- Sharp HealthCare (San Diego, CA)
- …and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit ... Administration team members. Assumes additional responsibilities in the absence of the Director . **Required Qualifications** + 5 Years in HMO or Health Insurance… more
- Sharp HealthCare (San Diego, CA)
- …as appropriate for approval at the UM Care Coordinator level of review.Appropriately identify claims for review by the Medical Director to include obtaining the ... of the requested service. This position is responsible for conducting retrospective claims review for services to determine the medical appropriateness of the… more
- Walmart (Red Bluff, CA)
- …environmental impacts and assessments + Supports regulatory visits and prepares audit reports for management review + Assists in integrating environmental ... Assists with third party audits + Develops and presents audit findings to facility management + Responds to inquiries...to inquiries by regulatory authorities + Consults on complex claims and settlements + Designs preventative claims … more
- Actalent (Irvine, CA)
- …required health and safety documentation, such as OSHA 300 logs, workers compensation claims , and safety audit and inspection records; collaborate with Human ... programs. Manage safety records and ensure compliance with third-party client safety audit platforms (eg, Avetta). Training and Education Design and maintain a… more
- DoorDash (San Francisco, CA)
- …business by managing corporate insurance programs and mitigating risk across Actuarial, Claims Operations, and Risk Management & Mitigation. We operate at the ... with a preference for candidates near a DoorDash hub office, reporting to the Director of Risk & Insurance. You're excited about this opportunity because you will +… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …the general direction of the Supervisor, Professional Billing & Coding and Director , Professional Billing & Coding, this position operates from within the Revenue ... Cycle Center to address coding issues related to professional billing claims . The incumbent is responsible for reviewing provider charges to ensure accuracy, reduce… more
- LA Care Health Plan (Los Angeles, CA)
- …The Manager, Technology Application Production Support and Control will report to Director , Production Support within the IT Quality Assurance and Process excellence ... to provide 24/7 support for Production applications across LA Care's Claims /EDI, Member, Provider, Health Services, Customer Solutions Business functions. Provide… more
- Sharp HealthCare (San Diego, CA)
- …(subject to audit ).Observes and follows through on Pharmacist or Medical Director directions in research and resolution of all cases and initiatives. Prepares ... of the functions of Managed Care including HMO/PPO and ACO eligibility, claims , utilization management and the financial impact of decisions related to each.… more