Claims Examiner I Clever Care Health Plan IncClaims Examiner IHuntington Beach, CA$27–$32 / hourThis position requires considerable interaction with clients, claimants on the phone, with management, other Claims Examiners, and other staff in the office; therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Sr. Manager - Claims Astrana Health IncSr. Manager - ClaimsMonterey Park, CAThis role will report to the AVP - Claims Operations and enable us to continue to scale in the healthcare industry. About the Role: We are currently seeking a highly motivated Claims Manager.
Lead - Claims Examiner Astrana Health IncLead - Claims ExaminerMonterey Park, CAManager - Claims and enable us to continue to scale in the healthcare industry. We are currently seeking a highly motivated Lead - Claims Examiner.
Senior Manager, Claims Adjustments L.A. Care Health PlanSenior Manager, Claims AdjustmentsLos Angeles, CAThe Senior Manager, Claims Adjustments manages all adjustment-related operational workflows, including provider disputes, escalated claim reviews, complex adjustments, and litigation-related claim support. Ensures all provider adjustments meet Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and contractual (TAT) requirements.
Claims Processor ArsenaultClaims ProcessorLos Angeles, CaliforniaThrough our dedicated associates, Arsenault delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments creating exceptional outcomes for our clients and the millions of people who count on them. It is essential to have a good understanding of EOBs, FSAs, how to read receipts, doctor bills, and basic medical paperwork.
Sr. Claims Consultant - IAS BRP Group, Inc.Sr. Claims Consultant - IASIrvine, CAThe Baldwin group is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted commercial insurance and risk management, private insurance and risk management, employee benefits and benefit administration, asset and income protection, and risk mitigation strategies to clients wherever their passions and businesses take them throughout the U.S. and abroad. This role serves as a trusted consultant to our clients, insurance carriers, third-party administrators (TPAs), and internal account teams by providing strategic workers' compensation claims consulting, advocacy, and program management services.
NewSr. Manager, Risks & Claims Workers'' Compensation & General Liability Sweetgreen IncSr. Manager, Risks & Claims Workers'' Compensation & General LiabilityLos Angeles, CA$100,000–$130,000 / yearSitting on the Operations Services team and reporting to the Senior Director of Risk + Safety, you will direct the claims adjusting service provided by our workers'' compensation carrier, oversee our general liability carrier, and serve as the internal point of contact connecting our restaurants, carriers, brokers, and defense counsel. Build and partner with the People Team and Restaurant Operations on the return-to-work and modified duty program to reduce lost-time exposure, and serve as a clear, consistent point of contact for injured team members.
Claims Resolution Specialist, Covered California CalOptimaClaims Resolution Specialist, Covered CaliforniaOrange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist, 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 - Lead Covered California CalOptimaClaims Examiner - Lead Covered CaliforniaOrange, CA$55,966–$83,949 / yearWe are hoping you will join us as a Claims Examiner - Lead 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 - Lead CalOptimaClaims Examiner - LeadOrange, CA$55,966–$83,949 / yearWe are hoping you will join us as a Claims Examiner - Lead and help shape the future of healthcare where you'll be an integral part of our CLA - Claims Production 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.
Vice President, Claims and Provider Operations SCAN Health PlanVice President, Claims and Provider OperationsLong Beach, CaliforniaRemote$260,000–$325,000 / yearPartners closely with IT, EDI Operations, Finance, Network Management, Compliance, Clinical, Appeals and Grievances, and other business leaders to optimize claims system configuration, edit logic, benefit loading accuracy, provider and contract data integrity, accumulator logic, dispute root cause remediation, operational readiness, provider experience, and downstream member outcomes for new products, regulations, contracts, and enterprise initiatives. Drives affordability through payment integrity, configuration discipline, and disciplined claims controls, including pre-payment and post-payment review, clinical and non-clinical editing, duplicate detection, unbundling, upcoding, billing anomaly detection, provider audits, coordination of benefits, and high-dollar claims review.
Claims Advocate- P&C Edgewood Partners Insurance CenterClaims Advocate- P&CNewport Beach, CA$95,000–$105,000 / yearFueled and driven by capable, committed people who share common beliefs and values and "bring it" every day, EPIC is always looking for people who have "the right stuff" - people who know what they want and aren't afraid to make it happen. Managed PTO for salaried/exempt employees (personal time off without accruals or caps); 22 PTO days starting out for hourly/non-exempt employees; 12 company-observed paid holidays; 4 early-close days.
Accounts Receivable & Claims Specialist - Barebells & NOCCO, USA Vitamin Well GroupAccounts Receivable & Claims Specialist - Barebells & NOCCO, USALos Angeles, California$70,000–$80,000 / yearSuccess in this role requires strong analytical skills, attention to detail, excellent communication, and the ability to collaborate across Sales, Operations, and Finance to resolve issues while protecting company cash flow and profitability. Our growth is driven by a focus on building strong brands, creating products with uncompromising taste and clear functionality, and consistently raising the bar across our categories.
NewSenior Claims Specialist Macpower Digital Assets Edge Private LimitedSenior Claims SpecialistOrange, CA$110,000–$130,000 / yearJob Summary: Seeking a Senior Claims Specialist to manage a complex caseload of medical malpractice claims, supervise junior claims specialists, and contribute to ongoing training efforts. Key Responsibilities: Manage medical malpractice claims , including assigning and directing defense counsel, following Claims Technical Manual, Defense Attorney Guidelines, and MPT Agreement.
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.
Senior Workers Compensation Claim Representative The Travelers CompaniesSenior Workers Compensation Claim RepresentativeGlendale, CA$70,400–$116,200 / yearEducation/Course of Study: Work Experience: Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW.
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.
NewEPL & D&O Liability Claim Counsel The Travelers CompaniesEPL & D&O Liability Claim CounselRancho Cucamonga, 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.
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.
Workers'''' Compensation Claims Examiner | CA WC Experience Required Sedgwick Claims Management Services, Inc.Workers'''' Compensation Claims Examiner | CA WC Experience RequiredCARemote$80,000–$105,000 / yearPRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult California 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. Mental: 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.