- Ontic (Los Angeles, CA)
- …Reduce quality costs, primarily focusing on manufacturing process controls and warranty claims reduction using quality tools such as RCCA, SPC, MSA, PFMEA, ... pace. Our team is looking for a Director of Quality Control to join them. You will report to...Chatsworth, California. To be considered for the Director of Quality Control opening, here's what you'll need to bring… more
- Sedgwick (Orange, CA)
- …and documentation standards. + Provides technical and jurisdictional guidance on claims adjudication, including quality reviews and reserve evaluations for ... best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing… more
- Elevance Health (Walnut Creek, CA)
- …applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum ... and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims … more
- Sharp HealthCare (San Diego, CA)
- …reasonableness checks). Providing efficient and cost-effective solutions as required.Oversees all claims testing and quality assurance activities and defect ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- Sharp HealthCare (San Diego, CA)
- …checks) provide efficient, cost-effective solutions as directed.Serve as the lead on claims testing and quality assurance activities and assisting in defect ... investigating and responding to internal and external benefit inquiries, and supporting claims testing activities. **Required Qualifications** + 3 Years in HMO or… more
- Kemper (Cerritos, CA)
- …and payments that exceed staff authority. + Leverages analytics to monitor assigned claims staff production, inventory, quality and results. + Monitors KPIs to ... metrics. **POSITION RESPONSIBILITIES:** + Manages the day-to-day operations for assigned claims staff by establishing schedules and priorities, coaches employees in… more
- Highmark Health (Sacramento, CA)
- …and/or performing quality control review and final adjudication of paper/electronic claims . Determines whether to return, deny or pay claims following ... claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit… more
- Dignity Health (Bakersfield, CA)
- **Responsibilities** The Claims Research Specialist will oversee and manage research efforts related to claims overpayments, underpayments, and billing issues ... and working collaboratively with providers and internal departments to enhance claims processes and improve financial outcomes. **Essential Functions:** - To… more
- Centene Corporation (Sacramento, CA)
- …PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims ... a monthly, quarterly and annual basis to ensure regulatory compliance. + Perform claims compliance audits for either federal or state programs. + Evaluate processes… more
- Adecco US, Inc. (San Diego, CA)
- **Adecco is currently assisting a Client in their search to fill Claims Examiner positions located in San Diego, CA (Remote)** **Description:** **Min 3 years of ... experience with CA claims mandatory.** **PRIMARY PURPOSE:** To analyze complex or technically...RESPONSIBILITIES** Performs other duties as assigned. Supports the organization's quality program(s). CA SIP preferred not mandatory Travels as… more