- Breakthru Beverage Group (Commerce, CA)
- …and executing on all Safety related programs and policies. Manages the Workers Compensation claims and works to reduce the financial impact of claims in the ... company insurance carrier to reduce the financial impact of claims in the state. The position requires strong relationship...DOT compliance. Conducts a monthly review to assess DOT audit risk, puts plans in place to correct any… more
- The County of Los Angeles (Los Angeles, CA)
- …operating statements, final accounting for construction and other projects, and claims for reimbursement from other government agencies or private contractors. + ... Evaluates and reconciles complex operating systems for cost reporting and claims processing reimbursements from other government agencies. + Prepares balance sheets,… more
- Sharp HealthCare (San Diego, CA)
- …investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or ... insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role. **Other Qualification Requirements** + Bachelor's degree in… more
- Sharp HealthCare (San Diego, CA)
- …and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit ... insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role. **Other Qualification Requirements** + Bachelor's degree in… more
- Highmark Health (Sacramento, CA)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Applied Materials (Santa Clara, CA)
- …closely with Management to implement corrective actions. + Evaluate data against audit requests and ensure completeness of data. Assist the Organization Audit ... Focal prepare for the internal/external audits. + Create and submit claims for AMAT lost or damaged materials and assist suppliers with their parts claims .… more
- Highmark Health (Sacramento, CA)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- Sharp HealthCare (San Diego, CA)
- …of the requested service. This position is responsible for conducting retrospective claims review for services to determine the medical appropriateness of the ... coverage criteria, etc. + Retrospective Review Coordinate, review, and process retrospective claims for medical care and services including, but not limited to… more
- LA Care Health Plan (Los Angeles, CA)
- …reporting and corrective action plans monitoring of financial solvency and claims processing compliance for specialty health plans and vendors. These audits ... of business. The position is responsible for the DMHC claims data submissions for LA Care and its Plan...for Centers for Medicare and Medicaid Services (CMS) claim audit section of LA Care delegates. + Annually reviews… more
- Ventura County (Ventura, CA)
- …to the Auditor-Controller for fund accounting purposes; maintains accounting records for audit purposes. Learns to prepare and submit (Accountant I) or prepares and ... and analyzes (Accountant II) Incurred but not Reported medical claims based on system generated claim lag reports to...(Accountant I) or reviews and reconciles (Accountant II) bond claims to verify that charges for the project on… more