NewClaims Resolution Specialist - Covered California CalOptimaClaims Resolution Specialist - Covered CaliforniaOrange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist - Covered California and help shape the future of healthcare where you'll be an integral part of our CLA - Claims Production team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
Junior Claims Processor Southern California Pipe Trades Administrative CorporationJunior Claims ProcessorLos Angeles, CAFull timeJOB RESPONSIBILITIES:Specific:Review and resolve participant repayment accounts, including determining amounts owed and issuing repayment notices through the WEX online benefits platform. Review and resolve vision auto-adjudication claims, including approving claims and requesting additional information through the WEX online benefits platform.
Claims Associate - Workers Compensation Apidel TechnologiesClaims Associate - Workers CompensationBrea, CARemoteContractorSkills & Knowledge Excellent oral and written communication skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
NewSenior Claims Auditor - Managed Care Cedars-Sinai Medical CenterSenior Claims Auditor - Managed CareCalifornia, CAThe incumbent leads cross departmental audit initiatives, performs specialized system testing, and supports internal and external regulatory audits. Produces written and verbal reports summarizing audit findings for leadership, highlighting compliance risks and recommending mitigation strategies.
Property & Casualty Claims Manager (Workers Compensation & General Liability) Sweetgreen IncProperty & Casualty Claims Manager (Workers Compensation & General Liability)Los Angeles, CAProperty & Casualty Claims Manager (Workers Compensation & General Liability) - Sweetgreen Inc.
Claims Assistant ICONMA, LLCClaims AssistantLos Angeles, CA$16.90–$23.71 / hourProficient computer skills and extensive knowledge of the Microsoft suite of Office products, including Outlook (use templates that are provided), Word (utilizing templates), Excel (data entry), and PowerPoint (basic creation of slide deck); knowledge of state EDI systems and/or familiarity with CA Workers Compensation terminology are a plus. Responsibilities: This worker will be assisting Lost Time Examiners with benefit notices, settlement documents, requesting records, and indemnity payments.
Claims Advocate- P&C Edgewood Partners Insurance CenterClaims Advocate- P&CLos Angeles, CA$95,000–$105,000 / yearFueled and driven by capable, committed people who share common beliefs and values and "bring it" every day, EPIC is always looking for people who have "the right stuff" - people who know what they want and aren't afraid to make it happen. Managed PTO for salaried/exempt employees (personal time off without accruals or caps); 22 PTO days starting out for hourly/non-exempt employees; 12 company-observed paid holidays; 4 early-close days.
Senior Workers Compensation Claims Advocate Alliant Insurance Services, Inc.Senior Workers Compensation Claims AdvocateIrvine, CAManages workers' compensation claims for assigned clients; Provides value added services for Producers, focusing on account retention and obtaining new business; Provides technical field support on complex claims and accounts; Assists Unit Manager with units administration; Conducts quarterly claims review meetings with employer representatives; Obtains loss runs and claim status; discusses claims finalization plans with adjusters; Provides individual claims analysis reports; Conducts unit statistical review meetings; Obtains customers' experience rating worksheet from the Workers Compensation Insurance Rating Bureau; Produces experience modification projections and "what if" scenarios; Attends new business calls and presents department services; Provides technical assistance to Producers and clients; Other duties as assigned. We operate through a network of specialized national platforms and local offices to offer our clients a comprehensive portfolio of solutions built on innovative thinking and personal service.