- Ventura County (Ventura, CA)
- …general direction, the incumbent is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, ... analyzes credits, payments, and over adjustments; + Analyzes and updates claims generated prior to transmitting to the appropriate intermediary/payor within billing… 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...documentation to determine the validity and value of disaster-related claims . This may involve reviewing income statements, balance sheets,… more
- BrightSpring Health Services (Union City, CA)
- …Prior supervisory experience. Skills/Knowledge: + Required: Knowledge of Medicaid claims regulations and processes. Basic understanding of drugs, medication ... Identifies and resolves issues of denials or follow-up of claims . + Maintains current knowledge of Medicaid claim regulations...+ Produces reports and keeps management informed of unpaid claims and claims pending follow-up. + Understands… more
- Travelers Insurance Company (Sacramento, CA)
- …Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition of claims and claim litigation to achieve superior customer service and to ... Accountants Professional Liability (APL) and Real Estate Professional Liability (RPL) claims and litigation against various types of accounting and real estate… 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 ... to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest risk for...and professional knowledge to identify educational trends and select claims for audit in alignment to department procedures and… more
- Evolent (Sacramento, CA)
- …into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based on relevant ... findings. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate raw unadjudicated claims data.… more
- Carrington (Anaheim, CA)
- …completes the Set-up bankruptcy filings process, Motion for Reliefs, Proof of Claims , Transfer of Claims , Reaffirmations, Notice of Final Cures, Post-Petition ... the set-up bankruptcy filings, Motion for Reliefs, Proof of Claims , Transfer of Claims , Reaffirmations, Notice of Final Cures, Post-Petition Fee notices, Payment… more
- Cognizant (Sacramento, CA)
- …degree preferred. + **Technical Skills** : Proficiency in Excel, payer portals, and claims clearinghouses. + **Accounts Receivables** : AR follow up on a physician's ... + **These will help you stand out:** + **Examine Claims ** : Analyze denied and underpaid claims ...**Examine Claims ** : Analyze denied and underpaid claims to determine discrepancies. + **Follow-Up** : Communicate with… more
- Cardinal Health (Fresno, CA)
- …works directly with insurance companies, healthcare providers, and patients to ensure claims are processed and paid accurately and efficiently. The position requires ... **Responsibilities/Essential Functions** + Research, correct, and resubmit rejected, and clean claims to insurance companies electronically or by paper. + Maintain… more
- Elevance Health (Los Angeles, CA)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...of 3 years experience working in grievances and appeals, claims , or customer service; or any combination of education… more