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.
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.
Claims Customer Service Representative I Partnership HealthPlan of CaliforniaClaims Customer Service Representative IFairfield, California$29.95–$35.19 / hourFull timeTo accurately research and process paper and electronic medical, outpatient, ancillary, long term care, CHDP, encounter data and paper crossover/other coverage claims within established time frames, applying appropriate program policies related to claims processing and analysis. Overview: To research and resolve provider telephone and written inquiries within established time frames, accurately screen claims, and participate in provider meetings and projects.
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.
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.
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.
Claims Customer Service Representative III Partnership HealthPlan of CaliforniaClaims Customer Service Representative IIIFairfield, California$33.65–$40.38 / 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 of the tasks that an employee may be required to perform. Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and.
Engagement Lead - Risk Consulting- Forensic Accounting/Claims-Remote - US Marsh & McLennan Companies IncEngagement Lead - Risk Consulting- Forensic Accounting/Claims-Remote - USSan Francisco, CARemote$112,600–$239,800 / yearAs an Engagement Lead - Forensic Accounting & Claims Services Consultant, you will act as a recognized subject matter expert, leading large-scale strategic projects, coaching team members, and solving complex client problems. Marsh Risk is a business of Marsh (NYSE: MRSH), a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries.
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.
Claims Examiner II Partnership HealthPlan of CaliforniaClaims Examiner IIFairfield, California$31.45–$37.74 / hourFull timeReviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established. The 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.
MSO Claims Manager North East Medical ServiceMSO Claims ManagerBurlingame, CAThis role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
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.
Pharmacist -Starting at $73.80/hr & Relocation Walgreen CoPharmacist -Starting at $73.80/hr & RelocationPalo Alto, CA$67.35–$82.30 / hourWalgreens has approximately 211,000 team members, including roughly 85,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities. Opportunities for growth - Many pharmacists advance quickly into leadership roles in pharmacy operations, retail management, multi-site leadership, and corporate support functions.
Associate Revenue Cycle Analyst - Claim Rejections Natera IncAssociate Revenue Cycle Analyst - Claim RejectionsCA$58,700–$77,000 / yearIndependently manage improvement initiatives from identification through implementation, including coordinating with cross-functional partners, tracking progress, testing solutions, validating resolution, and monitoring results after implementation. Utilize advanced Excel functionality, including pivot tables and lookup functions, to analyze large datasets, identify meaningful trends, and translate complex data into actionable insights.
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.
NewPIP Claim Rep I Michigan AAA Southern New EnglandPIP Claim Rep I MichiganFremont, 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.
EPL & 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.
NLP Scientist Claim Accuracy and Compliance - ROCGJP00042840 Triune InfomaticsNLP Scientist Claim Accuracy and Compliance - ROCGJP00042840South San Francisco, CAGiven a statement and a corpus of approved claims, product labeling, clinical study results and references, the system retrieves the relevant evidence, decomposes compound statements into checkable assertions, tests whether the evidence supports each one, and returns a decision with citations a reviewer can follow. Must Have: Evidence-Grounded NLP, Hybrid Retrieval & RAG, NLI/Entailment & Claim Verification, Claim Decomposition & Evidence Attribution, Evaluation & Human-in-the-Loop, Python & NLP Frameworks.
COLL REPR SR UCSF Medical CenterCOLL REPR SRSan Francisco, CAThe Senior Collections Representative helps with Claim submission, Accounts receivable, working denial, Patient Billing Inquiries, Correspondence, Payment Allocation and Process Improvement to ensure compliant and through collections of professional fees performed in the Dental Center. Payment Allocation: Preparation and submission of PeopleSoft journals for payments routing to PBS centralized Lockbox, MyChart deposits, ACH, EFT, i835 and insurance credit card, adhering to the Cash Handling Procedure Policy.