Claims Specialist Lead The Progressive CorpClaims Specialist LeadConcord, CA$39.18–$51.92 / hourFor 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.
Claims Appraiser - Auto Estimatics State FarmClaims Appraiser - Auto EstimaticsFremont, California$78,862.06–$102,500 / yearFull timeWith the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! Additional Details: Employees must successfully complete all required training, including applicable proficiency, licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s).
Claims Process Specialist LancesoftClaims Process SpecialistOakland, CARemote$18Job duties include: Examine garnishments, levies, liens and information subpoenas to ensure accuracy, completeness and legal sufficiency. Claims include garnishments, levies, liens and information subpoenas received from creditors and taxing authorities.
Claims Examiner II North East Medical ServiceClaims Examiner IIBurlingame, CAESSENTIAL JOB FUNCTIONS: Perform the daily examination, auditing and adjudication activities to submitted hospital and professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual. Responsible to prepare files and documents for the annual health plan delegation oversight audits, assist Claims Supervisor with MSO management reports, and other special projects as needed.
NewRemote Workers Compensation Claims Examiner | CA Jurisdiction Sedgwick Claims Management Services, Inc.Remote Workers Compensation Claims Examiner | CA JurisdictionConcord, CARemote$80,000–$105,000 / yearPRIMARY 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.
Senior Contracts & Claims Manager Aequor Technologies LLCSenior Contracts & Claims ManagerVacaville, CABusiness and financial acumen; " Contracting strategy & execution, strategic sourcing expertise, procurement/sourcing knowledge/experience for large CAPEX projects; " A strong understanding of construction technology, sequencing and practices; " Exceptional problem solving and analytical skills; " Demonstrated project management skills; " Demonstrated experience developing and implementing sourcing strategies that have yielded measurable business results. " Identifying opportunities for outgoing claims, development of claim strategies, supporting/preparing notifications/correspondence as well as negotiation and settlement; " Analysis of incoming claims, development of defense strategies, supporting/preparing response/correspondence, claim negotiation and settlement; " Collection and registration of all claim related documentation in company's claim repository.
General Liability Claims Examiner - Public Entity Sedgwick Claims Management Services, Inc.General Liability Claims Examiner - Public EntityConcord, CARemote$80,000–$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 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.
NewSenior Claims Examiner - Workers'''' Compensation (California) ICW GroupSenior Claims Examiner - Workers'''' Compensation (California)Pleasanton, CA$68,481.25–$115,489.01 / yearHeadquartered 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.
NewNonprofit Medi-Cal Claims Specialist (Part-Time) WestCoast Children's ClinicNonprofit Medi-Cal Claims Specialist (Part-Time)Oakland, CA$26–$28 / hourBA/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).
Claims Manager, Professional Liability Starr International Co IncClaims Manager, Professional LiabilitySan Francisco, CA$150,000–$175,000 / yearThe 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.
Senior Contracts & Claims Manager TalentBurst, Inc.Senior Contracts & Claims ManagerVacaville, CA$65–$85 / hourBusiness and financial acumen; " Contracting strategy & execution, strategic sourcing expertise, procurement/sourcing knowledge/experience for large CAPEX projects; " A strong understanding of construction technology, sequencing and practices; " Exceptional problem solving and analytical skills; " Demonstrated project management skills; " Demonstrated experience developing and implementing sourcing strategies that have yielded measurable business results. " Manage escalation of issues and claims management with supplier; " Develop the supplier relationship according to the expectations per supplier segment; " Support supplier relationship management and to ensure reliable high quality supply; " Support the supplier performance, compliance and accountability through supplier scorecards and performance metrics; " Involved in periodic commercial audits of main contractors.
Director, Claims Starr InsuranceDirector, ClaimsSan Francisco, California$150,000–$175,000 / yearThe 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.
Claims Customer Service Representative I Partnership HealthPlan of CaliforniaClaims Customer Service Representative IFairfield, California$29.95–$35.19 / hourFull timeTo 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.
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.
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.
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 Customer Service Representative III Partnership HealthPlan of CaliforniaClaims Customer Service Representative IIIFairfield, California$33.65–$40.38 / hourFull timeThe 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.
Claims Examiner II Partnership HealthPlan of CaliforniaClaims Examiner IIFairfield, California$31.45–$37.74 / hourFull timeReviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established. 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.
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.
Senior Contracts & Claims Manager Sunrise Systems IncSenior Contracts & Claims ManagerVacaville, CA$80–$83 / hourCLAIM MANAGEMENT Identifying opportunities for outgoing claims, development of claim strategies, supporting/preparing notifications/correspondence as well as negotiation and settlement; Analysis of incoming claims, development of defense strategies, supporting/preparing response/correspondence, claim negotiation and settlement; Collection and registration of all claim related documentation in company's claim repository. SUPPLIER RELATIONSHIP MANAGEMENT Manage escalation of issues and claims management with supplier; Develop the supplier relationship according to the expectations per supplier segment; Support supplier relationship management and to ensure reliable high quality supply; Support the supplier performance, compliance and accountability through supplier scorecards and performance metrics; Involved in periodic commercial audits of main contractors.