- Molina Healthcare (San Bernardino, CA)
- …focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring… more
- Genentech (South San Francisco, CA)
- …clinical workflows + Expertise in managing and applying healthcare data (RWD, RWE, claims , EHR). + Strong knowledge of AI/ML for insights and process automation, ... along with familiarity with digital health technology (CRM) and data privacy regulations (HIPAA) **Preferred Qualifications & Experience** + A medical degree or prior experience in Medical Affairs is a strong plus. **Location & Travel Requirements** This… more
- BeOne Medicines (San Mateo, CA)
- …competing trials, recent or upcoming approvals, prescribing data, insurance claims data, diversity, and recruitment capabilities. This includes intelligence ... gathering and risk assessment with therapeutic knowledge balanced with data analytics and interpretation. The Global Strategic Feasibility Analytics Lead supports the Head of Global Strategic Feasibility to improve the Global Strategic Feasibility processes,… more
- City and County of San Francisco (San Francisco, CA)
- …the Worker's Compensation Supervisor assists and provides first-line oversight of claims adjusting and processing teams for the Workers' Compensation Division. ... the review, analysis, investigation and disposition of workers' compensation claims and reports. Provides claims supervision of...result of appeals), as directed by the Human Resources Director or the Civil Service Commission. The duration of… more
- University of Southern California (Alhambra, CA)
- …Denials Management Specialist" analyze, investigate, mitigate, and resolve all coding-related ' claims denials' and ' claims rejections,' specific to ICD-10-CM, ... the denial management process for coding-related denials, triage denied claims to distinguish coding-related denials versus clinical-related denials, evaluating … more
- Ventura County (Ventura, CA)
- …for consistent personal planning. The Position Reporting to the County Human Resources Director , the Deputy Executive Officer - Risk Management will oversee one or ... County's financial exposure. It also involves overseeing all aspects of the claims process for the County's self-insured programs, from initial reporting to… more
- The County of Los Angeles (Los Angeles, CA)
- …Recreation's five operational regions. Positions in this class report to an Assistant Director of Parks and Recreation and support the overall management of regional ... Job Functions + Under the direction of an Assistant Director , manages the recreation services, crafts and ground maintenance,...steps to view correspondence, and we will not consider claims of missing notices to be a valid reason… more
- The County of Los Angeles (Los Angeles, CA)
- …STANDARDS: Positions allocable to this class report to a Deputy Director , Agricultural Commissioner/Weights and Measures and are distinguished by their management ... letters, press releases and special reports on behalf of the Agricultural Commissioner/ Director of Weights and Measures. + Recommends bureau policy to the Deputy… more
- Sacramento County (Sacramento, CA)
- …Or: Two years of full-time paid experience providing technical support for claims administration, developing and/or administering insurance programs for a public or ... an arithmetic 70% of the total possible score as determined by the Director . APPEAL PROCESS: Persons who believe their applications have been improperly rejected may… more
- Allied Universal (San Jose, CA)
- …This position is responsible for employee relations, employment compliance, unemployment claims , and monitoring of employment status for the employees of that ... and responses to the Department of Labor for unemployment claims . + Participation in employee retention and human capital...to negating a lawsuit. + Support the Regional HR Director and Legal team on sensitive investigations. + Assure… more