Claims Quality Review Sr Consltant CNA Financial CorpClaims Quality Review Sr ConsltantSan Francisco, CA$72,000–$141,000 / yearWorks with the Claim Quality Review Director and the Claim Quality Technical Lead for assigned line of business to aggregate and analyze results from quality and manager reviews to identify trending of best practice and opportunity areas for assigned line of business and across the Claim organization. Performs a combination of duties in accordance with departmental guidelines: Completes technical file reviews for assigned line of business; gathers and interprets data, evaluating both technical and operational behaviors associated with functional roles.
Senior Software Engineer, Claims Submissions CommureSenior Software Engineer, Claims SubmissionsMountain View, CaliforniaThe claim generation pipeline: transforming structured claim payloads into valid electronic EDI claims across professional (CMS-1500), institutional (CMS-1450/UB), and dental (CDT) formats, plus paper-claim and PDF generation for payers that require mail or fax. Our platform spans the full care journey: Ambient AI and Dictation eliminating documentation burden at the point of care, intelligent Agents automating patient and revenue workflows, and autonomous RCM processing billions in claims, all on a single AI-native platform integrated with 60+ EHRs.
APeX Claims Analyst UCSF Medical CenterAPeX Claims AnalystSan Francisco, CAYesWorks on complex initiatives to analyze patient care workflow in various clinical departments, and to develop and define information technology solutions for improved system integration and functionality. Ability to work with senior staff and managers, serving as a technical resource and providing advice and counsel on issues of functionality, efficiency, cost-effectiveness, policy, and performance.
Manager, Claims Operations San Francisco Health PlanManager, Claims OperationsSan Francisco, CA$140,000–$150,000 / yearSFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. ABOUT SFHP: Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County.
Senior Complex Claims Manager Airbnb IncSenior Complex Claims ManagerCARemote$125,000–$145,000 / yearIn partnership with key stakeholders in the organization, you'll support our Complex Claims Leader and contribute to Airbnb's multiple year strategy (vision, risk appetite, operating model, goals, KPIs), manage partners to influence prioritization, drive accountability, deliver improvements, and scale changes on claims which impact Airbnb. Philosophy will be to identify intelligence / risk gaps and work with other internal risk management teams (such as Trust team, and Safety team), third party adjusters, our partners, Platform Product Management, Global Crisis Management, Community support, Policy, Privacy Legal teams to strengthen Airbnb's platform.
Claims Assistant PG&E CorpClaims AssistantOakland, CAThe position requires solid management skills, effective communication skills (oral and written), interpersonal skills, conflict resolution skills, the ability to interact with others, including external and internal clients (venders, medical and legal professionals, etc.), knowledge of medical terminology and WC rules and regulations. Must have strong organizational skills, the ability to prioritize, basic arithmetic, computation skills and must be able to make "judgment calls" as needed, when the WCR/WCS is unavailable to provide direction.
Property & Casualty Claims Advocate Hub International LtdProperty & Casualty Claims AdvocateSan Francisco, CA$68,000–$100,000 / yearMaintains accurate and organized claim files by appropriately documenting conversations with clients and carrier representatives; updates all HUB computer systems and automated agency management systems; ensures the accuracy of data. QUALIFICATIONS: High School Diploma / GED 2-3 years property & casualty claims adjustment experience (brokerage preferred) or equivalent combination of education & experience Property & Casualty License required or willingness to obtain within 3 months.
