Senior Complex Claims Specialist EMC Insurance Group Inc.Senior Complex Claims SpecialistCA$103,954–$149,372 / yearServes as the subject matter expert on highly complex coverage issues impacting assigned claims, seeks assistance when needed or appropriate, issues coverage correspondence, and takes coverage into account when setting reserves and driving claims towards resolution. Reviews and communicates comprehensive evaluations of assigned claims presenting serious injuries (such as fatality, amputation, loss of sight, burns, paraplegia, quadriplegia, sex abuse, etc.), intellectual property claims, and claims with exposures of $750,000 or greater.
Fractional Customer Service (Claims) Manager Silva-Lining HRFractional Customer Service (Claims) Managerlos Angeles, CARemoteSilva-Lining HR is seeking a Fractional Customer Service (Claims) Manager for a client to oversee and optimize the end-to-end claims process, ensuring timely resolution, operational efficiency, and exceptional customer experience. Lead project management efforts for claims resolution, including task delegation and coordination with internal team members, vendor partners, shipping providers, and repair services.
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.
Medical Claims Resolution Specialist Kinetic Personnel Group, Inc.Medical Claims Resolution SpecialistOrange, CA$25–$31 / hourA full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one! Job duties: Addresses provider inquiries, questions, and concerns in all areas including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.
Lead - Claims Examiner Astrana Health IncLead - Claims ExaminerMonterey Park, CAManager - Claims and enable us to continue to scale in the healthcare industry. We are currently seeking a highly motivated Lead - Claims Examiner.
Senior Claims Auditor Astrana Health IncSenior Claims AuditorMonterey Park, CAThis role will report to the Director - Claims and enable us to continue to scale in the healthcare industry. About the Role: We are currently seeking a highly motivated Senior Claims Auditor.
(USA) Tire and Battery Service Advisor Walmart Inc(USA) Tire and Battery Service AdvisorLONG BEACH, CA$21–$29 / hourLeverages technology to enhance operations and engagement by using digital tools and handheld devices to plan sales, improve the service experience, make real-time business decisions, stay informed about products and training, and encourage THE adoption of new tools among team members. Respect the Individual: Embraces differences in people, cultures, ideas, and experiences; creates a workplace where associates feel seen, supported and connected through a culture of belonging; creates opportunities for all associates to thrive and perform; helps to attract the best talent.
Assistant Director, Claims Operations Impresiv HealthAssistant Director, Claims OperationsHuntington Beach, CA$95,000–$120,000 / yearThe Assistant Director will provide operational, analytical, administrative, and project support across claims processing, 837 file oversight, payment integrity, issue resolution, provider and IPA coordination, reporting, audit readiness, system initiatives, and process improvement. Track, document, escalate, and help resolve complex claims issues involving providers, IPAs, delegated entities, vendors, and internal departments.
WC Claim Associate I LevelUP CCMSIWC Claim Associate I LevelUPIrvine, CaliforniaRemoteIn simple terms: you’ll learn how to help employees who are injured at work navigate the claim process, communicate with people involved, gather information, document decisions, and keep things moving forward—accurately, timely, and with care. 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.
Senior Claim Representative - Liability (Hybrid) Intact InsuranceSenior Claim Representative - Liability (Hybrid)Irvine, CA$88,000–$92,000 / yearSome of the Senior Claim Representative responsibilities include but are not limited to: Makes timely and appropriate contacts, determines and completes appropriate level of investigation to make determination of coverage, assess liability and determine damages. We currently have an opportunity for a Senior Claim Representative to join our Liability team based in our Plymouth, MN; Denver, CO; Canton, MA; New York City, NY; Chicago, IL; Alpharetta, GA; Irvine, CA; Southfield, MI offices on a hybrid schedule.
Commercialization Professional - Contracts Jacobs Solutions IncCommercialization Professional - ContractsLos Angeles, CA$98,900–$167,625 / yearBachelor's degree in Business Management, Supply Chain Management, Procurement, Finance, Economics, Commerce, Engineering, Operations Management, or a related field; or a Master's degree in Business Administration (MBA), Supply Chain Management, Finance, Economics, Operations Management, or a related discipline. At Jacobs, we're challenging today to reinvent tomorrow by solving the world's most critical problems for thriving cities, resilient environments, mission-critical outcomes, operational advancement, scientific discovery and cutting-edge manufacturing, turning abstract ideas into realities that transform the world for good.
Sales Implementation Analyst (50505) Western GrowersSales Implementation Analyst (50505)Irvine, CADo everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results. The position acts as the primary liaison between Sales, Account Management, brokers, clients, and Installation by leading requirements discovery, confirming scope, identifying operational dependencies, and translating complex client expectations into clear, actionable implementation documentation.
Eligibility Specialist II (50925) Western GrowersEligibility Specialist II (50925)Irvine, CAIntermediate knowledge of generally accepted health care eligibility and billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California Continuation Benefits Replacement Act (Cal-COBRA) and Employee Retirement Income Security Act (ERISA) legislation. The Eligibility Specialist II requires the ability to process enrollment and billing functions, both automated and manual, with in the company's processing system necessary to maintain Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc. (PCMI) accounts) as assigned including groups that submit Electronic Data Interchange (EDI) eligibility.
Group Set-Up Specialist (50519) Western GrowersGroup Set-Up Specialist (50519)Irvine, CAResponsible for set-up and rate structure of new groups, maintaining and updating existing groups/clients for Western Growers Assurance Trust (WGAT), and Pinnacle Claims Management Inc. (PCMI) using the Health Care Processing System (HCPS). Proven project management abilities -including time and task management, delegating assignments, and working collaboratively to meet deadlinesInternet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Claims Adjuster Senior GallagherClaims Adjuster SeniorTorrance, CaliforniaRemoteFull timeThe actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
Installation Auditor (50574) Western GrowersInstallation Auditor (50574)Irvine, CADo everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results. The Installation Auditor ensures accurate setup of new and renewing health benefit plans by auditing documentation for compliance with Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc (PCMI).
Supervisor, Benefit Distribution and Installation (50544) Western GrowersSupervisor, Benefit Distribution and Installation (50544)Irvine, CAInterface with personnel in all field offices, TPA employers and brokers, and management staff as necessary to communicate any problems or issues with paperwork submission or installation issues for new business, plan changes, rate renewals and rate changes. Oversee the implementation of each new client with the third party administratorion (TPA) client, with necessary communication between the broker, PCMI operational areas, the client and any external vendor as necessary, including the review, completion & sign-off on Client Set-up Sheetsforms/screens.
NewSpecialist, Accounts Receivable Lundbeck LLCSpecialist, Accounts ReceivableCARemoteWorking with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork. Documents client's host system utilizing the 5 W's framework and related policies/procedures to ensure accurate and complete documentation and then copies account notes into Amplify's workflow tool.
Claims Adjuster, Worker''s Compensation Pie Insurance Holdings IncClaims Adjuster, Worker''s CompensationCARemote$70,000–$90,000 / yearThis role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie's customers. The Claims Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience.
Account Manager - PCMI (50870) Western GrowersAccount Manager - PCMI (50870)Irvine, CAThis position reports to the Director, Account Management for Pinnacle Claims Management (PCMI) and is responsible for managing customer accounts during and following the sale of employer benefit programs and services including Pinnacle third party administration (TPA), Pinnacle Rx Solutions (PRxS), Pinnacle Health Management (PHM), and complete ancillary benefits offered by PCMI vendor partners including the Western Growers Insurance Services (WGIS) employer benefit programs. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.