- Zurich NA (San Francisco, CA)
- …School Diploma or Equivalent and 10 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an ... Associate Degree and 3 or more years of experience...and 8 or more years of experience in the Claims or Underwriting Support areaAND + Knowledge of Microsoft… more
- LA Care Health Plan (Los Angeles, CA)
- …multi-departmental (Member Services, Product Network Operations (PNO), Claims , Utilization Management (UM), Pharmacy, Medicare Enrollment/Disenrollment, Sales ... and Quality Management (QM)) processes to ensure identification of member's claims of gaps in coverage and resolution of cases for members' satisfaction and of… more
- HUB International (Fresno, CA)
- …not limited to, Pre-Renewal Strategic Planning, Risk ID Assessments, Contract Reviews, Claims Reviews (in coordination with Claims Management), Market Analysis, ... Coordinating the value-added services being provided by our Risk Services and Claims Management Divisions. + Acts as liaison between clients and insurance carriers… more
- Highmark Health (Sacramento, CA)
- …the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the ... of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of medical documentation,… more
- LA Care Health Plan (Los Angeles, CA)
- …or any additional service needs according to specific program guidelines. Uses claims processing and care management software to look up member information, document ... stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data… more
- The County of Los Angeles (Los Angeles, CA)
- …experience at the level of the Los Angeles County class of Associate Agricultural/Weights & Measures lnspector performing agricultural or weights and measures ... the Level of the Los Angeles County class of Associate Agricultural/Weights & Measures lnspector performing agricultural or weights...steps to view correspondence, and we will not consider claims of missing notices to be a valid reason… more
- Sysco (Stockton, CA)
- …product complaints with potential for food safety issues and to support the Claims Process with Sysco's 3rd party claims administrator. Frequently interacts with ... Operations to collect data for Sysco's legal team during claims issues to ensure relevant purchase and sales records...School or GED Equivalent Required. In lieu of an associate or bachelor's Degree, a combination of education and… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- **Job Summary** Under the direction of the Director/ Associate Director of Clinical Management, the Senior Clinical Study Manager is responsible for the oversight and ... communication of any variances in budget forecast to the Director/ Associate Director. * Establish communication flow with CRO and...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Zurich NA (Fresno, CA)
- …+ Work to have a timely resolution to matters by collaborating with the claims adjuster, developing a case strategy and escalating issues as appropriate. + Ensure ... tools and resources and legal strategies. + Protect Zurich's reputation by keeping claims information confidential Basic Qualifications: + Juris Doctor and 5 or more… more
- Zurich NA (Irvine, CA)
- …challenging and varied caseload. Responsibilities will include working directly with claims professionals providing legal analysis and advice, preparing and filing ... needs in mind, the ZNA hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating… more