- Molina Healthcare (San Diego, CA)
- …and financial outcomes for all PI solutions. + Leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial performance ... a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health… more
- Travelers Insurance Company (Sacramento, CA)
- …key decisions. You will be working with the Pricing, Product, Underwriting, and Claims teams to both learn the business and communicate your findings and ... B&SI reserving team embraces innovative methods, such as advanced claim level models, you'll play a key role in...the Financial Institutions business unit. + Work with the Claims department to ensure best estimates are appropriately reserved… more
- Nestle (Los Angeles, CA)
- …and consumers. **Position Summary:** The Regulatory & Scientific Affairs Senior Manager is responsible for assuring that Nestle Health Science (NHSc) products ... compliance as pertains to ingredient and product composition, labeling, product claims , and associated communications. This position is expected to master the… more
- Sedgwick (Sacramento, CA)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance Telephonic Case Manager **PRIMARY PURPOSE OF THE ROLE:** While partnering with the injured worker, ... support systems. + Effectively communicates and builds relationships with the claims ' examiner, client, injured worker, attorney and supervisor. + Identifies issues… more
- Adecco US, Inc. (Vallejo, CA)
- …environment. We are seeking a proactive **Environmental Health & Safety (EH&S) Manager ** to champion a culture of safety, regulatory compliance, and environmental ... employee-union and non-union-works in a healthy, safe, and sustainable environment. The Manager will supervise one direct report with potential to expand the team… more
- The Hartford (San Francisco, CA)
- …execute the investigation, valuation, disposition and settlement of large Commercial property claims in a manner consistent with corporate claim settlement ... Field - Opportunity Phoenix, Seattle, Denver or San Francisco preferred , but would consider immediate surrounding states in the...value or 3+ years experience as a full file Claim Adjuster managing moderately severe commercial property claims… more
- Towne Park (San Jose, CA)
- …(http://www.townepark.com/wp-content/uploads/2023/06/CCPA-CPRA-Notice-at-Collection-Applicants\_Towne-Park-Careers.pdf) . The Account Manager directly oversees one ... may be subject to a specific plan or program terms. **JOB SUMMARY** The Account Manager directly oversees one Tier 1 or 2 Towne Park account and is responsible for… 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...history, and/or referrals, and submit recommended audit plan to manager for approval; finalize onsite audit plans and schedule… more
- CVS Health (Sacramento, CA)
- …we do it all with heart, each and every day. **Position Summary:** This Case Manager RN position is with Aetna's National Medical Excellence (NME) team and is a ... role doing both Case Management and Utilization Management. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning,… 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 ... subject to renewal on 11/28/2025.** JOB SUMMARY: Under the direction of the Manager Professional Billing & Coding, the Billing & Collections Representative II (BCII)… more