- Humana (Sacramento, CA)
- …products, or other Medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, other healthcare providers, clinical group practice ... management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG(R) or InterQual + Internal Medicine,… more
- Naval Air Systems Command (San Diego, CA)
- …overhaul, reassemble, test, install, remove, arm and de-arm Aviation Life Support Systems (ALSS). You will visually inspect ballistic lines, tubes, hoses, and ... modifications and other appropriate action. You will load cartridges into aircraft systems and remove as needed, following applicable handling, loading and checkout… more
- The County of Los Angeles (Los Angeles, CA)
- …They also assist project managers in the development of project plans and system integration test plans for new systems or complex enhancements to ... systems ; prepares user acceptance test documentation; collaborates with system users to conduct user acceptance testing. Coordinates the identification and… more
- University of Southern California (Alhambra, CA)
- … rejections and denials which might prevent or delay payment of a particular claim or group of claims . Prepares appeals and rebuttals letters/packages in ... Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related ' claims denials' and ' claims rejections,' specific to ICD-10-CM,… more
- LA Care Health Plan (Los Angeles, CA)
- …Plan Core Systems applications, and databases (eg, QNXT Migration Utility, Claims Workflow, Claims Test Pro, NetworX Pricer, etc.). This position serves ... management testing and related best practices. Facilitate production controls and system configuration data codification. Monitor and review systems edits,… more
- Sharp HealthCare (San Diego, CA)
- … claims , provider, billing, capitation, financial and structural. The Systems Analyst-EDI Mgmt will work to streamline processes, create efficiencies and ... + Associate's Degree + 2 Years Direct experience in project planning and system implementation. + Experience as systems analyst within a large Health… more
- Ventura County (Ventura, CA)
- …reports for agency directors and managers. + Monitors TPA and insurance carrier claim systems for accuracy. + Reviews, revises, designs, coordinates, implements, ... resources management) AND two (2) years' experience handling workers' compensation claims , including experience with claim evaluation, management, or adjustment,… more
- Sedgwick (West Hills, CA)
- …payment information and claims status by phone, written correspondence and/or claims system . + Communicates with the claimants' providers to set expectations ... aspects of claims process by phone, written correspondence and/or claims system . + Coordinates investigative efforts ensuring appropriateness; provides… more
- Allied Universal (Fresno, CA)
- Company Overview: Advance Your Career in Insurance Claims with Allied Universal(R) Compliance and Investigation Services. Allied Universal(R) Compliance and ... Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim … more
- Sedgwick (West Hills, CA)
- … claim status through phone calls, written correspondence, and system updates.** **Engages with healthcare providers to establish expectations for return-to-work ... consistent and transparent communication with claimants and clients throughout the claims process via phone, written updates, and system documentation.**… more