NewClaims Examiner I Clever Care Health PlanClaims Examiner IHuntington Beach, CAThis 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.
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.
Lead - Claims Examiner Astrana Health IncLead - Claims ExaminerMonterey Park, CAManager - Claims and enable us to continue to scale in the healthcare industry. We are currently seeking a highly motivated Lead - Claims Examiner.
Sr. Manager - Claims Astrana Health IncSr. Manager - ClaimsMonterey Park, CAThis role will report to the AVP - Claims Operations and enable us to continue to scale in the healthcare industry. About the Role: We are currently seeking a highly motivated Claims Manager.
NewSr. Manager, Risks & Claims Workers'' Compensation & General Liability Sweetgreen IncSr. Manager, Risks & Claims Workers'' Compensation & General LiabilityLos Angeles, CA$100,000–$130,000 / yearSitting on the Operations Services team and reporting to the Senior Director of Risk + Safety, you will direct the claims adjusting service provided by our workers'' compensation carrier, oversee our general liability carrier, and serve as the internal point of contact connecting our restaurants, carriers, brokers, and defense counsel. Build and partner with the People Team and Restaurant Operations on the return-to-work and modified duty program to reduce lost-time exposure, and serve as a clear, consistent point of contact for injured team members.
Sr. Manager, Risks & Claims (Workers' Compensation & General Liability) sweetgreenSr. Manager, Risks & Claims (Workers' Compensation & General Liability)Los Angeles, CA$100,000–$130,000 / yearSitting on the Operations Services team and reporting to the Senior Director of Risk + Safety, you will direct the claims adjusting service provided by our workers' compensation carrier, oversee our general liability carrier, and serve as the internal point of contact connecting our restaurants, carriers, brokers, and defense counsel. Build and partner with the People Team and Restaurant Operations on the return-to-work and modified duty program to reduce lost-time exposure, and serve as a clear, consistent point of contact for injured team members.
Senior Manager, Claims Adjustments L.A. Care Health PlanSenior Manager, Claims AdjustmentsLos Angeles, CAThe Senior Manager, Claims Adjustments manages all adjustment-related operational workflows, including provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support. Ensures all provider adjustments meet Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and contractual (TAT) requirements.
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.
Senior Claims Specialist I, Workers Compensation - West Region Liberty Mutual Holding Company IncSenior Claims Specialist I, Workers Compensation - West RegionLos Angeles, 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. Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state s tort laws as normally acquired through a bachelor s degree (or equivalent training) plus 3 to 5 years directly related work experience.
Vice President, Claims and Provider Operations SCAN Health PlanVice President, Claims and Provider OperationsLong Beach, CaliforniaRemote$260,000–$325,000 / yearPartners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration, edit logic, benefit loading accuracy, provider and contract data integrity, accumulator logic, dispute root cause remediation, operational readiness, provider experience, and downstream member outcomes for new products, regulations, contracts, and enterprise initiatives. Drives affordability through payment integrity, configuration discipline, and disciplined claims controls, including pre-payment and post-payment review, clinical and non-clinical editing, duplicate detection, unbundling, upcoding, billing anomaly detection, provider audits, coordination of benefits, and high-dollar claims review.
Claims Team Lead I Workers Compensation I CA experience required Sedgwick Claims Management Services, Inc.Claims Team Lead I Workers Compensation I CA experience requiredCA$75,000–$100,000 / yearTo supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Supervises multiple teams of examiners, multiple product line examiners and/or several (minimum seven) technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealthEPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full TimeCAEpic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.
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.
Claims Examiner VenbrookClaims ExaminerLos Angeles, CaliforniaVenbrook works across the claims lifecycle with services that include Third Party Administration (TPA), Complex Claims Management, Catastrophe, Independent Adjusting, subrogation recovery, litigation management, investigative, and special investigations unit (SIU) services. Venbrook's team of experts and industry specialists partners with their clients to manage their risks, create security, promote growth, and add value by delivering best-in-class commercial property & casualty, employee benefits, and personal risk insurance products and programs.
Workers'''' Compensation Claims Examiner | CA WC Experience Required Sedgwick Claims Management Services, Inc.Workers'''' Compensation Claims Examiner | CA WC Experience RequiredCARemote$80,000–$105,000 / 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.
NewWorkers Compensation Claims Examiner Sedgwick Claims Management Services, Inc.Workers Compensation Claims ExaminerCARemote$85,000–$110,000 / 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.
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.
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.