- Sutter Health (Sacramento, CA)
- …advancement and upkeep of the risk financing portfolio for Sutter Health, manages all claims and litigation, and serves as an advisor to senior leadership on risk ... mitigation related to insurance services. Partners with Sutter Health's captive insurance management and board to align strategic risk financing decisions, optimize coverage structures, and ensure governance and oversight of captive operations. Designs and… more
- AbbVie (Irvine, CA)
- …Understands and supports clinical studies to optimize promotional and economic claims . + Develops close working relationship with R&D, regulatory/legal, medical ... affairs, clinical, GMAP, HEOR, market research, operations, downstream marketing and key opinion leaders; bringing together the best of the business to drive results in a heavily matrixed environment. + Supports handover to downstream marketing, through… more
- Marriott (Los Angeles, CA)
- …* Works with the unemployment services provider to respond to unemployment claims . * Attends unemployment hearings and ensures property is properly represented. * ... Ensures employees are treated fairly and equitably. * Ensures Guarantee of Fair Treatment policy is consistently followed and proper documentation is maintained on all disciplinary issues. * Ensures employees are treated fairly and equitably and that issues… more
- Kyndryl (Sacramento, CA)
- …Partner with CCaaS architects to build future-proof architectures with EHR, CRM, and claims system integrations. The compensation range for the position in the US is ... $159,240 to $286,560 based on a full-time schedule. Your actual compensation may vary depending on your geography, job-related skills and experience. For part time roles, the compensation will be adjusted appropriately. The pay or salary range will not be… more
- Molina Healthcare (San Bernardino, CA)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Genentech (South San Francisco, CA)
- …clinical workflows + Expertise in managing and applying healthcare data (RWD, RWE, claims , EHR). + Strong knowledge of AI/ML for insights and process automation, ... along with familiarity with digital health technology (CRM) and data privacy regulations (HIPAA) **Preferred Qualifications & Experience** + A medical degree or prior experience in Medical Affairs is a strong plus. **Location & Travel Requirements** This… more
- University of Southern California (Newport Beach, CA)
- …scan/email ABNS to front area reception for signatures as needed. + Coordinate with Director on denied or disputed claims to obtain documentation to support ... area of service. + Pref Medical Prior Authorizations or Claims experience in a managed care setting. + Pref...+ Pref Knowledge of the health insurance industry and claims processing. Required Licenses/Certifications: + Req Fire Life Safety… more
- City and County of San Francisco (San Francisco, CA)
- …the Worker's Compensation Supervisor assists and provides first-line oversight of claims adjusting and processing teams for the Workers' Compensation Division. ... the review, analysis, investigation and disposition of workers' compensation claims and reports. Provides claims supervision of...result of appeals), as directed by the Human Resources Director or the Civil Service Commission. The duration of… more
- University of Southern California (Alhambra, CA)
- …Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related ' claims denials' and ' claims rejections,' specific to ICD-10-CM, ... the denial management process for coding-related denials, triage denied claims to distinguish coding-related denials versus clinical-related denials, evaluating … more
- Ventura County (Ventura, CA)
- …for consistent personal planning. The Position Reporting to the County Human Resources Director , the Deputy Executive Officer - Risk Management will oversee one or ... County's financial exposure. It also involves overseeing all aspects of the claims process for the County's self-insured programs, from initial reporting to… more