Health Source MSOClaims Auditor Health Source MSOClaims AuditorAlhambra, CAFull timeResponsibilities include, but not limited to: Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including:Contractual agreement rates. Job Description: Claims Auditor will be responsible for auditing claims processed by Claims Examiners.
Health Source MSOClaims Supervisor Health Source MSOClaims SupervisorAlhambra, CAFull timeProviding expertise or general claims support to teams in reviewing, researching, investigating, negotiating, process, and adjusting claims. Responsibilities include, but not limited to: • Maintain up-to-date knowledge of procedures for all ICD-10, CPT, HCPC codes including: Contractual agreement rates.
State Farm Mutual Automobile Insurance CompanyNewClaim Specialist - Property Field Inspection State Farm Mutual Automobile Insurance CompanyClaim Specialist - Property Field InspectionSanta Monica, CA$64,965.62–$111,595 / yearAdditional Details: Employees must successfully complete all required training, including applicable licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s). 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!
Kinetic Personnel GroupClaims Adjuster Kinetic Personnel GroupClaims AdjusterMonrovia, CA$55,000–$75,000 / yearTemporaryThe ideal candidate has a strong understanding of coverage analysis, liability evaluation, and California insurance regulations, and is able to resolve claims efficiently and fairly. This role is responsible for providing high-quality customer service while managing a volume of property damage claims.
IconmaClaims Examiner - Workers Compensation (Hourly) IconmaClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / 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.
JobotQuality Control Supervisor JobotQuality Control SupervisorLos Angeles, CA$75,000–$110,000 / yearInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Corrective Actions and Continuous Improvement: Identify non-compliant practices on the production floor, propose corrective actions, and collaborate with production leaders to implement improvements.
JobotMedical Billing Specialist JobotMedical Billing SpecialistLos Angeles, CA$25–$29 / hourInformation collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. This role is responsible for preparing, reviewing, and submitting claims, resolving denied or unpaid claims, and maintaining compliance with local, state, and federal billing regulations.
Health Source MSOCustomer Service Representative Health Source MSOCustomer Service RepresentativeAlhambra, CAFull timeAbility to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time as needed. Review and research incoming healthcare claims from members and providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g.
Ultimate Staffing ServicesSr. Medical Claims Processor Ultimate Staffing ServicesSr. Medical Claims ProcessorPasadena, California$24–$29 / hourEnsure accuracy of claim details, including patient information, coding (ICD-10, CPT, HCPCS), and billing data prior to submission. Investigate and resolve denied, rejected, or pending claims by working with providers, payers, and internal departments.
AxelonF&O Technical Architect AxelonF&O Technical ArchitectAliso Viejo, CALead data migration initiatives using Data Management Framework (DMF) ensuring data quality across master and transactional datasets. We are seeking an experienced D365 Finance & Operations (F&O) Technical Architect to lead architecture, development, and performance optimization initiatives in healthcare environments.
Highmark IncNewClaims Processor Highmark IncClaims ProcessorRemote Position, WVRemoteReviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information; may coordinate benefits and interact with customers. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Conduent IncClaims Processor Conduent IncClaims ProcessorCARemoteThrough our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded: click here to access or download the form.
Solugenix CorpSpecial Investigation Unit Investigator II Solugenix CorpSpecial Investigation Unit Investigator IILos Angeles, CA$43.29–$48.29 / hourTemporaryContractorFull timeAfter making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Minimum of 3 years of experience in healthcare fraud investigation/detection and/or healthcare related specialty including but not limited to; Pharmacy, DME, Mental Health, Behavioral Health, Hospice, Home Health, Dental etc.
Solugenix CorpSpecial Investigation Unit Investigator III Solugenix CorpSpecial Investigation Unit Investigator IIILos Angeles, CA$42.71–$55.53 / hourTemporaryContractorFull timeThe Special Investigation Unit Investigator III performs in-depth evaluation of potential fraud & abuse cases and develops complex investigations that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for fraud, waste & abuse. After making a conditional offer and running a background check, if we are concerned about conviction that is directly related to the job, applicants will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
CPSIMeditech Claims Processor - UB-04 and HCFA 1500 CPSIMeditech Claims Processor - UB-04 and HCFA 1500CAEssential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: Prepares and submits hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing. The Meditech Claims Processor position is responsible for acting as a liaison for hospitals and clinics using TruBridge's complete business office services.
