- Molina Healthcare (San Diego, CA)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Sedgwick (Sacramento, CA)
- …to apply critical thinking under pressure + Knowledge of the insurance industry and claims processing + Knowledge of field case management + Excellent oral and ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- Prime Therapeutics (San Diego, CA)
- …skill and understanding of the point of sale and on-line pharmacy claims processing environment + Excellent oral, written and interpersonal communication ... and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance,...to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest risk for… more
- LA Care Health Plan (Los Angeles, CA)
- …Advanced understanding of managed care operations (including but not limited to, claims processing , population health, appeals and grievances, etc.) and the ... of major factors, root causes, etc. that impact member access to care, claims payments, etc.; and assessment and roll-out of key measures to facilitate improvement,… more
- Movn Health (CA)
- …experienced Senior Medical Biller & A/R Specialist to take full ownership of claims processing and accounts receivable recovery. This is a hands-on, senior-level ... of medical billing and payer systems is essential. Functional Responsibilities + Submit clean claims via EHR to all payers within 24 hours of service + Review and… more
- Kelly Services (Roseville, CA)
- …best practices and quality service standards **What's a typical day as a Claims Examiner? You'll be:** + Analyzing and processing complex workers' compensation ... style isn't always easy. That's where Kelly(R) comes in. We're seeking a ** Claims Examiner - Workers' Compensation** to work with a leading organization committed to… more
- The County of Los Angeles (Los Angeles, CA)
- …+ Evaluates and reconciles complex operating systems for cost reporting and claims processing reimbursements from other government agencies. + Prepares balance ... operating statements, final accounting for construction and other projects, and claims for reimbursement from other government agencies or private contractors.… more
- Humana (Sacramento, CA)
- …to make an impact** **Required Qualifications** **5+ years of medical claims processing /auditing or encounter data management experience** **Demonstrated deep ... to assignments. The Senior Encounter Data Management professional ensures data integrity for claims errors that result from the data exchange between Humana and its… more
- TEKsystems (Mission Hills, CA)
- …accurate information and resolution support related to RMG services, including claims processing and eligibility verification. Key Responsibilities: + Respond ... and processes, particularly those related to eligibility, provider availability, and claims . + Provide claim status updates and basic information for externally… more
- Sharp HealthCare (San Diego, CA)
- …level of service and interaction is provided, including accurate and timely claims processing , issue resolution, performance recognition, education and training ... a) Plan policies and procedures including authorizations and referrals, claims /encounters, provider utilization reports and grievance procedures; b) Rules,… more