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.
Claims Supervisor Workers Compensation GallagherClaims Supervisor Workers CompensationSacramento, CaliforniaRemoteFull timeHow you'll make an impact : Supervise: Lead and encourage a Workers Compensation claims team handling a variety of caseload sizes and complexities to deliver high-quality and efficient service. Prioritize and Develop: Effectively manage multiple competing priorities, identify coaching opportunities, and position team members for successful development.
Workers Compensation Claims Supervisor - CA GallagherWorkers Compensation Claims Supervisor - CASacramento, CaliforniaRemoteFull timeHow you'll make an impact : Supervise: Lead and encourage a Workers Compensation claims team handling a variety of caseload sizes and complexities to deliver high-quality and efficient service. Prioritize and Develop: Effectively manage multiple competing priorities, identify coaching opportunities, and position team members for successful development.
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.
Claims Supervisor GallagherClaims SupervisorOakland, 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.
Senior Workers Compensation Claims Assistant Alliant Insurance Services, Inc.Senior Workers Compensation Claims AssistantWalnut Creek, CACoordinates claims-related activities, maintains program documentation and tracking systems, supports vendor and client initiatives, prepares recurring reports, and assists with risk management and claims administration projects. We are proud to provide comprehensive, high quality employee programs to meet employees needs now and in the future, including a very competitive financial package.
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.
Complex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - 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.
Workers Compensation Claims Technician Liberty Mutual Holding Company IncWorkers Compensation Claims TechnicianSacramento, CAEffective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with claim specific on-going medical management.
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 Specialist Lead The Progressive CorpClaims Specialist LeadConcord, 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.
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 & Provider Relations Oversight Specialist Western Health AdvantageClaims & Provider Relations Oversight SpecialistSacramento, CASupport Annual Network Review (ANR), Geo Access, Provider Appointment Availability Surveys (PAAS), Provider Satisfaction Surveys (PSS), after-hours surveys, and related compliance activities. Western Health Advantage is seeking a detail-oriented Claims & Provider Relations Oversight Specialist to support compliance and regulatory operations within our Claims and Provider Relations department.
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.
Senior Contracts & Claims Manager Aequor Technologies LLCSenior Contracts & Claims ManagerVacaville, CABusiness and financial acumen; " Contracting strategy & execution, strategic sourcing expertise, procurement/sourcing knowledge/experience for large CAPEX projects; " A strong understanding of construction technology, sequencing and practices; " Exceptional problem solving and analytical skills; " Demonstrated project management skills; " Demonstrated experience developing and implementing sourcing strategies that have yielded measurable business results. " Identifying opportunities for outgoing claims, development of claim strategies, supporting/preparing notifications/correspondence as well as negotiation and settlement; " Analysis of incoming claims, development of defense strategies, supporting/preparing response/correspondence, claim negotiation and settlement; " Collection and registration of all claim related documentation in company's claim repository.
NewSr. 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.
Claims Specialist - Workers'''' Compensation (California) ICW GroupClaims Specialist - Workers'''' Compensation (California)Sacramento, CA$78,678.61–$132,686.15 / yearHeadquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. Bachelor's degree (or equivalent combination of education and experience) required along with a minimum of 8 - 10+ years' related claims handling experience involving complex litigation, reserving, settlement strategy, and high exposure claims.
NewLiability Claims Examiner Sedgwick Claims Management Services, Inc.Liability Claims ExaminerConcord, CA$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.
NewSenior Litigation Construction Liability Claims Representative The Travelers Companies IncSenior 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.
Property & Casualty Claims Advocate Hub International LtdProperty & Casualty Claims AdvocateSacramento, CA$68,000–$100,000 / yearMaintains 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. QUALIFICATIONS: High School Diploma / GED 2-3 years property & casualty claims adjustment experience (brokerage preferred) or equivalent combination of education & experience Property & Casualty License required or willingness to obtain within 3 months.