Sr. Claims Specialist, Professional Liability | Medical Malpractice | California Sedgwick Claims Management Services, Inc.Sr. Claims Specialist, Professional Liability | Medical Malpractice | CaliforniaConcord, CA$100,000–$125,000 / yearIdeal candidates demonstrate strong analytical and negotiation skills, exercise sound judgment, and are committed to delivering timely, cost‑effective claim resolutions while maintaining a high level of customer service. ESSENTIAL RESPONSIBLITIES MAY INCLUDE: Analyzes and processes complex or technically difficult medical malpractice 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.
Electronic Data Interchange (EDI) Claims Assistant UCSF Medical CenterElectronic Data Interchange (EDI) Claims AssistantEmeryville, CAThe Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children's Hospital Oakland (BCH Oakland), By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production supports all electronic claim production to various payers and clearinghouses, including Medicare, Medi-Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally.
Pharmacy Technician – Prescription Routing & Claims Support PHILPharmacy Technician – Prescription Routing & Claims SupportSan Francisco, CaliforniaRemoteUtilize 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.
Liability Claims Examiner Sedgwick Claims Management Services, Inc.Liability Claims ExaminerCA$85,000–$105,000 / 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: To address and handle high end General Liability cases with serious injuries, complex coverage scenarios and legal inquiries or disputes; to develop a strategy to bring a case to satisfactory resolution.
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 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.
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.
Senior Software Engineer, Claims Submissions CommureSenior Software Engineer, Claims SubmissionsMountain View, CaliforniaThe claim generation pipeline: transforming structured claim payloads into valid electronic EDI claims across professional (CMS-1500), institutional (CMS-1450/UB), and dental (CDT) formats, plus paper-claim and PDF generation for payers that require mail or fax. Our platform spans the full care journey: Ambient AI and Dictation eliminating documentation burden at the point of care, intelligent Agents automating patient and revenue workflows, and autonomous RCM processing billions in claims, all on a single AI-native platform integrated with 60+ EHRs.
Fremont Michigan Claim Support Assistant I AAA Southern New EnglandFremont Michigan Claim Support Assistant IFremont, CABy continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance. Important Note: ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals.
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.
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.
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.
Victim Claims Specialist I San Joaquin CountyVictim Claims Specialist ISan Jose, CAMobility-Frequent keyboard operation, sitting; occasional pushing, pulling, bending, squatting; Lifting-Frequent lifting up to 5 pounds; Vision-Constant reading and close-up work requiring good overall vision; frequent eye/hand coordination; occasional color/depth perception and peripheral vision; Dexterity-Frequent holding, gripping, writing and repetitive motion; occasional reaching; Hearing/Talking-Constant hearing normal speech, hearing/talking in person and on the telephone; occasional hearing faint sounds; Emotional/Special Conditions-Frequent public contact, decision making, and concentration; frequent exposure to trauma, grief and death; occasional working overtime. Learns to review and process a variety of claims submitted by victims including medical bills, mental health bills, funeral/burial bills, wage loss requests and other expenses; learns to research information as required to establish a link to the qualifying crime and to verify losses claimed by the victim; learns to calculate losses to victims and determine reimbursements considering all other sources of compensation available; learns to recommend approval or denial of reimbursement and level of services; notifies victims of claim determinations.
Senior Complex Claims Manager Airbnb IncSenior Complex Claims ManagerCARemote$125,000–$145,000 / yearIn partnership with key stakeholders in the organization, you'll support our Complex Claims Leader and contribute to Airbnb's multiple year strategy (vision, risk appetite, operating model, goals, KPIs), manage partners to influence prioritization, drive accountability, deliver improvements, and scale changes on claims which impact Airbnb. Philosophy will be to identify intelligence / risk gaps and work with other internal risk management teams (such as Trust team, and Safety team), third party adjusters, our partners, Platform Product Management, Global Crisis Management, Community support, Policy, Privacy Legal teams to strengthen Airbnb's platform.
APeX Claims Analyst UCSF Medical CenterAPeX Claims AnalystSan Francisco, CAYesWorks on complex initiatives to analyze patient care workflow in various clinical departments, and to develop and define information technology solutions for improved system integration and functionality. Ability to work with senior staff and managers, serving as a technical resource and providing advice and counsel on issues of functionality, efficiency, cost-effectiveness, policy, and performance.
Michigan APD Claim Representative II - Fremont AAA Southern New EnglandMichigan APD Claim Representative II - FremontFremont, CABy continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance. Important Note: ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals.
Customer Operations Claims Analyst Kinder'sCustomer Operations Claims AnalystWalnut Creek, CaliforniaMost of our work happens in the office to spark creativity and community, but we also offer flexibility so team members have the autonomy to work outside the office when needed to support their work-life balance and personal commitments. This person will act as both a detective and a problem-solver — validating customer complaints or charges, identifying the true root causes, and pushing toward resolution either through claim recovery or internal process improvement.
Complex Claim Director - Mass Tort Unit CNA Financial Corp.Complex Claim Director - Mass Tort UnitWalnut Creek, CA$97,000–$189,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Leads the work activities of medium to high severity specialized Claims Professionals, has full management responsibility for setting and communicating expectations, providing direction and situational coaching, and facilitating ongoing training. Leads a team of Claims Consultants and Consulting Directors that are responsible for the handling of complex, high exposure mass tort and environmental claims, including social media addiction, PFAS, talc, sexual molestation, and other long tail general liability and pollution related matters.
NewEPL & D&O Liability Claim Counsel The Travelers CompaniesEPL & D&O Liability Claim CounselWalnut Creek, CA$111,600–$184,200 / yearTravelers' Private/Non-Profit Team provides executive and organizational management liability coverage to privately held companies and non-profit entities of all types and sizes as well as certain governmental public entities. Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposure, reserve adjustments, coverage issues, and claim and recovery strategies.
NewStrategy & Operations RaydarStrategy & OperationsSan Francisco, CAThe business reached multi-seven-figure annual recurring revenue in under a year, has grown roughly 50% month over month, and recently raised a $50M Series A from leading venture investors. You will work directly with the CEO, turn ambiguous problems into structured operating systems, and help build the processes that allow insurance claims to be handled efficiently at scale.