- Insight Global (Burbank, CA)
- …Fund. The Senior Participant Service Specialist/Analyst will process health insurance claims and answers calls from the customer (participant, providers, physicians, ... hospitals etc.) Adhere to eligibility, claims and call policies and procedures while making sound...for this position in the areas of: efficiency, accuracy, quality , productivity, system adherence, customer satisfaction and attendance -… more
- Providence (Irvine, CA)
- …and case strategy. This role works closely with Risk Management, Compliance, Claims , and operational leaders to protect the organization's interests while advancing ... its mission of delivering high- quality , patient-centered care. This role is hybrid and can...closely with Risk Management and insurance carriers on pre-litigation claims and insured matters. + Oversee outside counsel: approve… more
- Cedars-Sinai (Los Angeles, CA)
- …Corporation's Consumer Choice Award 19 years in a row for providing the highest- quality medical care in Los Angeles. We off an outstanding benefit package that ... definition, applications development and maintenance and enhancements for finance, claims processing, revenue management, and billing systems. Primary duties… more
- Travelers Insurance Company (West Hollywood, CA)
- …position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality ... negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring… more
- NTT DATA North America (San Francisco, CA)
- …we know that with the right people on board, anything is possible. The quality , integrity, and commitment of our employees have been key factors in our company's ... including benefits, provider contracts, pricing, accumulators, authorization rules, and claims processing. -Collaborate with configuration analysts, business analysts, and… more
- Prime Therapeutics (San Diego, CA)
- …pharmacy audits and is responsible for the selection and auditing of claims , educating Prime's network pharmacies and driving contract compliance, and supporting ... to Prime's travel and expense policy + Analyze pharmacy claims to identify those at the highest risk for...+ 2 years of work experience in audit or quality assurance + 1 year of work experience in… more
- Ventura County (Ventura, CA)
- …(III, IV), performs and is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, ... incumbents perform program administrative duties to assure that all claims are billed timely. WHAT WE OFFER The County...and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E,… more
- Walmart (Yuba City, CA)
- …deficiencies andproviding process improvement leadership to ensure a high quality customer experience Provides supervision and development opportunities for hourly ... Manages facilitylevel training and execution of asset protection safety and claims and receiving procedures by reviewing the application of policiesprocedures… more
- Sedgwick (Rancho Cucamonga, CA)
- …+ This role will be primarily responsible for **_Large Complex Property_** claims . **PRIMARY PURPOSE** **:** To investigate losses or claims internationally ... be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probably costs. + Prepares loss experience reports to help… more
- Molina Healthcare (San Diego, CA)
- …monitors Health Plan Scorable Action Items (SAIs) to ensure performance and quality levels exist in PI Business products and processes. Establishes procedures and ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more