- Pacific Northwest National Laboratory (Sacramento, CA)
- …of federal background investigation post hire and receive a favorable federal adjudication . The tier of federal background investigation will be determined by job ... duties and national security or public trust responsibilities associated with the job. All tiers of investigation include a declaration of illegal drug activities, including use, supply, possession, or manufacture within the last 1 to 7 years (depending on the… more
- LA Care Health Plan (Los Angeles, CA)
- …in the application of medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization ... Management projects. The position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well as validation of accuracy and completeness of all coding elements. The position is also responsible for guidance… more
- RTX Corporation (El Segundo, CA)
- …This position requires an active Top Secret security clearance. DCSA Consolidated Adjudication Services (DCSA CAS), an agency of the Department of Defense, handles ... and adjudicates the security clearance process. More information about Security Clearances can be found on the US Department of State government website here: https://www.state.gov/m/ds/clearances/c10978.htm RTX Corporation is an Aerospace and Defense company… more
- Sciolex Corporation (Los Angeles, CA)
- …Providing support for the processing of forms and applications used in the adjudication process, + Scanning large multi-page documents, + Other duties as assigned. ... Qualifications & Physical Requirements + High school diploma or equivalent + Must be able to obtain a Public Trust/Suitability Clearance under the Department of Homeland Security from the United States Citizenship and Immigration Services + Ability to read and… more
- Sedgwick (Sacramento, CA)
- …of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific ... client service requirements. **ESSENTIAL RESPONSIBILITIES** + Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. +… more
- Guidehouse (Fairfield, CA)
- …and MAINTAIN a Federal or DoD "PUBLIC TRUST"; candidates must obtain approved adjudication of their PUBLIC TRUST prior to onboarding with Guidehouse. Candidates with ... an ACTIVE PUBLIC TRUST or SUITABILITY are preferred. + Bachelor's Degree + THREE (3) or more years of experience in healthcare supply chain and/or master data management with at least TWO (2) or more years working with Supply Chain ERP systems. + Experience… more
- The County of Los Angeles (Los Angeles, CA)
- …with the information (Insurance billing codes and coverage, claim adjudication , drug names, and medical terminology), equipment (Pharmacy Automation Units- ... Kirby, Parata and Pyxis), and techniques needed to appropriately dispense, mix and fill pharmaceuticals. Includes deciphering, verifying and processing prescriptions and/or drug orders in order to provide quality patient care + Consistent use of computers to… more
- US Tech Solutions (Whittier, CA)
- …per policy guidelines **Experience:** 2+ years of experience in claims adjudication (HMO, IPA, or hospital environment) **Skills:** + Claims reimbursement knowledge ... + Experience working with DOFR (Division of Financial Responsibility) + Hands-on experience processing lab claims + Familiar with UB-92 and HCFA-1500 forms + Understanding of provider contracts, Medi-Cal, commercial, and senior plan claims + Strong knowledge… more
- Sedgwick (Sacramento, CA)
- …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. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult claims by investigating and gathering information to… more
- Stanford University (Stanford, CA)
- …conflict resolution meetings as needed. + Provide back-up support for background check adjudication . + May act as team lead for Employee and Labor Relations staff. ... + Perform other duties as assigned. * _Note: The job duties listed are typical examples of work performed by positions in this job classification and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and… more