- US Tech Solutions (Whittier, CA)
- …education of the Claims department staff 5.Coordinate the generation and review of claims audit , status and pending claims reports ensuring authorized ... 12.Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit … more
- LA Care Health Plan (Los Angeles, CA)
- …upstream controls, and ensures consistent application of rules across the claims lifecycle. Through rigorous audit practices, validation of corrective ... and actionable for operational leaders. Designs and oversees the claims QA audit methodology, including sampling standards, audit frequency, scoring… more
- LA Care Health Plan (Los Angeles, CA)
- …control points, and reducing operational rework. The Director has ownership of claims regulatory compliance and audit readiness. This position oversees daily ... Director, Claims Administration Job Category: Management/Executive Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- Sedgwick (Sacramento, CA)
- …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Workers Compensation **PRIMARY PURPOSE:** To supervise the operation… more
- TEKsystems (Santa Barbara, CA)
- …communication skills. Core Responsibilities + Research, correct, and respond to all D-SNP pended claims in a timely manner. + Review audit reports and determine ... Professional Summary Detail-oriented and highly organized claims specialist with expertise in D-SNP (Dual Eligible Special Needs Plan) claims processing. Skilled… more
- Prime Healthcare (Ontario, CA)
- … Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the VP will identify financial ... Ontario, California. TheVice President of Health Plan Operations and Claims is responsible for the development and execution of...Health Plans. The VP of Health Plan Operations and Claims will provide strategic leadership and development of the… more
- Cedars-Sinai (Los Angeles, CA)
- …fuels innovation. **Req ID** : 13340 **Working Title** : Outpatient Surgical and Claims Edit Auditor **Department** : CSRC Coding Audit **Business Entity** : ... productivity and accuracy standards. Assists with processing re-bills post coding audit changes and assists with coding corrections needed from billing department.… more
- WTW (Irvine, CA)
- …management program design, pharmacy solutions, disability/absence management strategies and claims audit services. Product-based solutions such as our ... pharmacy purchasing coalition round out our broad-based suite of offerings. **Explore an opportunity.** As a Health and Benefits Intern, you will work beside some of the industry's top consultants while you progress toward becoming a thought leader of the… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Claims Compliance Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... safety net required to achieve that purpose. Job Summary The Manager, Claims Compliance is responsible for ensuring Core Administrative Operations meet federal,… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Claims Research and Remediation Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position ... the safety net required to achieve that purpose. Job Summary The Manager, Claims Research and Remediation manages LA Care's specialized "Tiger Team" responsible for… more