- The County of Los Angeles (Los Angeles, CA)
- …complete this questionnaire completely, correctly, and accurately. The experience you claim in this supplemental questionnaire MUST also be consistent with ... complete this questionnaire completely, correctly, and accurately. The experience you claim in this supplemental questionnaire MUST also be consistent with… more
- LA Care Health Plan (Los Angeles, CA)
- …or any additional service needs according to specific program guidelines. Uses claims processing and care management software to look up member information, document ... stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data… more
- Zurich NA (Los Angeles, CA)
- …challenging and varied caseload. Responsibilities will include working directly with claims professionals providing legal analysis and advice, preparing and filing ... Lexis or Westlaw + Knowledge of the insurance industry, claims and the insurance defense litigation legal environment +...Lexis or Westlaw + Knowledge of the insurance industry, claims and the insurance defense litigation legal environment +… more
- Elevance Health (Costa Mesa, CA)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...of 3 years experience working in grievances and appeals, claims , or customer service; or any combination of education… more
- Robert Half Accountemps (Lynwood, CA)
- …opportunities may be available. Key Responsibilities: Submit and process medical claims accurately to Medi-Cal, commercial insurance, government payers, and other ... Manage denials and appeals, researching root causes, documenting issues, and resubmitting claims as needed. Collaborate with payers and providers to resolve complex… more
- Elevance Health (Walnut Creek, CA)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- …is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial ... DUTIES/RESPONSIBILITIES: * Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate… more
- Highmark Health (Sacramento, CA)
- …supervisory direction and oversight for all enrollment, premium billing, claims and/or customer service telephone and written correspondence inquiries (routine, ... problems. Provides research and technical support need to address complex claims and inquiries and/or when systems problems occur. Provides direction for… more
- Sedgwick (Sacramento, CA)
- …the Finance Manager or Director. + Process account collections/receivables. + Reconcile claims activity between general ledger and claims system and investigate ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- The County of Los Angeles (Los Angeles, CA)
- …applicant's responsibility to take steps to view correspondence, and we will not consider claims of missing notices to be a valid reason for re-scheduling an exam ... to view correspondence. Los Angeles County will not consider claims of not viewing or receiving notification to be...steps to view correspondence, and we will not consider claims of missing notices to be a valid reason… more