- 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
- 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
- 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
- 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
- Molina Healthcare (Los Angeles, CA)
- …for a wide variety of inquiries and assistance involving their benefits, claims , premiums, and other areas including very complex issues. Conducts initial research ... needs for a wide variety of inquiries and assistance involving claims , authorizations, appeals, contracting, credentialing and other areas including the most… more
- Bowman (San Diego, CA)
- …purchases, permit rights, encroachments resolutions and settlements of damage claims of company's client. **Responsibilities** **Leadership and Direction** + Perform ... on the client's behalf. + Negotiate property damage settlements and loss claims associated with client's capital projects. + Regularly and persuasively communicate… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …advisory boards, and congress logistics, through direct leadership of the Associate Director, HCP Program Operations. . Field Training and development: Overseeing ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more