- HCA Healthcare (Campbell, CA)
- …the lead on implementation of such contracts to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are ... and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible...Team include the CEO, CFO, President of SCCIPA, AVP Claims and Manager of Network Operations. We want you… more
- Highmark Health (Sacramento, CA)
- **Company :** United Concordia Dental **Job Description :** **JOB SUMMARY** This job leads a team charged with the responsibility of reviewing, verifying, ... met. Individual contributor roles as needed. **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities including, but not limited to: involved in hiring… more
- Kemper (Cerritos, CA)
- …policies and knowledge of relevant state laws and regulations governing auto insurance claims . + Time management skills ensuring deadlines are met for claim ... Manager is responsible for the oversight of all claim processing and management activities assigned to claim units. This role is responsible for performance,… more
- The Cigna Group (Los Angeles, CA)
- …of communication with matrix partners including but not limited to, Claims Operations, Medical Management . Credentialing, Legal, Medical Economics, Compliance, ... in the Glendale/Los Angeles, CA area.** The **Manager, Provider Contracting Network Management ** serves as an integral member of the Provider Contracting Team and… more
- Cedars-Sinai (Los Angeles, CA)
- …solution definition, applications development and maintenance and enhancements for finance, claims processing, revenue management , and billing systems. Primary ... alignment on revenue cycle initiatives. + Monitor and analyze claims data sent to the clearinghouse, including resolution of...ensure accuracy and compliance. + Manage specific Payer Revenue Management (PRM) Claim Edit work queues (WQs) and WQ… more
- Providence (Irvine, CA)
- …to risk mitigation and case strategy. This role works closely with Risk Management , Compliance, Claims , and operational leaders to protect the organization's ... disputes, business torts, and regulatory enforcement. + Coordinate closely with Risk Management and insurance carriers on pre-litigation claims and insured… more
- Elevance Health (Walnut Creek, CA)
- **Utilization Management Representative I** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person ... between 8 am - 8 pm EST. The **Utilization Management Representative I** is responsible for coordinating cases for...impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides… more
- Towne Park (San Jose, CA)
- …claims are reported timely and accurately and cooperates with the Risk Management department to resolve claims + Consistently follows the progressive ... policy guidelines. **Benefits:** Employees are eligible to enroll in medical, dental , and vision insurance, accident insurance, critical illness insurance, hospital… more
- NBC Universal (Universal City, CA)
- …briefs, declarations, discovery demands and responses + Advise business clients and senior management on strength of claims and defenses, dispute avoidance and ... matters, including general commercial disputes, media litigation (including defamation claims and journalist privilege issues), employment litigation, privacy … more
- BrightSpring Health Services (Union City, CA)
- …knowledge of Medicaid claim regulations and processes. + Produces reports and keeps management informed of unpaid claims and claims pending follow-up. ... Prior supervisory experience. Skills/Knowledge: + Required: Knowledge of Medicaid claims regulations and processes. Basic understanding of drugs, medication… more