- 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
- RTX Corporation (San Diego, CA)
- …employee referral. This position requires a security clearance. DCSA Consolidated Adjudication Services (DCSACAS), 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 **_As part of our commitment to maintaining a secure… more
- Sedgwick (Roseville, 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 workers' compensation claims by investigating and… more
- Sacramento Behavioral Healthcare Hospital (Sacramento, CA)
- …and an out-of-pocket maximum are + Knows how these affect claim adjudication and patient responsibility + Knows how to calculate patient's estimated responsibility ... based on benefits and scheduled procedure(s) using Excel + Knows how to read and interpret insurance benefits + Current CPI Certification ( or obtained within first 30 days of hire) + Current BLS Certification (or obtained within first 30 days of hire) Skills… more
- Sedgwick (Brea, 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** + Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by… more