- Sedgwick (Orange, CA)
- … claim activities. Offers technical and jurisdictional guidance on claims adjudication and maintains regular diaries, especially for complex or high-exposure ... best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing… more
- Sedgwick (West Hills, CA)
- …as suggested by the claim status; and provides written resumes of specific claims as requested by client. + Assures that direct reports are properly licensed in ... operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …and risk partners to identify and recommend risk management approaches for CHLA Claims Management * Overseeing and optimizing claim investigation, reserving and ... is directly accountable for contributing to audit functions, business continuity, claims management, insurance, physical security, integrated risk management and all… more
- Prime Therapeutics (San Diego, CA)
- …pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting ... downstream claim corrections to eliminate potential waste. **Responsibilities** + Evaluate...to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest risk for… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …all necessary documentation required from payors to ensure accurate adjudication of claim for reimbursement. They will process claims correctly following ... not limited to; Commercial, Medi-Cal and Managed Care professional claims . This position is responsible checking status of unpaid...edits and take necessary steps to send a corrected claim or appeal to payor for reprocessing of … more
- TevisHR (CA)
- …home office in Sacramento, CA. Job Summary: A Loss Consultant for insurance claims is responsible for evaluating the extent of damage to residential properties ... with policyholders, contractors, and other relevant parties to ensure fair and timely claim settlements. Overall, an estimator for a claim plays a critical… more
- USAA (Los Angeles, CA)
- …accurately manages claims outcomes. + Maintains accurate, thorough, and current claim file documentation throughout the claims process. + Advance knowledge ... and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes… more
- Sedgwick (San Diego, CA)
- …and review new claims and maintain data integrity in the claims system. + Conduct claim file activities including evaluations, investigations, litigation ... your adjuster knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...+ Prepare settlement documents and requests payment for the claim and expenses. + Work with external vendors and… more
- Sedgwick (West Hills, CA)
- …CA 91304 **PRIMARY PURPOSE** : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan ... and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations;… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …needed for accurate reporting of the service. The incumbent completes daily processing of claim edits or rejected claims processed through the billing system and ... ensuring it is correctly reflected on submission of the claim . They register new patients in the system, including...is responsible for pulling medical records to submit with claims and appeals as required by payors. Responsible to… more