120 Results for

Claims Jobs in Berkeley, CA

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Remote Liability Claims Examiner | General Liability Exp. Required Sedgwick Claims Management Services, Inc.

Concord, CA

Remote

$90,000–$115,000 / year

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. PRIMARY PURPOSE: To address and handle high end Public Entity 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.

4 days ago

Claims Specialist Lead The Progressive Corp

Concord, CA

$39.18–$51.92 / hour

For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://careers.progressive.com/pages/how-we-hire-faq-job-scams/ . As a claims specialist on our team, you'll play a critical role in our ability to successfully and efficiently resolve large-loss injury claims valued over $60k.

30+ days ago

Senior Claims Examiner - Workers'''' Compensation (California) ICW Group

Pleasanton, CA

$68,481.25–$115,489.01 / year

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for the twelfth consecutive year in a row and for the 20th time overall as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. Bachelor's degree (or equivalent combination of education and experience) required along with a minimum of 5+ years' related claims handling experience required; complex litigated claims experience is highly preferred.

15 days ago

Nonprofit Medi-Cal Claims Specialist (Part-Time) WestCoast Children's Clinic

Oakland, CA

$26–$28 / hour

BA/BS degree preferred Minimum one year of experience with Microsoft Office applications - Excel and Word At least one year of experience with Google Suite Professional experience in an office setting At least one year of experience with Medi-Cal billing procedures and processes is preferred. Generate billing reports from Welligent (WestCoast’s internal EHR) and input claims data into Alameda County’s EHR (Smart Care) and upload services to the City and County San Francisco EHR (EPIC).

4 days ago

Pharmacy Claims and Rebates Audit Consultant Marsh & McLennan Companies Inc

San Francisco, CA

$102,500–$204,500 / year

We will count on you to: Lead end-to-end pharmacy claims and rebate audits for complex, high-visibility clients, applying deep working knowledge of pharmacy claims data and every claim field and component (e.g., NDC, days' supply, quantity, ingredient cost, dispensing fee, copay/coinsurance, DAW code, prior authorization, and plan/formulary edits) to manually and analytically identify claims that were mispriced, misadjudicated, or paid outside of contract or plan terms. As a Pharmacy Claims and Rebates Audit Consultant, you will lead complex pharmacy claims and pharmacy rebate audits from planning through final report, applying deep expertise in pharmacy benefits, PBM contracts, and rebate economics.

8 days ago

Workers Compensation Claims Examiner Sedgwick Claims Management Services, Inc.

Concord, CA

$80,000–$100,000 / year

PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult California workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. 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.

2 days ago

Veterans Claims Examiner U.S. Department of Veterans Affairs

Oakland, CA

$133,060–$172,980 / year

Please make sure you have included other documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50s (current/former Federal employees), documentation to support Veterans Preference claims, or ICTAP/CTAP documentation (for displaced Federal employees). MINIMUM QUALIFICATION REQUIREMENT: You may qualify based on your experience as described below: GS-13 Grade Level: Specialized Experience: Specialized Experience is experience that has equipped the applicant with the particular knowledge, skills, and abilities to perform successfully the duties of the position(s), and that is typically IN OR RELATED TO the work of the position to be filled.

3 days ago

Claims Manager, Professional Liability Starr International Co Inc

San Francisco, CA

$150,000–$175,000 / year

The successful candidate will be required to evaluate coverage, draft coverage correspondence, undertake claims investigations, manage defense counsel and legal spend, assess liability and financial exposure, and effectively negotiate cost effective, good faith claims resolutions. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets: experience and training: licensure and certifications: and other business and organizational needs.

30+ days ago

Director, Claims Starr Insurance

San Francisco, California

$150,000–$175,000 / year

The role requires coordinated activity with third-party administrators (TPAs), close collaboration with home office personnel on large losses exceeding branch authority, and establishing strong, productive relationships with underwriting and other key stakeholders. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets: experience and training: licensure and certifications: and other business and organizational needs.

