- Alameda Health System (Oakland, CA)
- …multiple plans. + Generous paid time off plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role ... Their responsibilities span from managing admissions to ensuring clean claims , identifying trends, and optimizing resource utilization. This role supports… more
- Elevance Health (Los Angeles, CA)
- …data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . ... in order to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health insurance policies,… more
- EPAM Systems (Los Angeles, CA)
- …E2E testing strategies + Develop and communicate test strategies covering pharmacy claims processing, NCPDP transactions, and benefit designs + Design test scenarios ... leading large, complex, cross-functional teams + Extensive knowledge of pharmacy claims adjudication, NCPDP protocols, formulary management, and benefit design +… more
- Dignity Health (Bakersfield, CA)
- …teams as needed when questions arise. The Provider Data Analyst partners with Configuration Claims and Enrollment to ensure end to end accuracy to pay claims ... with other business functions. Working knowledge of DHPR and CMS rules for Claim . Submission, Claim Payment, Eligibility, Appeals for Commercial, MediCare and… more
- Sedgwick (Sacramento, CA)
- …Field Case Manager assignment and facilitates initial onsite hospital visit for the claim . + Maintains communication with the customer, Client Service Director, and ... Claims Examiner providing timely updates on changes in injured...is professionally documented and enters incident data into computer system . + Educates the assigned FCM on Sedgwick benchmarks… more
- Alameda Health System (Oakland, CA)
- …staff to research and share best practices. 16. Conducts investigations including claims of sexual harassment, bullying and discrimination. 17. Performs other duties ... as possession of any required licenses or certifications is qualifying._ Alameda Health System is an equal opportunity employer and does not discriminate against any… more
- VetsEZ (CA)
- …models that support secure, interoperable data exchange across care coordination and claims systems . + Define architectural patterns and reusable components that ... HL7, X12) and data governance in regulated environments; prior experience with claims adjudication, care coordination, or patient engagement systems is highly… more
- Travelers Insurance Company (Rosemead, CA)
- …Imagine loving what you do and where you do it. **Job Category** Claim , Legal **Compensation Overview** The annual base salary range provided for this position ... local expertise and outstanding client service. We handle litigation arising from claims asserted against policyholders or the company and take cases from inception… more
- Travelers Insurance Company (Sacramento, CA)
- …Imagine loving what you do and where you do it. **Job Category** Claim , Legal **Compensation Overview** The annual base salary range provided for this position ... local expertise and outstanding client service. We handle litigation arising from claims asserted against policyholders or the company and take cases from inception… more
- Naval Air Systems Command (San Diego, CA)
- …website: https://www.opm.gov/policy-data-oversight/classification-qualifications/federal-wage- system -qualifications/#url=List-of-Approved-Job-Elements Experience ... when selecting individuals under this specific hiring authority. However, if you claim veteran's preference, you will be required to submit supporting documentation… more