- Sedgwick (Sacramento, CA)
- …and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on ... projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- Sedgwick (West Hills, CA)
- …and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on ... projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles,...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
- CDM Smith (San Diego, CA)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting, auditing, and investigative… more
- LA Care Health Plan (Los Angeles, CA)
- …reporting and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. These audits ... responsible for the Department of Managed Health Care (DMHC) claims data submissions for LA Care and its Plan...liaison for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care delegates. Reviews and… more
- City of Long Beach (Long Beach, CA)
- …and consultant contracts, including analyzing and negotiating contract changes, evaluating claims and reviewing and processing progress payments; and performs other ... Technologist Certification from the California Water Environment Association; Plans Examiner certification from the International Code Council (ICC), Certified… more
- UCLA Health (Los Angeles, CA)
- …reviewing treatment progress, recommending medical treatment interventions to the third-party claims examiner , and ensuring compliance with applicable workers' ... Compensation Analyst and department manager, you will manage workers' compensation claims by supporting employees who have experienced work-related injuries or… more
- LA Care Health Plan (Los Angeles, CA)
- …data by delegates on a monthly basis to assign the annual claim processing and financial solvency audits, adherence to regulatory requirements. Manages complex ... lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree Experience Required: At least 6 years of experience in… more
- Highmark Health (Sacramento, CA)
- …+ None ** Preferred ** (any of the following) + Certified Fraud Examiner (CFE) + Certified Professional Coder (CPC) + Certified Outpatient Coder (COC) + ... 6 years of related and progressive experience in lieu of Bachelor's degree ** Preferred ** + Master's Degree in Fraud, Forensics Accounting, Business or related field… more