Medical Claims Review Medical Director - Surgeon - Remote UnitedHealth Group Inc.Medical Claims Review Medical Director - Surgeon - RemoteSan Jose, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
Victim Claims Specialist I San Joaquin CountyVictim Claims Specialist ISan Jose, CAMobility-Frequent keyboard operation, sitting; occasional pushing, pulling, bending, squatting; Lifting-Frequent lifting up to 5 pounds; Vision-Constant reading and close-up work requiring good overall vision; frequent eye/hand coordination; occasional color/depth perception and peripheral vision; Dexterity-Frequent holding, gripping, writing and repetitive motion; occasional reaching; Hearing/Talking-Constant hearing normal speech, hearing/talking in person and on the telephone; occasional hearing faint sounds; Emotional/Special Conditions-Frequent public contact, decision making, and concentration; frequent exposure to trauma, grief and death; occasional working overtime. Learns to review and process a variety of claims submitted by victims including medical bills, mental health bills, funeral/burial bills, wage loss requests and other expenses; learns to research information as required to establish a link to the qualifying crime and to verify losses claimed by the victim; learns to calculate losses to victims and determine reimbursements considering all other sources of compensation available; learns to recommend approval or denial of reimbursement and level of services; notifies victims of claim determinations.
Supervisor, Claims Zenith American SolutionsSupervisor, ClaimsSan Francisco, CaliforniaZenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.
Claims Processor 3 Zenith American SolutionsClaims Processor 3San Francisco, CaliforniaWe are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. High school diploma or general education degree (GED); two years related experience processing all types of group health and/or dental benefit claims.
Claims Processor 1 Zenith American SolutionsClaims Processor 1San Francisco, CaliforniaWe are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide.
Senior Construction Claims Specialist Jacobs Solutions IncSenior Construction Claims SpecialistOakland, CAAlbuquerque, New Mexico, United States | 43090 | Cities & Places | Drafting and Design | Multiple Locations. Philadelphia, Pennsylvania, United States | 42970 | Advanced Manufacturing | Drafting and Design | Multiple Locations.
Senior Epic Applications Analyst - Professional Billing and Claims Delta Dental of California Inc.Senior Epic Applications Analyst - Professional Billing and ClaimsOakland, CA$80,500–$174,300 / yearWorks independently to prepare and plan all aspects of the Requirements discipline, including controlling or participating in estimating, feasibility analysis, meeting facilitation, management and executive reporting, change request management, issue tracking, process improvements, and project planning. Provides support as needed throughout the project lifecycle, participating directly in issue resolution, break and hot fix support, and triage in the identification and resolution of all project incidents, documentation maintenance and traceability as related to the Requirements discipline.
MSO Claims Manager North East Medical ServiceMSO Claims ManagerBurlingame, CAThis role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
NewMedicare Compliance Claim Analyst - Michigan AAA Southern New EnglandMedicare Compliance Claim Analyst - MichiganFremont, CAFor all Medical related areas: Act as a liaison between the customer, and providers in order to: research payment status, explain payment amounts approved, resolve lower-level reconsiderations, verify coverage, explain coordination of benefits pre-authorization and correct billing procedures to providers, etc. By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
Senior Medical Content Writer, Claims-Capable Pride GlobalSenior Medical Content Writer, Claims-CapableSouth San Francisco, CA$50–$68.68 / hourOnly applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, upon any inquiry of parental leave or lactation accommodation. This role focuses on creating and substantiating medical claims, producing MLR-ready content, and collaborating with creative, medical, and regulatory teams to deliver accurate, compliant, and engaging materials.
Workers Compensation Associate Claim Representative The Travelers Companies IncWorkers Compensation Associate Claim RepresentativeSan Francisco, CA$52,600–$86,800 / yearAs an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Senior Medical Content Writer, Claims-Capable Actalent IncSenior Medical Content Writer, Claims-CapableSouth San Francisco, CA$41–$64 / hourWe are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing winner for both client and talent service. Write medical content across various formats, including HCP materials, patient education, disease-state content, congress panels, digital assets, video scripts, and sales materials.
Senior Medical Content Writer, Claims-Capable Pride Technologies LLCSenior Medical Content Writer, Claims-CapableSouth San Francisco, CA$50–$68 / hourOnly applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, upon any inquiry of parental leave or lactation accommodation. This role focuses on creating and substantiating medical claims, producing MLR-ready content, and collaborating with creative, medical, and regulatory teams to deliver accurate, compliant, and engaging materials.