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 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.
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. 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.
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.
Customer Operations Claims Analyst Kinder'sCustomer Operations Claims AnalystWalnut Creek, CaliforniaMost of our work happens in the office to spark creativity and community, but we also offer flexibility so team members have the autonomy to work outside the office when needed to support their work-life balance and personal commitments. This person will act as both a detective and a problem-solver — validating customer complaints or charges, identifying the true root causes, and pushing toward resolution either through claim recovery or internal process improvement.
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.
Fremont Michigan Claim Support Assistant I AAA Southern New EnglandFremont Michigan Claim Support Assistant IFremont, CABy 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. Important Note: ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals.
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.
Michigan APD Claim Representative II - Fremont AAA Southern New EnglandMichigan APD Claim Representative II - FremontFremont, CABy 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. Important Note: ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals.
Complex Claim Director - Mass Tort Unit CNA Financial Corp.Complex Claim Director - Mass Tort UnitWalnut Creek, CA$97,000–$189,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Leads the work activities of medium to high severity specialized Claims Professionals, has full management responsibility for setting and communicating expectations, providing direction and situational coaching, and facilitating ongoing training. Leads a team of Claims Consultants and Consulting Directors that are responsible for the handling of complex, high exposure mass tort and environmental claims, including social media addiction, PFAS, talc, sexual molestation, and other long tail general liability and pollution related matters.
EPL & D&O Liability Claim Counsel The Travelers CompaniesEPL & D&O Liability Claim CounselWalnut Creek, 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.
Claim Specialist - Property Field Inspection State FarmClaim Specialist - Property Field InspectionConcord, California$78,862.06–$118,245 / yearFull timeCompetitive candidates should reside within one of the listed zip codes and will service this same territory: 94505, 94506, 94509, 94513, 94517, 94518, 94519, 94520, 94521, 94523, 94525, 94526, 94531, 94553, 94561, 94565, 94595, 94596, 94597, 94598. With 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!
NLP Scientist Claim Accuracy and Compliance - ROCGJP00042840 Triune InfomaticsNLP Scientist Claim Accuracy and Compliance - ROCGJP00042840South San Francisco, CAGiven a statement and a corpus of approved claims, product labeling, clinical study results and references, the system retrieves the relevant evidence, decomposes compound statements into checkable assertions, tests whether the evidence supports each one, and returns a decision with citations a reviewer can follow. Must Have: Evidence-Grounded NLP, Hybrid Retrieval & RAG, NLI/Entailment & Claim Verification, Claim Decomposition & Evidence Attribution, Evaluation & Human-in-the-Loop, Python & NLP Frameworks.
NewStrategy & Operations RaydarStrategy & OperationsSan Francisco, CAThe business reached multi-seven-figure annual recurring revenue in under a year, has grown roughly 50% month over month, and recently raised a $50M Series A from leading venture investors. You will work directly with the CEO, turn ambiguous problems into structured operating systems, and help build the processes that allow insurance claims to be handled efficiently at scale.
NewStrategy & Operations Our clientStrategy & OperationsSan Francisco, CaliforniaThe business reached multi-seven-figure annual recurring revenue in under a year, has grown roughly 50% month over month, and recently raised a $50M Series A from leading venture investors. You will work directly with the CEO, turn ambiguous problems into structured operating systems, and help build the processes that allow insurance claims to be handled efficiently at scale.
Dental Office Receptionist All Care DentalDental Office ReceptionistFremont, California$22–$29Knowledgeable about dental insurance billing, insurance aging, patient aging reports, and can manage A/R for the office. Knowledge of centric ascend is a big plus and inputting patient data on computer is necessary.
Sr. Assurance Manager, SCS Standards & Assurance Systems SCS Global ServicesSr. Assurance Manager, SCS Standards & Assurance SystemsEmeryville, CA$76,000–$100,000 / yearIn addition, the Senior Assurance Manager serves as a senior advisor to clients, providing technical advisory services related to assurance system design, certification readiness, claims governance, chain of custody implementation, and responsible sourcing programs. The role is also responsible for monitoring emerging legislation, regulatory developments, and market expectations related to sustainability claims, environmental marketing, responsible sourcing, and certification systems to ensure SAS programs remain credible, compliant, and future-ready.
NewEpidemiology programmer K3 InnovationsEpidemiology programmerSouth San Francisco, CARemoteContribute to the design of observational studies, including registries, providing critical appraisal of observational study protocols through participation in inter-departmental and cross-functional committees as needed. Required to draw upon their experience to develop data/statistical analysis plans and execute data analysis with minimal technical oversight.
NewInvestigator Ethos Risk Services LLCInvestigatorSan Francisco, CAREQUIREMENTS: Previous Experience: Demonstrated proficiency in covert surveillance techniques, capturing high-quality video footage, and preparing thorough, well-organized investigative reports. This role involves performing both stationary and mobile surveillance, obtaining video and photographic evidence, and preparing thorough, detailed reports for clients.
Senior Full Stack .NET Developer Glint Tech Solutions LLCSenior Full Stack .NET DeveloperFremont, CAThe client's Insurance Claims Application team is seeking a Backend/Full Stack Software Engineer to contribute to the development of their Web App, part of advanced platforms managing service workflows for Vehicle, Insurance Claims, and Energy products. Collaborate with cross-functional teams including product managers and service engineers to define and implement features enhancing operational efficiency.