Kaiser PermanenteOHS Claims Processor I (Bilingual) Kaiser PermanenteOHS Claims Processor I (Bilingual)Los 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.
Ultimate Staffing ServicesHealth Claims Examiner Ultimate Staffing ServicesHealth Claims ExaminerPasadena, California$24–$28 / hourCommunicate professionally with members and providers to resolve inquiries, follow up on pended claims, and complete corrections or adjustments. This position is ideal for someone who enjoys problem‑solving, working with complex benefit plans, and collaborating with both internal teams and external partners.
Providence Health & ServicesClaims Specialist - Claims Processing Providence Health & ServicesClaims Specialist - Claims ProcessingAnaheim, CA$24–$33.73 / hourRequsition ID: 429445 Company: Providence Jobs Job Category: Claims Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Admin Support Department: 7520 CLAIMS PROCESSING CA HERITAGE SERVICES Address: CA Anaheim 200 W Center St Promenade Work Location: St Joseph Home Health-Anaheim Workplace Type: On-site Pay Range: $24.00 - $33.73 Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Providence St. Joseph HealthSenior Claims Specialist - Claims Processing Providence St. Joseph HealthSenior Claims Specialist - Claims ProcessingMission Hills, CATogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary.
Providence St. Joseph HealthClaims Specialist - Claims Processing Providence St. Joseph HealthClaims Specialist - Claims ProcessingAnaheim, CATogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Required Qualifications: HMO claims processing experience in a managed care environment, preferably PMG/IPA setting within the last 3 years or any combination of education and/or experience which produces an equivalency.
Clever Care Health Plan IncClaims Analyst Clever Care Health Plan IncClaims AnalystHuntington Beach, CA$88,000–$100,000 / yearThe Claims Analyst will work with the Senior Director of Medicare Operations in identifying potential areas for process improvement initiatives to support development of automation, payment accuracy, audit activities, business rules and P&Ps. Utilize and access computer and appropriate software (e.g., Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems (e.g., EZCAP Claims Processing System and Authorization system) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
University of CaliforniaClaims Resolution and Reconciliation Supervisor University of CaliforniaClaims Resolution and Reconciliation SupervisorLos Angeles, CA$78,500–$163,600 / yearAs 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. The Claims Resolution and Reconciliation Supervisor oversees daily claims resolution operations, ensuring timely, accurate, and compliant processing of complex claims adjustments, provider disputes, appeals, and grievances.
Welbe Health LLCClaims Examiner Welbe Health LLCClaims ExaminerCA$55,930.55–$73,828.33 / yearOur Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Understanding of Industry pricing methodologies, such as Medicare/Medi-Cal fee schedule, Diagnosis Related Groups (DRG), Multiple Procedure Payment Reduction (MPPR) and benefit interpretation and administration .
Providence Health & ServicesEducation and Training Specialist - CLAIMS PROCESSING Providence Health & ServicesEducation and Training Specialist - CLAIMS PROCESSINGMission Hills, CA$29.62–$45.31 / hourRequsition ID: 427121 Company: Providence Jobs Job Category: Learning & Development Job Function: Human Resources Job Schedule: Full time Job Shift: Day Career Track: Business Professional Department: 7520 CLAIMS PROCESSING CA HERITAGE SERVICES Address: CA Mission Hills 11165 N Sepulveda Blvd Work Location: Facey Sepulveda Annex-Mission Hills Workplace Type: Hybrid Pay Range: $29.62 - $45.31 Working under the general supervision of the Claims Director, provide an effective education program to advance the quality and production level of the Claims Department by developing and delivery claims training programs that continuously improves the Claims Department performance to meet the NSS strategic goals.
Western GrowersClaims Auditor Western GrowersClaims AuditorIrvine, CAThis position reports to the Supervisor of Payment Integrity and performs in-depth audits to ensure existing health (medical/dental) benefit plans of Western Growers Assurance Trust and Pinnacle Claims Management, Inc. clients are in compliance with the respective employers summary plan descriptions. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management.
