Claims Examiner - Workers Compensation (Hybrid - Concord, CA) Sedgwick Claims Management Services, Inc.Claims Examiner - Workers Compensation (Hybrid - Concord, CA)Concord, CA$80,000–$85,000 / yearMental: 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. PRIMARY PURPOSE OF THE ROLE: To analyze workers' compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Inside Sales - Claims (Mandarin Required) ASUSTeK ComputerInside Sales - Claims (Mandarin Required)Fremont, CA$70,304–$71,400 / yearIn this role, you will partner closely with Sales, Product Management, Finance, and external customers to verify promotional documentation, resolve pricing and invoice discrepancies, coordinate claim resolution, and support the successful execution of channel programs. Essential Duties and Responsibilities: Serve as the primary liaison between ASUS Asia headquarters and North American Sales, Product Management, Finance, Accounts Receivable, and customers, ensuring timely communication and resolution of operational issues.
Pharmacy Technician – Prescription Routing & Claims Support PHILPharmacy Technician – Prescription Routing & Claims SupportSan Francisco, CaliforniaRemote$20–$24 / hourUtilize reroute best practices for orders falling outside normal workflow, including orders with state changes, insurance exceptions, pharmacy rejections, or failed transfers. Company Overview: Founded in 2015, Phil is a San Francisco-based, Series D health-tech startup that is revolutionizing prescription access by streamlining how doctors, pharmacies, and patients interact.
Claims Process Specialist LancesoftClaims Process SpecialistOakland, CARemote$18Job duties include: Examine garnishments, levies, liens and information subpoenas to ensure accuracy, completeness and legal sufficiency. Claims include garnishments, levies, liens and information subpoenas received from creditors and taxing authorities.
Claims Resolution Coordinator Partnership HealthPlan of CaliforniaClaims Resolution CoordinatorFairfield, California$37.22–$46.53 / hourFull timeThe job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. Acts as a resource and provides support to customer service staff, as well as Provider Relations staff for complex Provider questions regarding claims and payments.
Claims Examiner GallagherClaims ExaminerOakland, CaliforniaRemoteFull timeBehaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges. As part of Gallagher, a global leader in insurance, risk management, and consulting, you’ll be joining a team that’s passionate about helping individuals and organizations thrive.
Senior Claims Examiner, Workers' Compensation GallagherSenior Claims Examiner, Workers' CompensationPleasanton, CaliforniaRemote$75,000–$105,000 / yearFull timeThe actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. Behaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
Senior Claims Examiner GallagherSenior Claims ExaminerPleasanton, CaliforniaRemoteFull timeBehaviors: Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges. Introduction : At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they’re free to grow, lead, and innovate.
Claims Supervisor, Complex General Liability GallagherClaims Supervisor, Complex General LiabilityOakland, CaliforniaRemoteFull timeAbility to actively review work of others via file reviews; identify coaching opportunities, act on needed coaching opportunities and position subordinates for successful development leading to advancement within the organization. As part of Gallagher, a global leader in insurance, risk management, and consulting, you’ll be joining a team that’s passionate about helping individuals and organizations thrive.
Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, Private & NFP D&OWalnut Creek, CA$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Claims Examiner II North East Medical ServiceClaims Examiner IIBurlingame, CAESSENTIAL JOB FUNCTIONS: Perform the daily examination, auditing and adjudication activities to submitted hospital and professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual. Responsible to prepare files and documents for the annual health plan delegation oversight audits, assist Claims Supervisor with MSO management reports, and other special projects as needed.
Workers Compensation Large Loss Claims Director CNA Financial Corp.Workers Compensation Large Loss Claims DirectorWalnut Creek, CA$97,000–$189,000 / yearWorking closely with claims leadership, disposition consultants, legal services, customers, brokers, and business partners, the Large Loss Director drives superior claim outcomes, technical excellence, operational effectiveness, and profitable growth while serving as a mentor and resource to claims professionals across the organization. This individual contributor role provides company-wide influence and leadership in the interpretation of complex policy coverages, litigation management, reserving, claim resolution strategies, regulatory compliance, and large loss methodologies.
Claims Examiner I MSO North East Medical ServiceClaims Examiner I MSOBurlingame, CAESSENTIAL JOB FUNCTIONS: Perform the daily examination, auditing and adjudication activities to submitted professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence of Benefit, and policies and procedures outlined in the MSO Claims Manual. Identify claims payment errors and/or system configuration flaws during day-to-day operation, report to department manager/supervisor and MSO System Configuration team to correct/resolve them.
NewProperty & Casualty Claims Advocate II Hub InternationalProperty & Casualty Claims Advocate IISan Francisco, CAMaintains 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. The expected salary range for this position is $80,000 - $120,000k depending on geographical location and will be impacted by factors such as the successful candidate's skills, experience and working location, as well as the specific position's business line, scope and level.
Claims Appraiser - Auto Estimatics State FarmClaims Appraiser - Auto EstimaticsFremont, CA$78,862.06–$102,500 / yearWith 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! Additional Details: Employees must successfully complete all required training, including applicable proficiency, licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s).
Program Manager - Workers Compensation Claims | CA Claims Exp. Preferred (Hybrid - California) Sedgwick Claims Management Services, Inc.Program Manager - Workers Compensation Claims | CA Claims Exp. Preferred (Hybrid - California)Concord, CA$95,000–$120,000 / yearMental: 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. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.
Senior Litigation Construction Liability Claims Representative The Travelers CompaniesSenior Litigation Construction Liability Claims RepresentativeWalnut Creek, CA$94,400–$155,800 / yearDirectly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
Claims Processor 1 Zenith American SolutionsClaims Processor 1San Francisco, CaliforniaWe are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide.
Supervisor, Claims Zenith American SolutionsSupervisor, ClaimsSan Francisco, CaliforniaZenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.
Claims Processor 3 Zenith American SolutionsClaims Processor 3San Francisco, CaliforniaWe are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. High school diploma or general education degree (GED); two years related experience processing all types of group health and/or dental benefit claims.