Workers Compensation Claims Examiner | Hybrid | Orange, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Hybrid | Orange, CAOrange, CA$80,000–$100,000 / yearMental: 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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Workers Compensation - Claims Examiner | HYBRID | Riverside, CA Sedgwick Claims Management Services, Inc.Workers Compensation - Claims Examiner | HYBRID | Riverside, CARiverside, CA$80,000–$100,000 / yearMental: 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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Workers Compensation Claims Examiner | HYBRID | Orange, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | HYBRID | Orange, CAOrange, CA$80,000–$100,000 / yearMental: 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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Workers Compensation Claims Examiner | Long Beach or Roseville, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Long Beach or Roseville, CALong Beach, CA$85,000–$105,000 / yearMental: 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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Workers Compensation - Claims Standards & Compliance Analyst | Ontario, California Sedgwick Claims Management Services, Inc.Workers Compensation - Claims Standards & Compliance Analyst | Ontario, CaliforniaOntario, CA$80,000–$98,000 / yearProgram compliance initiatives supported for audit compliance, subject to but not limited to benefit timeliness and accuracy, file balancing compliance, training for penalty and interest avoidance strategies, and mitigation of excess costs. Prepares offices for regulatory audits, serves as a liaison with state auditors, participates in audit debriefs, and assists in developing rebuttal responses when required.
Analyst I, Epic Application Professional Billing and Claims PDS HealthAnalyst I, Epic Application Professional Billing and ClaimsIrvine, California$83,000–$103,000 / yearFull timeOverview: The Analyst I, Epic Application Professional Billing and Claims is primarily responsible for assisting with basic Epic Professional Billing and Claims system configuration, routine tasks like build updates, testing, and report creation. Strong problem-solving and troubleshooting skills with the ability to analyze complex issues and recommend effective solutions.
Supervisor, Medicare Claims Clever Care Health PlanSupervisor, Medicare ClaimsHuntington Beach, CA5% - Facilitates and creates a team environment within the unit and with other departments; runs regular unit meetings, attends monthly claims review meetings and/or Clever Care meetings, as appropriate, in order to ensure effective communication between team members and disciplines. Participates in interviewing and hiring of new staff and facilitates or conducts effective onboarding and orientation for new employees; coordinates with the Manager for development of formal training programs; assigns staff to special projects and oversees workflow and workload of staff.
Sr. Manager - Claims Delegation Audit Astrana Health IncSr. Manager - Claims Delegation AuditMonterey Park, CAThis role will be responsible for the development and execution of department strategies, overall Audit program, Audit process optimization, and management, identifying and leveraging technology and data to improve the quality and minimizing process cost of Claims. The 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.
Workers Compensation Large Loss Claims Director CNA Financial Corp.Workers Compensation Large Loss Claims DirectorBrea, CA$97,000–$189,000 / yearWorking closely with claims leadership, disposition consultants, legal services, customers, brokers, and business partners, the Large Loss Director drives superior claim outcomes, technical excellence, operational effectiveness, and profitable growth while serving as a mentor and resource to claims professionals across the organization. This individual contributor role provides company-wide influence and leadership in the interpretation of complex policy coverages, litigation management, reserving, claim resolution strategies, regulatory compliance, and large loss methodologies.
Claims Specialist Diversity Caree HubClaims SpecialistOrange, CaliforniaManage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement. Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience.
Workers' Compensation Claims Supervisor - Orange, CA (PERM - HYBRID) Johnson Service GroupWorkers' Compensation Claims Supervisor - Orange, CA (PERM - HYBRID)Orange, CA$100,000–$110,000 / yearManaging People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services; Continually works to improve supervisory skills. Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Inspires respect and trust; Accepts feedback from others; Provides vision and inspiration to peers and subordinates; Gives appropriate recognition to others; Displays passion and optimism; Mobilizes others to fulfill the vision.
