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.
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.
Assistant Director, Claims Operations Impresiv HealthAssistant Director, Claims OperationsHuntington Beach, CA$95,000–$120,000 / yearThe Assistant Director will provide operational, analytical, administrative, and project support across claims processing, 837 file oversight, payment integrity, issue resolution, provider and IPA coordination, reporting, audit readiness, system initiatives, and process improvement. Track, document, escalate, and help resolve complex claims issues involving providers, IPAs, delegated entities, vendors, and internal departments.
Claims Examiner Sr, Covered California CalOptimaClaims Examiner Sr, Covered CaliforniaOrange, CA$51,744–$72,441 / yearWe are hoping you will join us as a Claims Examiner Sr, Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
Claims Examiner - Workers Compensation (Hourly) Apidel TechnologiesClaims Examiner - Workers Compensation (Hourly)Brea, CAContractorTo analyze complex or technically difficult 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. Analyzes and processes complex or technically difficult workers\' compensation 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.
Quality Claims Administrator Assistant Bentley Mills IncQuality Claims Administrator AssistantCABentley Mills reserves the right to pay outside of the given range based on a variety of factors including but not limited to: candidate skills and experience, complexity of the job, budgetary factors, and local/geography. Skills: The Quality Claims Administrator Assistant uses strong organizational skills daily to manage multiple claims efficiently and ensure accurate documentation.
Claims Examiner - Workers Compensation (Hourly) MindlanceClaims Examiner - Workers Compensation (Hourly)Brea, CARemote$47–$48 / hourDuties: PRIMARY PURPOSE: To analyze complex or technically difficult 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. Analyzes and processes complex or technically difficult workers' compensation 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 Quality Supervisor UCLA Health SystemClaims Quality SupervisorLos Angeles, CA$78,500–$163,600 / yearAs a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. Provide direct supervision and guidance for Quality Control and Customer Service staff and provide developmental and training opportunities for team members.
Cust Serv Rep I -Claims Alert Crawford & CoCust Serv Rep I -Claims AlertCARemoteAll resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. Provides excellent customer service to all internal team members and external customers.
Medical Claims Intake Coordinator UCLA Health SystemMedical Claims Intake CoordinatorLos Angeles, CA$26.42–$37.49 / hourb'nn n n n n n n n n n n n nn n n n n n n n n n n n n n n n n n Medical Claims Intake Coordinator - - 29680 - UCLA Healthn n nnnn nn n n n nn n n n n Skip to content nn n n n n n UCLA Health Home Page n n nn nnn n nn n Main menu. Press enter or space keys to expands and escape key to collapse nn n n n n n n Search jobs n n nn...
Claims Quality Auditor UCLA Health SystemClaims Quality AuditorLos Angeles, CA$31.51–$62.64 / hourAs a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures.
Claims Adjustment Specialist UCLA Health SystemClaims Adjustment SpecialistLos Angeles, CA$32.42–$64.51 / hourThe Claims Adjustment Specialist analyzes and processes medical claim adjustments related to overpayments, underpayments, provider corrected claims, and reimbursement discrepancies. As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Outside Property Claim Representative The Travelers CompaniesOutside Property Claim RepresentativeRosemead, CA$67,000–$110,600 / yearAs a Claim Rep, Outside Property, you will be responsible for managing, inspecting, evaluating, negotiating, and settling 1st party property claims in a timely and accurate manner which includes performing in-person inspections at customers' residences and properties to accurately assess damages. Ideal locations include El Monte, San Gabriel, Rosemead, West Covina, Covina, Glendora, Azusa, La Puente, East Los Angeles, Montebello, Burbank, Simi Valley, Santa Clarita, and surrounding areas.
Business Analyst III-Encounters & Claims Data L.A. Care Health PlanBusiness Analyst III-Encounters & Claims DataLos Angeles, CAThe Business Analyst III manages and coordinates the implementation and/or integration of products or new features for clients including client training and provides subject matter expertise (SME) and support of the departments inbound and outbound functions. Perform data analysis to support evaluation of system defects or to develop requirements for new functionality; assist in various system trouble shooting and balancing and correction efforts including analysis, verification and validation of issues and fixes.
Claims Coordinator (Hybrid in CA) First AmericanClaims Coordinator (Hybrid in CA)Santa Ana, CaliforniaFirst American reasonably believes that a criminal history may have a direct, adverse and negative relationship with the following material job duties for this position potentially resulting in the withdrawal of the conditional offer of employment: handling of confidential, proprietary or trade secret information belonging to First American or its customers, administrating or facilitating financial transactions, and the ability to meet customer-imposed criminal history requirements. This is an excellent opportunity for a detail-oriented professional who enjoys researching and connecting information from multiple sources, uncovering critical transaction details, and working in a fast-paced, collaborative environment.
Senior Claim Examiner I, CA AmTrust Financial Services, Inc.Senior Claim Examiner I, CATBD, California$49–$54 / hourFull timeSalaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations . Your ability to effectively interact with insureds, claimants, and their legal representatives will be essential in driving timely settlements while adhering to AmTrust’s mission, vision, and values.
Senior Claim Director Chubb LtdSenior Claim DirectorLos Angeles, CA$107,800–$156,200 / yearThe company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. Proficient computer skills and extensive knowledge of the Microsoft suite of Office products including Outlook, Word, Excel, and PowerPoint, and Adobe Acrobat.
Claim Director Chubb LtdClaim DirectorChatsworth, CA$78,100–$114,400 / yearPerform assignments, tasks or activities that contribute to the overall objectives of the business division being supported including but not limited to; conducting audits, providing financial analysis on reserve adequacy, identifying occupational disease exposures, and providing expertise on jurisdictional nuances. Provide direction, reserve and settlement authority to claim handlers as outlined in Chubb North American Claim Handling Guidelines and within Director's authority, elevating requests above authority to appropriate management levels for approval.
NewSenior Claim Benefit Specialist - Remote CVS Health CorpSenior Claim Benefit Specialist - RemoteCARemote$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. Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication.