- Cardinal Health (Sacramento, CA)
- …broader access to innovative therapies. + ** Claims Adjudication:** Oversee the claims adjudication process, ensuring timely and accurate processing of ATSP ... for CGT treatments. + **Compliance:** Ensure all contracting and claims activities comply with regulatory requirements and company policies. + **Documentation:**… more
- Sunrise Senior Living (Rocklin, CA)
- …internal business controls. + Process and manage unemployment and worker's compensation claims and update claim activity as necessary. + Clearly communicate ... Process payroll and follow established business processes and "Do It Daily" processing activities and submit accurate bi-weekly payroll by established schedule. +… more
- Allied Universal (Irvine, CA)
- …for all insurance carriers and third-party administrators for employee eligibility, claim and plan coverage inquiries, providing accurate and timely responses. ... research, and answering employees' questions + Coordinate daily benefits processing . Handle enrollments, COBRA, terminations, qualifying life event changes,… more
- Aston Carter (Valencia, CA)
- …preferred or equivalent relevant experience. + Proficiency in CRM systems, insurance claim processing software, and Microsoft Office. + Sales experience with ... customer service. + Obtain necessary documentation and submit insurance claims accurately. + Handle referral authorizations, pre-service appeals, and denials… more
- CenterWell (San Jose, CA)
- …personnel communication systems, overall management of agency supplies / mail, and processing of accounts payables. Depending on branch census you may be responsible ... computer programs as appropriate. + Complete End of Period claim workflow as part of Billing Specialist responsibilities. This...to ensure other billing requirements are satisfied to release claims timely. + Adhere to and participate in Agency's… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …**Data Integration & Management** + Explore and analyze common pharmaceuticals data (eg, claims ) as well as novel data sets based on lab and EHR systems. ... unified view of stakeholder interactions. + Apply natural language processing (NLP) to extract insights from unstructured medical texts,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- CVS Health (Sacramento, CA)
- …relevant to the member to determine accuracy/appropriateness of benefit/administrative denial. + Research claim processing logic to verify accuracy of claim ... + At least 2+ years in one of the following areas: claim platforms, products, and benefits; patient management; product or contract drafting; compliance… more
- Datavant (Sacramento, CA)
- …resolving complex coding edits efficiently and accurately to ensure timely and compliant claim processing .** **What You Will Do:** + Review medical records and ... and optimizing service outcomes in both hospitals and alternative care settings. ** Claim edit experience is required; Must be proficient in resolving claim… more
- LA Care Health Plan (Los Angeles, CA)
- …Domain Specific Experience and Skills: Domain Focus: Authorization & Claims Operations Analytics Required: Experience with Utilization Management (UM) authorization ... workflows and prior authorization metrics. Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution. Knowledge of clinical… more
- LA Care Health Plan (Los Angeles, CA)
- …acumen transforming complex, multi-domain data (membership, encounters, providers, claims , quality metrics) into interpretable and actionable insights used ... Domain Specific Experience and Skills: Domain Focus: Authorization & Claims Operations Analytics Required: Experience with Utilization Management (UM) authorization… more
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