23 days ago

Claims Customer Service Representative I Partnership HealthPlan of California

Fairfield, California

$29.95–$35.19 / hour
Full time

To accurately research and process paper and electronic medical, outpatient, ancillary, long term care, CHDP, encounter data and paper crossover/other coverage claims within established time frames, applying appropriate program policies related to claims processing and analysis. Overview: To research and resolve provider telephone and written inquiries within established time frames, accurately screen claims, and participate in provider meetings and projects.

30+ days ago

Supervisor, Claims Zenith American Solutions

San Francisco, California

Zenith 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.

23 days ago

Nonprofit Medi-Cal Claims Specialist Part-Time WestCoast Childrens Clinic

Oakland, CA

$26–$28 / hour

Responsibilities: Generate billing reports from Welligent (WestCoast's internal EHR) and input claims data into Alameda County's EHR (Smart Care) and upload services to the City and County San Francisco EHR (EPIC). WestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families.

13 days ago

Claims Processor, Specialist Blue Cross and Blue Shield Association

Oakland, CA

We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially.

2 days ago

Claims Customer Service Representative III Partnership HealthPlan of California

Fairfield, California

$33.65–$40.38 / hour
Full time

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and.

30+ days ago

Claims Examiner II Partnership HealthPlan of California

Fairfield, California

$31.45–$37.74 / hour
Full time

Reviews, researches, and resolves pended claims for Medi-Cal types: medical, hospital, ancillary, long term care, encounter data, other coverage, and batch claims within. The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.

30+ days ago

MSO Claims Manager North East Medical Service

Burlingame, CA

This 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.

30+ days ago

Workers' Compensation Claim Supervisor CCMSI

Concord, California

Remote

$110,000–$115,000 / year

Responsibilities: When we hire supervisors at CCMSI, we look for people-leaders who recognize that every claim impacts a real person’s livelihood, hold themselves and their teams accountable for results, and approach challenges as opportunities to develop others and drive excellence. At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.

27 days ago

Director, Senior Cyber Claims Advocate Willis Towers Watson PLC

San Francisco, CA

$150,000–$215,000 / year

WTW provides a competitive benefit package which includes the following (eligibility requirements apply): Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identify Theft Protection, Wellbeing Program and Work/Life Resources (including Employee Assistance Program). This role serves as a trusted advisor to clients on complex coverage issues, litigation strategy, carrier negotiations, policy interpretation, and emerging insurance risks., while supporting client retention, business development, and the continued growth of the FINEX Practice.

1 day ago

Workers' Compensation Claim Specialist CCMSI

Concord, California

Remote

$88,000–$92,000 / year

Responsibilities: When we hire Workers’ Compensation Adjusters at CCMSI, we look for detail‑driven problem‑solvers who balance empathy with sound judgment, navigate complex regulations with confidence, and deliver fair, timely outcomes that support injured workers and strengthen client trust. At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.

30+ days ago

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Claims Jobs in Berkeley, CA

Remote Liability Claims Examiner | General Liability Exp. Required Sedgwick Claims Management Services, Inc.

Claims Specialist Lead The Progressive Corp

Senior Claims Examiner - Workers'''' Compensation (California) ICW Group

Nonprofit Medi-Cal Claims Specialist (Part-Time) WestCoast Children's Clinic

Pharmacy Claims and Rebates Audit Consultant Marsh & McLennan Companies Inc

Workers Compensation Claims Examiner Sedgwick Claims Management Services, Inc.

Veterans Claims Examiner U.S. Department of Veterans Affairs

Claims Manager, Professional Liability Starr International Co Inc

Director, Claims Starr Insurance

Claims Customer Service Representative I Partnership HealthPlan of California

Supervisor, Claims Zenith American Solutions

Nonprofit Medi-Cal Claims Specialist Part-Time WestCoast Childrens Clinic

Claims Processor, Specialist Blue Cross and Blue Shield Association

Claims Customer Service Representative III Partnership HealthPlan of California

Claims Examiner II Partnership HealthPlan of California

MSO Claims Manager North East Medical Service

Workers' Compensation Claim Supervisor CCMSI

Director, Senior Cyber Claims Advocate Willis Towers Watson PLC

Workers' Compensation Claim Specialist CCMSI

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