- The Cigna Group (Oakland, CA)
- …of communication with matrix partners including but not limited to, Claims Operations , Medical Management. Credentialing, Legal, Medical Economics, Compliance, ... Sales and Marketing and Service. + Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution. + Works to meet unit cost targets, while preserving an… more
- Humana (Sacramento, CA)
- …facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations , and other business teams involved in the administration of ... Medicare business at Humana. The Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider… more
- TEKsystems (Santa Barbara, CA)
- …Description We are seeking a detail-oriented professional to manage D-SNP pended claims and ensure compliance with regulatory guidelines. This role involves: + ... Researching, correcting, and responding to all D-SNP pended claims in a timely manner. + Reviewing audit reports...our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions.… more
- LA Care Health Plan (Los Angeles, CA)
- …culturally-appropriate manner. Coordinates multi-departmental (Member Services, Product Network Operations (PNO), Claims , Utilization Management (UM), Pharmacy, ... Sales and Quality Management (QM)) processes to ensure identification of member's claims of gaps in coverage and resolution of cases for members' satisfaction… more
- Google (Sunnyvale, CA)
- …Your primary focus will be the strategic support for the internal insurance operations , claims , captives and payments, while also delivering key financial ... and metrics to management on risk issues, financial performance, and claims trends. + Coordinate financials and reports that support Alphabet entities,… more
- Guidehouse (El Segundo, CA)
- …You Will Do** **:** The **Insurance Patient Account Representative** **(Hospital Claims )** is an extension of a client's business office staff. Representatives ... in Lieu of Diploma / GED. + 0-2+ year's experience in office, business, operations , customer service or healthcare field. **What Would Be Nice To Have** **:** +… more
- Cedars-Sinai (Los Angeles, CA)
- …internal and external partners and peer departments such as Coding Operations , Clinical Documentation Integrity (CDI), Payor Revenue Management (PRM), and Compliance ... innovation. **Req ID** : 13340 **Working Title** : Outpatient Surgical and Claims Edit Auditor **Department** : CSRC Coding Audit **Business Entity** : Cedars-Sinai… more
- Cognizant (Sacramento, CA)
- …consulting firms * Strong background in Healthcare industry, including health plans, claims , and provider operations * Project management and people management ... of payer functions and Medicaid plan implementations, including enrollment, billing, claims , care management, member portal, shopper tools, etc. **These will help… more
- ABM Industries (Los Angeles, CA)
- …and coordinates bus evacuation activities as appropriate * Immediately reports any incidents or claims to Operations Manager or Shift Lead * Refuel and maintain ... shuttle equipment and fuel use logs * Maintain a clean work environment, disinfecting shuttle after each use * Performs pre-inspection and post-inspection activities to ensure proper operating conditions, adherence to prescribed Department of Transportation… more
- ABM Industries (Oakland, CA)
- …and coordinates bus evacuation activities as appropriate * Immediately reports any incidents or claims to Operations Manager or Shift Lead * Refuel and maintain ... shuttle equipment and fuel use logs * Maintain a clean work environment, disinfecting shuttle after each use * Performs pre-inspection and post-inspection activities to ensure proper operating conditions, adherence to prescribed Department of Transportation… more