Astrana Health IncSr. Manager - Claims Delegation Audit Astrana Health IncSr. Manager - Claims Delegation AuditMonterey Park, CAThis role will be responsible for the development and execution of department strategies, overall Audit program, Audit process optimization, and management, identifying and leveraging technology and data to improve the quality and minimizing process cost of Claims. Working with the Department Director, Senior Manger will collaborate with other Astrana Health departments and personnel to develop strategies to identify, mitigate and optimize operational and financial gaps.
Mercury Insurance CompanyClaims Specialist II Mercury Insurance CompanyClaims Specialist IILos Angeles, CA$44,466–$77,881 / yearBodily Injury Claims Management: Analyze medical records to evaluate, negotiate, and settle moderate bodily injury claims with legal counsel for represented claimants and unrepresented parties. If you're passionate about helping people restore their lives when the unexpected happens, and providing high-quality customer experiences, then our Mercury Insurance Claims team could be the place for you!
Silva-Lining HRFractional 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.
Providence St. Joseph HealthEducation and Training Specialist - CLAIMS PROCESSING Providence St. Joseph HealthEducation and Training Specialist - CLAIMS PROCESSINGMission Hills, CAWorking under the general supervision of the Claims Director, provide an effective education program to advance the quality and production level of the Claims Department by developing and delivery claims training programs that continuously improves the Claims Department performance to meet the NSS strategic goals. Any combination of experience or equivalent background: 5 years of experience of acquired in-depth technical knowledge of functional area i.e., claims operations, HMO products, industry claims processing procedures, contracts, billing and overall managed care processes, etc.
Astrana Health, Inc.Sr. Manager - Claims Astrana Health, Inc.Sr. Manager - ClaimsMonterey Park, California$125,000–$140,000 / yearYou’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. Minimum of a Bachelor's degree (B.A.) from a four-year college or university; or at least four (4) years current Management or equivalent experience with an MSO or IPA Management.
CVS Health CorpNewSenior Claims Benefit Specialist CVS Health CorpSenior Claims Benefit SpecialistWork At Home, CA$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
University of CaliforniaClaims Intake Coordinator University of CaliforniaClaims Intake CoordinatorLos Angeles, CA$26.42–$37.49 / 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. Able to key between 6,000 to 8,000 keystrokes or type 40-50 WPM with high accuracy for alpha and numeric data inputting.
Crawford & CoContent Claims Specialist - Field - Level I Crawford & CoContent Claims Specialist - Field - Level ILos Angeles, CARemote$21–$25 / hourCommunicate with adjusters/policyholders and industry vendors to explain their roles as Content Claims Specialists and their respective roles/contributions in the claims handling process. Communicate with all parties (adjusters/policyholders) in adherence with edjuster''s commitment to timely and informative updates on the content claims process.
Molina Healthcare IncManager, Configuration - Claims Adjudication/Custom Solutions - Remote Molina Healthcare IncManager, Configuration - Claims Adjudication/Custom Solutions - RemoteCARemoteLeads and manages team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and system requirements as it pertains to contracting, benefits, prior authorizations, fee schedules and other business requirements. Represents as primary liaison with various functional areas/stakeholders (i.e. utilization management, claims, configuration, provider network, health plan leadership, etc.) to seek understanding of workflows and obtain required documentation for applicable audits.
Cedars-Sinai Medical CenterClaims Auditor, Managed Care (remote) Cedars-Sinai Medical CenterClaims Auditor, Managed Care (remote)Los Angeles, CARemoteThe Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. Provides process improvement suggestions to Management Monitors appeals from providers, members and health plans to make sure they are processed accurately and in timely manner.
MedPOINT ManagementHospital Claims Auditor MedPOINT ManagementHospital Claims AuditorSherman Oaks, CARemoteSummary: A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Knowledge, Skills and Abilities Required: · Strong organizational, analytical and oral/ written communication (English) skills required.
Cedars-Sinai Medical CenterClaims Examiner - Managed Care Cedars-Sinai Medical CenterClaims Examiner - Managed CareLos Angeles, CAExperience: Three (3) years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting required. Acquires and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.
UCLA Health SystemClaims Resolution and Reconciliation Supervisor UCLA Health SystemClaims Resolution and Reconciliation SupervisorLos Angeles, CA$78,500–$163,600 / yearAs 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. The Claims Resolution and Reconciliation Supervisor oversees daily claims resolution operations, ensuring timely, accurate, and compliant processing of complex claims adjustments, provider disputes, appeals, and grievances.
