Senior Manager, Claims Adjustments L.A. Care Health PlanSenior Manager, Claims AdjustmentsLos Angeles, CAThe Senior Manager, Claims Adjustments manages all adjustment-related operational workflows, including provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support. Ensures all provider adjustments meet Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and contractual (TAT) requirements.
NewSenior Claims Specialist I, Workers Compensation - West Region Liberty Mutual Holding Company IncSenior Claims Specialist I, Workers Compensation - West RegionGlendale, CARemoteResponsibilities: Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages. Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state s tort laws as normally acquired through a bachelor s degree (or equivalent training) plus 3 to 5 years directly related work experience.
EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealthEPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full TimeCAEpic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.
OHS Claims Processor I (Bilingual) FT Kaiser PermanenteOHS Claims Processor I (Bilingual) FTLos Angeles, CAOrdering and photocopying medical records; temporarily cover other desk/functions due to vacation and workload fluctuations; clears designated Health Connect work queues daily, creates patient accounts to register patients and fills in the required KP computerized systems, provides personalized and professional patient/employer/carrier services. Promotes, ensures and improves customer service to internal/external customers by demonstrating skills which are consistent with the organizations philosophy of providing extraordinary customer relations and quality service as well as all other Kaiser Permanente Policy Procedures.
Chief Claims Officer, Argo Group Argo Group International Holdings Ltd.Chief Claims Officer, Argo GroupLos Angeles, CAPossesses an extensive knowledge and experience with adjudicating and management claims for a portfolio of commercial products/program lines including surety, auto, general liability, workers' compensation, property, asbestos/environmental, reinsurance and the relevant claims handling practices supporting such products/programs. The Chief Claims Officer, Argo Group provides claim leadership and direction to the Senior Management of all the Argo Group claims operations with a focus on supporting the consistent execution of claims functions and maintenance of operational excellence.
Chief Claims Officer, Argo Group Argo Group International Holdings IncChief Claims Officer, Argo GroupLos Angeles, CAPossesses an extensive knowledge and experience with adjudicating and management claims for a portfolio of commercial products/program lines including surety, auto, general liability, workers' compensation, property, asbestos/environmental, reinsurance and the relevant claims handling practices supporting such products/programs. The Chief Claims Officer, Argo Group provides claim leadership and direction to the Senior Management of all the Argo Group claims operations with a focus on supporting the consistent execution of claims functions and maintenance of operational excellence.
Medical Claims Intake Coordinator UCLA Health SystemMedical Claims Intake CoordinatorLos Angeles, CA$26.42–$37.49 / hourb'nn n n n n n n n n n n n nn n n n n n n n n n n n n n n n n n Medical Claims Intake Coordinator - - 29680 - UCLA Healthn n nnnn nn n n n nn n n n n Skip to content nn n n n n n UCLA Health Home Page n n nn nnn n nn n Main menu. Press enter or space keys to expands and escape key to collapse nn n n n n n n Search jobs n n nn...
Claims Quality Auditor UCLA Health SystemClaims Quality AuditorLos Angeles, CA$31.51–$62.64 / hourAs a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures.
Sr Claim Examiner- WC TPI Global (formerly Tech Providers, Inc.)Sr Claim Examiner- WCBrea, CAEstablish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. Duties: Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
Sr Claim Examiner-WC (CA) Crawford & CompanySr Claim Examiner-WC (CA)Brea, CARemoteFull timeEstablish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. We're Hiring: Senior Claims Examiner - Workers Compensation (California) This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistCA$17–$28.46 / hourPerforms claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
Claiming Analyst - Revenue Cycle Management HATHAWAY-SYCAMORES CHILD AND FAMILY SERVICESClaiming Analyst - Revenue Cycle ManagementLos Angeles, CA$23–$26 / hourUse internal communication to track admissions across all programs, in order to accurately create and open consumers financial profile in both EHRS and IBHIS. In collaboration with Claiming and Revenue Manager, claim, track and monitor invoice/EDI claims to other funding entities to ensure timely submission.
Claim Examiner- WC TPI Global (formerly Tech Providers, Inc.)Claim Examiner- WCBrea, CAEstablish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. Duties:Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
EPL & D&O Liability Claim Counsel The Travelers CompaniesEPL & D&O Liability Claim CounselGlendale, CA$111,600–$184,200 / yearTravelers' Private/Non-Profit Team provides executive and organizational management liability coverage to privately held companies and non-profit entities of all types and sizes as well as certain governmental public entities. Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
Cash/Claims Processor Assignment ObjectWin Technology IncCash/Claims Processor AssignmentCAResearches and resolves data issues through coordination and communication with internal and/or external clients and team members, ensuring timely application of payments on open receivables. Detailed working knowledge of basic computer operations and systems, i.e. Web-based search engines, Windows, and Microsoft Office products.
NewLitigation Insurance Adjuster (Remote: Pacific Time Zone) TruStage Financial Group IncLitigation Insurance Adjuster (Remote: Pacific Time Zone)CARemote$93,100–$139,700 / yearClaim Litigation Consultant II will provide credit unions with superior claims service, building and solidifying a strong partnership through proactive professional consultation and delivering optimal solutions to meet their needs on third-party litigated claims. Collaborate with other claims and product experts to ensure the consistent handling of commercial insurance claims and will be accountable for decision-making regarding the appropriate use of investigators, experts and outside legal counsel.
Sr. Field SIU Adjuster Tesla IncSr. Field SIU AdjusterHawthorne, CA$87,400–$131,100 / yearProperty and Casualty (P&C) adjuster's license in the state of domicile, plus non-resident adjuster's licenses in all other states where required-or the ability to obtain them within 60 days of starting. Along with competitive pay, as a full-time Tesla employee, you are eligible for the following benefits at day 1 of hire: Medical plans > plan options with $0 payroll deduction.
Bilingual Triage Specialist Argo Group International Holdings IncBilingual Triage SpecialistLos Angeles, CA$26.76–$30.80 / hourOur Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is. Ability to develop and maintain productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information.
Sr. Benefits Analyst (Workers' Compensation) SpaceXSr. Benefits Analyst (Workers' Compensation)Hawthorne, CATo conform to U.S. Government export regulations, applicant must be a (i) U.S. citizen or national, (ii) U.S. lawful, permanent resident (aka green card holder), (iii) Refugee under 8 U.S.C. § 1157, or (iv) Asylee under 8 U.S.C. § 1158, or be eligible to obtain the required authorizations from the U.S. Department of State. Coordinate and facilitate claims process by acting as a liaison between the injured employee, employee’s leadership team, insurance third party administrator, medical provider, and consultant.
NewClaims Adjuster - Workers Compensation (HYBRID- Glendale, CA) Sedgwick Claims Management Services, Inc.Claims Adjuster - Workers Compensation (HYBRID- Glendale, CA)Glendale, CA$75,000–$80,000 / 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. Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.