CaliforniaThe Claims Examiner will be responsible for researching and resolving pending claims, reviewing claim denials requiring manual review, and ensuring timely processing in compliance with policies, procedures, and regulatory guidelines. Assist in claims processing and report billing/error trends identified during reviews.
Sr. Manager - Claims Delegation Audit Astrana Health, Inc.Sr. Manager - Claims Delegation AuditMonterey Park, California$125,000–$140,000 / yearThe position alongside the leadership team will contribute to driving strategic planning, operational excellence, and accuracy of the claims process and ensure compliance with regulations and contract requirements for Medicare, Commercial Exchange, and Medicaid service lines. External Audit planning, execution & support Own the end‑to‑end strategy and execution of all external audits (e.g., CMS, DMHC, health plan audits), ensuring readiness, successful delivery, and continuous score improvement.
NewGuidewire Developer, Senior Associate PwCGuidewire Developer, Senior AssociateLos Angeles, CA$77,000–$202,000 / yearThese individuals analyse client needs, implement software solutions, and provide training and support for seamless integration and utilisation of business applications, enabling clients to achieve their strategic objectives. PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy .
Patient Account Representative - Medicare, Medicaid, Commercial Claims GuidehousePatient Account Representative - Medicare, Medicaid, Commercial ClaimsEl Segundo, CA$34,000–$56,000 / yearCompensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com.
Account Manager - Valet of Operations Orange County Market Towne Park LtdAccount Manager - Valet of Operations Orange County MarketSan Pedro, CA$80,000–$90,000 / yearThe associate is regularly required to run; stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk and hear. Whether providing compassionate service that eases the anxiety of a patient and their family, creating a memorable experience for a guest in a new city, or helping a colleague, every day is a new opportunity to brighten someone else's day and make an impact.
Lead - Claims Examiner Astrana Health, Inc.Lead - Claims ExaminerMonterey Park, CA$27–$32 / hourWork closely with other Company departments and specifically, the Claims QA and Training Specialist to communicate findings of recovery audits and to facilitate accurate adjudication of claims. Ensures that all legal, regulatory and policy requirements are met by keeping informed of changes and by implementing necessary controls and/or programs to meet requirements.
Claim Account Manager, NAC Arch Capital Group LtdClaim Account Manager, NACLos Angeles, CA$123,400–$166,600 / yearMinimum of ten (12) years working experience overseeing and managing multi-line claims including auto liability, general liability, workers compensation, products and professional liability for high deductible and self-insured accounts. Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs.
Claims Representative Mercury Insurance CompanyClaims RepresentativeCA$32,363–$56,701 / yearThe Claims Representative will handle a high volume of calls and make regular contact with customers on multiple platforms, collaborating cohesively with other team members to achieve department goals. Sets reserves for anticipated losses, arranges vehicle inspections and rental authorizations, and makes referrals to specialty teams as warranted.
Worker's Compensation Claim Counsel TravelersWorker's Compensation Claim CounselWoodland Hills, CaliforniaAs a Counsel with Travelers you will be responsible for high quality, proactive case handling and will have the opportunity to use your legal expertise and litigation skills to handle a caseload of predominantly low to moderate complexity and deliver optimal results for Travelers' insured customers. Travelers offers the strength of a national legal organization committed to your professional development while maintaining a local focus, positioning you as a strong business partner and trusted advisor who delivers exceptional value through local expertise and outstanding client service.
Sr. Medical Case Manager Crawford & CoSr. Medical Case ManagerLos Angeles, CAReviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual''s medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.
NewCompliance Reviewer HCC Life Insurance CompanyCompliance ReviewerCARemote$50,000–$80,000 / yearThe Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e))(the "VCCLEA"), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. With the strength and stability that comes from being a member of the Tokio Marine Group, and more than fifty years of growth, profitability, and stability, we offer important insurance products that most people don't even know exist.
Business Technology Strategy Lead - Claims, Finance, HR, Legal & Compliance L.A. Care Health PlanBusiness Technology Strategy Lead - Claims, Finance, HR, Legal & ComplianceLos Angeles, CAThe TPM II applies functional healthcare systems knowledge to ensure solutions meet business intent and regulatory requirements, leverages data to measure outcomes and validate hypotheses, and promotes disciplined product management practices within the domain. Collaborates with IT and business partners to ensure solutions within the domain comply with Health Insurance Portability and Accountability Act (HIPAA), Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and other relevant regulatory requirements.
AVP, Central Operations Services Arch Capital Group LtdAVP, Central Operations ServicesCA$111,300–$172,700 / yearTotal individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential.
Nurse Utilization-ClinicalAnalyst (Bilingual Spanish/English) MedRisk LLCNurse Utilization-ClinicalAnalyst (Bilingual Spanish/English)CARemoteDemonstrates basic problem-solving skills to ensure early intervention and identification of those injuries which will benefit from medical case management or to deliver self-care advice during the triage process. The clinical advisor services analyst II nurse is responsible for performing telephonic assessments of work-related injuries.
Senior Contracts Manager SCS EngineersSenior Contracts ManagerLong Beach, California$130,000–$200,000 / yearFull timeIn this high-impact role, you'll serve as a trusted advisor to executive leadership, project managers, finance, procurement, and legal stakeholders, guiding complex agreements from initial negotiations through final closeout. SCS is building a world where environmental systems and infrastructure strengthen the health, safety and resilience of communities — from reducing methane emissions at landfills to producing alternative energy, from repurposing contaminated properties to sequestering carbon.
Claims Specialist II Mercury Insurance CompanyClaims Specialist IICA$44,466–$77,881 / yearBodily Injury Claims Management: Analyze medical records to evaluate, negotiate, and settle moderate bodily injury claims with legal counsel for represented claimants and unrepresented parties. If you're passionate about helping people restore their lives when the unexpected happens, and providing high-quality customer experiences, then our Mercury Insurance Claims team could be the place for you!
Environmental Health & Safety (EHS) Coordinator 8FleetEnvironmental Health & Safety (EHS) CoordinatorLos Angeles, CaliforniaThis role will work closely with the HR Generalist and Operations teams to ensure compliance with OSHA regulations, workers’ compensation procedures, workplace safety initiatives, and drug testing programs. 8Fleet is a rapidly growing LA-based technology and logistics startup building the operational infrastructure for both non-autonomous and future autonomous rideshare fleets.