Sr. Claims Examiner (Onsite, Roseville) Adventist Health SystemSr. Claims Examiner (Onsite, Roseville)Roseville, CAJob Requirements: Education and Work Experience: • Bachelors degree or equivalent combination of education/related experience: Required • Masters Degree or Juris Doctor: Preferred • Seven years liability claims management experience: Preferred • One years leadership experience: Preferred • Experience with legal matters and complex litigation: Preferred. • Involves structured settlement professionals as necessary to maximize settlement and identifies opportunities for subrogation, contribution, recovery and other case management opportunities to mitigate total claim costs.
Claims Examiner - Workers Compensation eTeam Inc.Claims Examiner - Workers CompensationRoseville, CA$45–$50 / hourPRIMARY PURPOSE: To analyze complex or technically difficult 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. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Property & Casualty Claims Advocate Hub International LtdProperty & Casualty Claims AdvocateSacramento, CA$68,000–$100,000 / yearMaintains accurate and organized claim files by appropriately documenting conversations with clients and carrier representatives; updates all HUB computer systems and automated agency management systems; ensures the accuracy of data. QUALIFICATIONS: High School Diploma / GED 2-3 years property & casualty claims adjustment experience (brokerage preferred) or equivalent combination of education & experience Property & Casualty License required or willingness to obtain within 3 months.
Claims Processing Specialist Wollborg Michelson RecruitingClaims Processing SpecialistRancho Cordova, CAThis role includes processing special claims that may involve manual review of actual treatment compared to authorized treatment, and adjudicating claims for specific client programs. The Claims Processing Specialist identifies and provides solutions for processing unique claims, refunds, overpayments, and underpayments.
Technical Claims Specialist, Workers Compensation - West Region Liberty Mutual Holding Company IncTechnical Claims Specialist, Workers Compensation - West RegionRocklin, CAHas developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role.
Workers Compensation Claims Examiner | Roseville, CA Sedgwick Claims Management Services, Inc.Workers Compensation Claims Examiner | Roseville, CARoseville, CA$80,000–$100,000 / 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.
Medical Claims Review Medical Director - Surgeon - Remote UnitedHealth Group Inc.Medical Claims Review Medical Director - Surgeon - RemoteSacramento, CARemote$248,500–$373,000 / yearThe Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on post-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members.
Claims Examiner - Workers Compensation Apidel TechnologiesClaims Examiner - Workers CompensationRoseville, CAContractorTo analyze complex or technically difficult 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. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Claims Examiner - Workers Compensation MindlanceClaims Examiner - Workers CompensationRoseville, CA$48–$50 / hourPRIMARY PURPOSE: To analyze complex or technically difficult 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. To analyze complex or technically difficult 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.
Claims Examiner - Workers Compensation ICONMA, LLCClaims Examiner - Workers CompensationRoseville, CA$45–$50 / hourResponsibilities: Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Claims Examiner Ova TechnologiesClaims ExaminerRoseville, CAPRIMARY PURPOSE: To analyze complex or technically difficult 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. To analyze complex or technically difficult 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.
Workers Compensation Associate Claim Representative The Travelers Companies IncWorkers Compensation Associate Claim RepresentativeRancho Cordova, CA$52,600–$86,800 / yearAs an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
EPL & D&O Liability Claim Counsel The Travelers CompaniesEPL & D&O Liability Claim CounselRancho Cordova, 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.
Sr Claim Examiner- WC TPI Global (formerly Tech Providers, Inc.)Sr Claim Examiner- WCFolsom, 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 & CoSr Claim Examiner-WC (CA)Folsom, CAWork within established authority on moderate-to-difficult claims, reviewing coverages, determining liability/compensability, collecting statements and essential information, and settling claims using best practices. Establish 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.
ASSISTANT PRINCIPAL CLAIM AUDITOR State Of CaliforniaASSISTANT PRINCIPAL CLAIM AUDITORSacramento, CA$4,779–$5,908Under general direction provided by the Principal Claim Auditor (PCA), the Assistant Principal Claim Auditor (APCA) is the lead staff person who assists in planning, organizing, and directing the work of the Claim Audits Section. Review Senior Claim Auditor and Claim Auditor work within the unit to determine the quality and extent of audit work meets the SCO's expectations and overall audit objectives.
Claim Operations Specialist The Travelers Companies IncClaim Operations SpecialistRancho Cordova, CA$45,400–$74,900 / yearCLAIM OPERATIONAL SERVICE AND PARTNERSHIPS: Partners with claim professionals in multiple departments to assist with the timely resolution of claims, which may include: Properly documents claim files, including notes and diaries, Requests reports and records, and reviews medical bills, mail and wage statements. CLAIM PAYMENTS AND EXPENSE PROCESSING: Ensures the proper handling of financial transactions to include: Processes and issues claim payments including outside vendor invoices, attorney expenses, and medical processing fees.
Medical Case Manager- CA Crawford & CoMedical Case Manager- CASacramento, CATo determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual''s medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services.
Life Insurance Position - State Farm Agent Team Member Frank Lewis - State Farm AgentLife Insurance Position - State Farm Agent Team MemberAuburn, CAFull timeFor our team, we offer bonuses and additional time off when goals are met, a Simple IRA, work-life balance, reimbursement for licensing costs, and of course, plenty of coffee to keep things running smoothly. We stay actively involved in the community through organizations like the Auburn Chamber of Commerce, the Downtown Business Association, and local volunteer efforts.
Customer Service Representative - State Farm Agent Team Member Frank Lewis - State Farm AgentCustomer Service Representative - State Farm Agent Team MemberAuburn, CAFull timeAs a Customer Service Representative - State Farm Agent Team Member with Frank Lewis - State Farm Agent, you will generate the kind of exceptional customer experiences that reinforce the growth of a successful insurance agency. For our team, we offer bonuses and additional time off when goals are met, a Simple IRA, work-life balance, reimbursement for licensing costs, and of course, plenty of coffee to keep things running smoothly.