- CDM Smith (San Diego, CA)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...of the disaster on the applicant's assets, inventory, and operations . * Expert Testimony and Litigation Support: In cases… more
- The County of Los Angeles (Los Angeles, CA)
- …which have the potential to negatively impact the County's programs, policies or operations or might result in serious monetary losses. Candidates are expected to ... of Los Angeles in the defense of workers' compensation claims before the California Workers' Compensation Board, the California...County of Los Angeles in defense of workers' compensation claims . Approves contract law firms request for payment of… more
- Evolent (Sacramento, CA)
- …into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based on relevant ... findings. + Extract, manage, and analyze claims and operational data using industry-standard metrics. + Process and validate raw unadjudicated claims data.… 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 ... + Experience working collaboratively across multiple functional areas (eg, operations , configuration, clinical, IT, plan design) and fostering teamwork. **Preferred… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …+ Experience working within the pharmaceutical industry within data operations /data management environments. + Significant experience with Commercial third-party ... data assets, including Xponent Plantrak, DDD, HCOS, Claims Data, Specialty pharma, omnichannel data, SalesForce/Veeva (Call/Sample/Detail), etc. + Strong working… 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 ... leadership experience working collaboratively across multiple functional areas (eg, operations , configuration, clinical, IT, plan design) and fostering teamwork. +… 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 ... business. The position is responsible for the Department of Managed Health Care (DMHC) claims data submissions for LA Care and its Plan Partners (PPs) and delegates… more
- TEKsystems (Roseville, CA)
- …person and written correspondence, answers questions regarding the Plans' Benefits, eligibility, claims processing and claims appeal * Obtains all pertinent ... as liaison between member and provider to communicate plan benefits and facilitate claims processing. * Calculates sick leave banks. * Refers calls, members, union… more
- Elevance Health (Costa Mesa, CA)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing… more
- Sedgwick (Sacramento, CA)
- …presentation of material. + Reconciles various accounts. + Assist with day-to-day operations of accounting department or special projects as assigned by the Finance ... Manager or Director. + Process account collections/receivables. + Reconcile claims activity between general ledger and claims system and investigate… more