United Seating & MobilityClaims Specialist I United Seating & MobilityClaims Specialist ICARemote$21.63–$28.13 / hourJOB PURPOSE: The Claims Specialist I supports the administration and coordination of workers' compensation and related healthcare claims by processing assigned activities, maintaining accurate documentation, and providing responsive customer service. As North America's largest provider of mobility products and services, we deliver personalized solutions from manual and power wheelchairs to medical supplies and other assistive technologies that support health, independence, and everyday participation.
L.A. Care Health PlanSenior Manager, Claims Administration L.A. Care Health PlanSenior Manager, Claims AdministrationLos Angeles, CARequired: Strong knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies. Responsible for translating enterprise expectations into consistent frontline execution, maintaining a strong control environment, identifying emerging risks quickly, and building upstream partnerships that drive long-term operational maturity.
L.A. Care Health PlanDirector, Claims Administration L.A. Care Health PlanDirector, Claims AdministrationLos Angeles, CAEstablishes and leads the Service Validation Unit (SVU) to function in a strategic, proactive and preventative manner by independently validate that billed services were authorized, medically supported, accurately represented, and provided/received prior to payment. This position is responsible for leading the end-to-end claims ecosystem, including claims adjudication, claims adjustments (escalations, disputes, general adjustments, and litigation-related requests), and strong focus on preventative controls through the Service Validation Unit (SVU).
HCC Service CompanyAssociate Bond Claims Attorney HCC Service CompanyAssociate Bond Claims AttorneySanta Ana, CaliforniaAs an insurance company, however, we must comply with certain Federal and state laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which limits our ability to employ individuals with certain types of criminal convictions. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report.
Next Insurance IncSenior Claims Advocate Next Insurance IncSenior Claims AdvocateCARemote$81,000–$123,000 / yearYou will join a team of experienced claims professionals and will investigate and resolve Commercial Property and Inland Marine claims to provide the best possible claim outcome and employ best efforts to ensure that the customers' interests are protected. You can find additional information about this type of scam and report any fraudulent employment offers via the Federal Trade Commission''s website (https://consumer.ftc.gov/articles/job-scams), or you can contact your local law enforcement agency.
University of CaliforniaClaims Manager, Medicare Advantage Plan University of CaliforniaClaims Manager, Medicare Advantage PlanLos Angeles, CA$95,400–$208,300 / yearThe Claims Manager of the Medicare Advantage Plan will: Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments. As 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.
University of CaliforniaClaims Quality Supervisor University of CaliforniaClaims Quality SupervisorLos Angeles, CA$78,500–$163,600 / yearAs 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. Provide direct supervision and guidance for Quality Control and Customer Service staff and provide developmental and training opportunities for team members.
Astrana Health, Inc.Sr. Manager - Claims Delegation Audit Astrana Health, Inc.Sr. Manager - Claims Delegation AuditMonterey Park, California$125,000–$140,000 / yearThe position alongside the leadership team will contribute to driving strategic planning, operational excellence, and accuracy of the claims process and ensure compliance with regulations and contract requirements for Medicare, Commercial Exchange, and Medicaid service lines. External Audit planning, execution & support Own the end‑to‑end strategy and execution of all external audits (e.g., CMS, DMHC, health plan audits), ensuring readiness, successful delivery, and continuous score improvement.
Collaborative SolutionsClaims Coordinator, PSA Collaborative SolutionsClaims Coordinator, PSASanta Ana, CaliforniaOur services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia. We grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions.
MSIG HoldingsClaims Counsel, Financial Lines & Cyber MSIG HoldingsClaims Counsel, Financial Lines & CyberLos Angeles, CaliforniaThe Claims Attorney will be responsible for handling complex matters, including high severity claims and class actions, from inception through resolution for Financial Lines and Cyber products with an emphasis on Directors & Officers (D&O), Financial Institutions Professional Liability (E&O), Pension Trust (Fiduciary), Employment Practices Liability, and Fidelity policies. You will work closely with internal and external customers and stakeholders, deliver excellent customer service, analyze coverage, draft coverage letters, evaluate liability, make claim presentations, set judgmental reserves, and formulate and execute resolution strategies.