Claims 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.
Claims 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.
Claims Examiner - Workers Compensation IconmaClaims Examiner - Workers CompensationRancho Cucamonga, CA$45–$50 / hourResponsibilities: 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.
Senior Workers Compensation Claims Examiner CYNET SYSTEMSSenior Workers Compensation Claims ExaminerLong Beach, CA$45–$50 / hourTemporaryContractorPart timeSubject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices, and Social Security and Medicare application procedures as applicable to line-of-business. As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers.
Cash/Claims Processor GlobalchannelmanagementCash/Claims ProcessorWhittier, CaliforniaCash/Claims Processor duties: Manage the flow of processes completed by Cash Processors to ensure all cash is applied in a timely manner to outstanding invoices and provide Cash Supervisor for daily updates. Train associates on how to process transactions, which include researching and applying cash for both Payers and Members, Provide a point of contact for any questions/issues regarding Cash for other areas of Assignment.
Claims 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.
Claims 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.
Claims Specialist II - Provider Claims Short-Term Assignment Inland Empire Health PlanClaims Specialist II - Provider Claims Short-Term AssignmentCalifornia, CAAdditional responsibilities include handling escalated claim-related telephone inquiries, assisting with cross-training as needed, performing complex claim adjustment projects, and processing Provider Disputes in accordance with regulatory requirements. The Claims Specialist II - Provider Claims is responsible for fulfilling the technical support needs of appeals and support staff, while ensuring that appeals and call center tasks are conducted consistently and accurately.
Claims Adjuster II/Senior Claims Adjuster (Senior Workers' Compensation Claims Adjuster) County of Riverside, CaliforniaClaims Adjuster II/Senior Claims Adjuster (Senior Workers' Compensation Claims Adjuster)Riverside, CA$112,778.77–$159,740.22 / yearKnowledge of: State of California Labor Code, Workers Compensation Law and rules and regulations (Title 8); Applicable case law of leading decisions of the Workers Compensation Appeals Board, Court of Appeals, and Supreme Court regarding workers compensation cases; Medical terminology, anatomy and technical terminology used in medical and legal fields regarding industrial cases; Jurisdiction, functions and procedures of the Workers Compensation Appeals Board; Vocational rehabilitation and procedures as it applies to Workers Compensation; Reserving practices and procedures; in-house litigation procedures; WCAB procedures; and hearing processes. Candidates must have achieved the level of Experienced Claims Adjuster (as defined by California Code of Regulations, Title 10, Chapter 5, Subchapter 3) defined as possessing one of the following: 1) Working 5 out of the last 8 years as a California Workers Comp Claims Adjuster, 2) Has worked continuously in California adjusting claims since passing the Self-Insurance Test, or 3) Has passed the Self-Insurance test in the last 2 years.
RCIS Crop Claims Specialist or Claims Crop Field Adjuster CA Zurich Insurance Group LtdRCIS Crop Claims Specialist or Claims Crop Field Adjuster CACARemote$51,300–$89,100 / yearRCIS offers a wide range of private product coverages, including a diverse selection of named-peril options, supplemental and stand-alone insurance products as well as federal crop insurance plans through the United States Department of Agriculture's Risk Management Agency. RCIS Crop Adjuster Physical Requirements: walk in agricultural fields up to 3 miles, climb agricultural storage bins up to 25 feet, lift 25 lbs to 50 lbs, work outdoors in varying temperatures/weather conditions.
Coordination of Benefits Processor (Managed Care) Remote Molina Healthcare IncCoordination of Benefits Processor (Managed Care) RemoteLong Beach, CARemoteAbility to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders. Attention to detail, organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
2027 Claim Trainee Program - Associate Claims Representatives CNA Financial Corp2027 Claim Trainee Program - Associate Claims RepresentativesBrea, CA$35,000–$65,000 / yearEssential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Develops a working knowledge of commercial insurance and learns to manage an inventory of low complexity claims by successfully completing a formal training program, and following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. After successful completion of a formal training program, this individual contributor position works under close supervision, and within defined authority limits, to handle and resolve low complexity commercial claims for a specific line of business.
Claims Examiner Sr, Covered California CalOptimaClaims Examiner Sr, Covered CaliforniaOrange, CA$51,744–$72,441 / yearWe are hoping you will join us as a Claims Examiner Sr, Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Claims Examiner Sr CalOptimaClaims Examiner SrOrange, CA$51,744–$72,441 / yearWe are hoping you will join us as a Claims Examiner Sr and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Senior Claims Benefit Specialist CVS Health CorpSenior Claims Benefit SpecialistCA$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.
Claims Examiner - Lead CalOptimaClaims Examiner - LeadOrange, CA$55,966–$83,949 / yearWe are hoping you will join us as a Claims Examiner - Lead and help shape the future of healthcare where you'll be an integral part of our CLA - Claims Production team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Claims Examiner - Lead Covered California CalOptimaClaims Examiner - Lead Covered CaliforniaOrange, CA$55,966–$83,949 / yearWe are hoping you will join us as a Claims Examiner - Lead Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
PM Warehouse Return Processor Living Spaces Furniture LLCPM Warehouse Return ProcessorRialto, CA$17.40–$22.60 / hourPay will be determined by several factors, including, but not limited to: applicant's education, relevant work experience, knowledge, applicable and relevant skills and abilities, market demand, Company budget, as well as internal equity and alignment with geographic market data. Will walk doors to validate inventory to match drivers returns manifest, validate returns accuracy, service and Quality Support and ensure all items are dispositioned and tagged.
AM-Warehouse Returns Processor Living Spaces Furniture LLCAM-Warehouse Returns ProcessorRialto, CA$17.40–$22.60 / hourPay will be determined by several factors, including, but not limited to: applicant's education, relevant work experience, knowledge, applicable and relevant skills and abilities, market demand, Company budget, as well as internal equity and alignment with geographic market data. Will walk doors to validate inventory to match drivers returns manifest, validate returns accuracy, service and Quality Support and ensure all items are dispositioned and tagged.
Claims Examiner I Clever Care Health Plan IncClaims Examiner IHuntington Beach, CA$27–$32 / hourThis position requires considerable interaction with clients, claimants on the phone, with management, other Claims Examiners, and other staff in the office; therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.