Avp, Claims Client Services CNA Financial Corp.Avp, Claims Client ServicesBrea, CA$152,000–$242,000 / yearLeads or participates in claim/ broker meetings, national meetings (i.e. RIMS), mid-term account reviews, stewardship meetings, renewals and new business offerings by collaborating and partnering with Client Service team, Marketing, Sales and Distribution, Underwriters, Brokers/Agents to understand customer needs, and package claim capabilities, customer-specific trends and industry data, into a compelling story and/or proposition for existing and prospective customers. Acts as a key point of contact both internally and externally at senior levels for National Brokers, Agencies and CNA Branch Vice Presidents by representing CNA Claims, communicating claim strategies, and initiatives, promoting product and service capabilities, establishing proactive touchpoints, ensuring timely responses and problem resolution and gathering and sharing feedback throughout the organization.
AVP, Claims Client Services CNA Financial CorpAVP, Claims Client ServicesBrea, CA$152,000–$242,000 / yearLeads or participates in claim/ broker meetings, national meetings (i.e. RIMS), mid-term account reviews, stewardship meetings, renewals and new business offerings by collaborating and partnering with Client Service team, Marketing, Sales and Distribution, Underwriters, Brokers/Agents to understand customer needs, and package claim capabilities, customer-specific trends and industry data, into a compelling story and/or proposition for existing and prospective customers. Acts as a key point of contact both internally and externally at senior levels for National Brokers, Agencies and CNA Branch Vice Presidents by representing CNA Claims, communicating claim strategies, and initiatives, promoting product and service capabilities, establishing proactive touchpoints, ensuring timely responses and problem resolution and gathering and sharing feedback throughout the organization.
New#8813.00 JPA Claims Services Manager - California Schools Joint Powers Authority, San Bernardino San Bernardino County Superintendent of Schools#8813.00 JPA Claims Services Manager - California Schools Joint Powers Authority, San BernardinoSan Bernardino, CA$176,388.08–$198,743.04 / yearMINIMUM QUALIFICATIONS •Possession of a Bachelor's Degree; •Four (4) years experience in workers' compensation claims handling, claims supervision or workers' compensation brokerage claims service, including supervision of staff; •Three (3) years experience developing, analyzing and preparing workers' compensation statistical claim data; •Two (2) years experience facilitating professional development workshops and trainings. The San Bernardino County Superintendent of Schools office acts as an intermediate service agency between the California Department of Education and the 33 school districts in San Bernardino County to help meet the educational needs of all children county-wide.
Sr. Manager - Claims Astrana Health IncSr. Manager - ClaimsMonterey Park, CAYou'll partner closely with internal teams, resolve escalations, and coach a team of claims professionals to deliver compliant, efficient, and accurate outcomes in a fast‑paced environment. In this role, you'll oversee daily claims processing, drive quality and turnaround time performance, and support the onboarding of new IPAs and implementations.
Claims Resolution Specialist (Customer Service) CalOptimaClaims Resolution Specialist (Customer Service)Orange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our Claims Administration 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.
Product Director, Healthcare Claims Payments-Executive Director JPMorgan Chase & CoProduct Director, Healthcare Claims Payments-Executive DirectorIrvine, CAAs a leader on the team, you leverage your advanced capabilities to challenge traditional approaches, remove barriers to success, and foster a culture of continuous innovation that helps inspire cross-functional teams to create groundbreaking solutions that address customer needs. Morgan Payments, we connect consumers, providers, payers, and health tech companies across every healthcare payment transaction, creating a faster, simpler experience for all.
NewLiability Claims Examiner Sedgwick Claims Management Services, Inc.Liability Claims ExaminerBrea, CA$85,000–$105,000 / yearMental: 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. PRIMARY PURPOSE: To address and handle high end General Liability cases with serious injuries, complex coverage scenarios and legal inquiries or disputes; to develop a strategy to bring a case to satisfactory resolution.
Senior Counsel, Claims & Litigation CR England, Inc.Senior Counsel, Claims & LitigationColton, CAWorking under the Associate General Counsel, this attorney directly conducts hands-on litigation work, particularly in early stages, with oversight of matters transitioned to outside counsel, focusing on strategy, risk management, and efficient resolution. Review and analyze discovery responses, medical records, accident reports, ELD data, driver qualification files, video evidence, maintenance records, and other litigation documentation to identify key facts and inform defense strategy.
Claims Examiner - Workers Compensation (Hourly) Iconma LLCClaims Examiner - Workers Compensation (Hourly)Brea, CAResponsibilities: Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.