- University of Southern California (Los Angeles, CA)
- …in managed health care. General understanding including but not limited to: claims processing functionality, benefit coverage, provider network, standard billing ... standards of quality and innovation. Manages and resolves human resource and member claims and plan related issues. . Plans and conducts quality assurance reviews… more
- HUB International (Roseville, CA)
- …Manager. **QUALIFICATIONS** + High School / GED + 1-2 years healthcare claims processing , or benefits administration preferred + Bilingual preferred **KNOWLEDGE ... Handles inbound calls on a queue system. + Assists clients and employees with various claims and benefit issues. + Respond to all phone calls and inquiries no later… more
- LA Care Health Plan (Los Angeles, CA)
- …Excel and Power Point. Requires strong knowledge of regulatory standards and claims processing ; strong analytical, oral, written and presentation skills, able ... and provider complaint and appeals issues, including eligibility, access to care, claims , benefit, and quality of care concerns. Experience working with firm… more
- Essel (Fairfield, CA)
- …employee record management, worker's comp and unemployment insurance management and claims processing Development, Implementation and oversight of HR ... initiatives, processes and systems Assists with asset management, background checks, drug screens, medical exams and logistics for employees Ensures candidates meet all state and federal compliance requirements, including daily meal and break laws Assists with… more
- Ryder System (Sacramento, CA)
- …action plans if deficiencies are noted. Monitors staff's workflow to ensure accurate processing of claims , timely establishment of reserves, reviews and logs ... : **SUMMARY** This position supervises adjusters and directly handles claims within Ryder's self-insured, self-administered liability program. Oversees claim-handling… more
- Sutter Health (Roseville, CA)
- …constant fast paced workload. + Requires ability to learn all Care Center related claims processing functions and pass a skill assessment for each application. ... **TRAVEL:** + Travel is required as needed between Roseville and Auburn locations. **Job Shift:** Days **Schedule:** Full Time **Shift Hours:** 8 **Days of the Week:** Monday - Friday **Weekend Requirements:** None **Benefits:** Yes **Unions:** No **Position… more
- Cedars-Sinai (CA)
- …rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine ... auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS. Duties and Responsibilities: + Ensures all services provided to Commercial, Medicare and… more
- Humana (Sacramento, CA)
- …Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing , prior authorization, formulary management and clinical ... programming + Represents Humana at all Pharmacy Medicaid meetings including those with the Michigan Department of Health and Human Services (MDHHS) **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Pharmacy or Doctor of… more
- Humana (Sacramento, CA)
- …2 years of Humana Experience + Knowledge of Humana Medical and Pharmacy Claims Processing Systems + Experience with data query/data programming applications (ie ... SQL, Python) + Knowledge of data visualization tools (ie Power BI, QlikView, Tableau) **Additional Information** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and… more
- Public Consulting Group (Sacramento, CA)
- …+ Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + ... Cost Allocation Plans and Time Studies + Cost Settlement and Supplemental Payment Strategies + Healthcare Access and Markets A Test Leader oversees the testing process, developing test strategies and plans, guiding a team of testers, and collaborating with… more