- Elevance Health (Costa Mesa, CA)
- …Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business ... with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable… more
- Robert Half Legal (Oakland, CA)
- …in employment law cases, with a focus on plaintiff-side matters and disability claims . * Conduct thorough legal research and draft compelling briefs to support case ... and trials. * Collaborate with clients to assess their claims and provide strategic legal guidance. * Utilize case... and provide strategic legal guidance. * Utilize case management software to efficiently organize case files and track… 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 ... responsible for the Department of Managed Health Care (DMHC) claims data submissions for LA Care and its Plan...quarterly and annual basis Performs financial analyses or vendor's management for LA Care vendors on the quarterly and… more
- Sedgwick (Sacramento, CA)
- …To prepare the necessary reports and communicate the results to management . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Creates and maintains accurate and ... the Finance Manager or Director. + Process account collections/receivables. + Reconcile claims activity between general ledger and claims system and investigate… more
- Sedgwick (Sacramento, CA)
- …role will be responsible for investigating and adjusting property and casualty claims , both residential and commercial, with little to no supervision. **ESSENTIAL ... Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Assists in...+ Attention to detail and accuracy + Good time management and organizational skills + Ability to work independently… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …and implementing procedures to ensure that the business units quality management and compliance program are effective and efficient in identifying, detecting, ... of the Quality Systems and Risks will be reported periodically to Senior Management through the Management Review process to ensure alignment with Company… more
- United Site Services (Fresno, CA)
- …, claims adjusters, injury counselors, etc. to ensure complete claims management for Worker's Compensation, Liability Insurance, and Auto Insurance ... such as safety rules, operating and maintenance instructions, and procedure manuals + Claims Management Experience a plus + Ability to perform simple arithmetic… more
- LA Care Health Plan (Los Angeles, CA)
- …etc. Collaborates with internal departments (Member Services, Provider Network Operations, Claims , Utilization Management , Pharmacy, and Quality Management ) ... quality of care issues and work collaboratively with multiple departments ( Claims , Provider Network Operations, Utilization Management , Quality Management… more
- Elevance Health (Walnut Creek, CA)
- …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 ... + Maintains accuracy and quality standards as established by audit management . + Identifies potential documentation and coding errors by recognizing aberrant… more
- Oura (San Francisco, CA)
- …this role will be responsible for advising on regulatory risk, marketing claims , product labeling, corporate compliance initiatives, and will oversee the privacy ... tracking, AI-driven diagnostics, real-world data applications, and health and wellness claims . + Provide legal and regulatory oversight for clinical studies and… more
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