Utilization Management Claims Review Nurse RN II L.A. Care Health PlanUtilization Management Claims Review Nurse RN IILos Angeles, CAPerform claims pre-payment review by supporting the Claims team in evaluating flagged claims prior to adjudication to ensure services are medically necessary, documentation supports billed services, coding is accurate and aligned with authorization when applicable, and unnecessary denials are reduced through accurate clinical validation. This position supports payment integrity initiatives through retrospective and pre-payment review processes, helps reduce unnecessary denials, and monitors for potential fraud, waste, and abuse (FWA).
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 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.
Contracts and Claims Specialist Luster NationalContracts and Claims SpecialistLos Angeles, CA$90,000–$155,000 / hourWe're seeking Contracts and Claims Specialists of various skill levels to support large, complex heavy civil infrastructure programs, including highways, roads, bridges, transit (bus and rail), aviation (international airports), and water/wastewater projects delivered through both traditional and alternative delivery methods. Luster provides the salary range that the company in good faith believes it might offer for this position based on the successful candidate's level and years of experience, knowledge, skills, abilities, education, certifications, licenses, geographic location, etc.
NewClaims Assistant Mitsui Sumitomo Insurance Company Of AmericaClaims AssistantLos Angeles, CA$45,000–$55,000 / yearThe Claims Assistant provides administrative and operational support to the Claims team, ensuring timely and accurate processing of claim-related documentation, regulatory notices, and correspondence. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business's unique risks.
Claims Counsel Capital Insurance GroupClaims CounselOrange County, CARemote$114,364–$190,607 / yearThis is a remote position, ideally with someone based in Orange County (Irvine, Costa Mesa, Newport Beach, Santa Ana, Anaheim, Orange, Huntington Beach, and Fullerton). Responsible for consultation with claims staff in a variety of claims issues, including but not limited to, coverage, indemnification, policy limit demand reviews, indemnity agreement review, release language review.
Claims Specialist Diversity Caree HubClaims SpecialistOrange, CaliforniaManage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement. Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience.
NewClaims Operations Manager 8FleetClaims Operations ManagerLos Angeles, California$130,000–$150,000 / yearOwn accident and vehicle-incident claims across all markets, from first notice of loss through investigation, repair coordination, negotiation, settlement and closure. At 8Fleet, claims sit at the intersection of fleet availability, driver experience, insurance costs, repair expenses, operational risk and company economics.
Claims Processor ArsenaultClaims ProcessorLos Angeles, CaliforniaThrough our dedicated associates, Arsenault 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. It is essential to have a good understanding of EOBs, FSAs, how to read receipts, doctor bills, and basic medical paperwork.
Accounts Receivable & Claims Specialist - Barebells & NOCCO, USA Vitamin Well GroupAccounts Receivable & Claims Specialist - Barebells & NOCCO, USALos Angeles, California$70,000–$80,000 / yearSuccess in this role requires strong analytical skills, attention to detail, excellent communication, and the ability to collaborate across Sales, Operations, and Finance to resolve issues while protecting company cash flow and profitability. Our growth is driven by a focus on building strong brands, creating products with uncompromising taste and clear functionality, and consistently raising the bar across our categories.
Authorizations and Claims Analytics Solutions Business Insights and Data Analyst III L.A. Care Health PlanAuthorizations and Claims Analytics Solutions Business Insights and Data Analyst IIILos Angeles, CAThis position combines strong data engineering fluency with analytical acumen transforming complex, multi-domain data (membership, encounters, providers, claims, quality metrics) into interpretable and actionable insights used by leaders across the health plan. The Authorizations and Claims Analytics Solutions and Data Analyst III serves as a Subject Matter expert (SME), technical and analytic integrator, responsible for designing, developing, and operationalizing advanced analytic solutions that drive strategic insight and organizational performance.
Claims Coordinator, PSA Collectors Holdings, Inc.Claims Coordinator, PSASanta Ana, CA$20.50–$23 / hourOur 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.
Green — Claims & Risk Data Analyst - Buyer Agency - INSU-6369 FuntoRecruitGreen — Claims & Risk Data Analyst - Buyer Agency - INSU-6369Los Angeles, California$30–$70 / hourTrace assigned work to the RFP scope, requirement or RTM row, deliverable, dependency, acceptance criterion, schedule milestone, and supporting evidence. Prepare role-specific technical inputs, work products, estimates, implementation details, quality records, and proposal or post-award delivery evidence.
Senior Claims Specialist, Workers Comp. - Remote Crum & ForsterSenior Claims Specialist, Workers Comp. - RemoteORANGE, CaliforniaRemoteSalary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.
Senior Claims Specialist, Workers Comp. Remote Crum & Forster Holdings Corp.Senior Claims Specialist, Workers Comp. RemoteOrange, CARemoteSalary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.
Claims Specialist Lead The Progressive CorpClaims Specialist LeadTorrance, CA$39.18–$51.92 / hourFor ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://careers.progressive.com/pages/how-we-hire-faq-job-scams/ . As a claims specialist on our team, you'll play a critical role in our ability to successfully and efficiently resolve large-loss injury claims valued over $60k.
Claims Resolution Specialist - Covered California CalOptimaClaims Resolution Specialist - Covered CaliforniaOrange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist - Covered California 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. Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
Claims Specialist, Workers Compensation - West Region Liberty Mutual Holding Company IncClaims Specialist, 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. As a Workers Compensation Claims Specialist, you will work within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately complex to complex within assigned authority limits.
Claims Examiner - Workers Compensation ObjectWin TechnologyClaims Examiner - Workers CompensationLong Beach, CATo 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. Subject 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.
GLOVIS: Temp Analyst, Claims Revenue and Cost Integration Elevated ResourcesGLOVIS: Temp Analyst, Claims Revenue and Cost IntegrationIrvine, CaliforniaThis role will focus on collecting, organizing, validating, and analyzing claims-related data to help develop an AI solution that can review claim photos, inspection reports, repair estimates, and other documentation to identify damages, estimate severity, and assist with determining liability. Collect, organize, and maintain claim photos, inspection reports, repair estimates, invoices, incident reports, and supporting documentation.