• Senior Health Care Audit Analyst

    LA Care Health Plan (Los Angeles, CA)
    …for planning audits and audit work programs that address appropriate claims and financial compliance criteria for specialty health plans. These audits ... Senior Health Care Audit Analyst Job Category:...also LA Care contractual agreements. The position handles DMHC claims data submissions for LA Care and its Plan… more
    LA Care Health Plan (05/26/25)
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  • Financial Compliance Auditor III Claims

    LA Care Health Plan (Los Angeles, CA)
    …for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted with LA Care. ... findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted with LA Care. Timely audit reports… more
    LA Care Health Plan (04/05/25)
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  • Senior Quality Analyst, Claims *Remote

    Providence (CA)
    …and retain the best people, we must empower them.** **Providence St Joseph Health operates a self-administered claims program for General and Healthcare ... organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending… more
    Providence (05/09/25)
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  • VP of Health Plan Operations…

    Prime Healthcare (Ontario, CA)
    …and minimize process cost of Claims for all Prime Healthcare's self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the ... position requires relocating to Ontario, California. TheVice President of Health Plan Operations and Claims is responsible...TheVice President of Health Plan Operations and Claims is responsible for the development and execution of… more
    Prime Healthcare (05/13/25)
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  • Medical Biller - Healthcare Claims

    Guidehouse (El Segundo, CA)
    …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
    Guidehouse (04/11/25)
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  • Claims Quality Auditor

    UCLA Health (Los Angeles, CA)
    …Take your career to the next level. You can do all this and more at UCLA Health . The Claims Quality Auditor will be responsible for the daily audit of ... + Knowledge of claims adjudication systems + Flexibility and adaptability UCLA Health is a world-renowned health system with four award-winning hospitals and… more
    UCLA Health (05/08/25)
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  • Pharmacy Claims Auditor CPhT

    Conduent (Los Angeles, CA)
    … Auditor CPhT** **Do you have a CPhT certification?** **Would you like to audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity ... behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will examine a wide variety...and pharmacy practices. + Responding to pharmacy calls regarding audit results and dealing with clients periodically to report… more
    Conduent (05/25/25)
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  • Claims Team Lead - Workers Compensation

    Sedgwick (Ontario, CA)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Team Lead - Workers Compensation **PRIMARY PURPOSE:** To supervise the operation… more
    Sedgwick (06/06/25)
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  • Workers Compensation Claims Supervisor…

    Sedgwick (Long Beach, CA)
    …management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract requirements, and ... to Work(R) Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Supervisor | Long Beach, CA (Hybrid) | SIP Required Are you looking… more
    Sedgwick (03/13/25)
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  • Claims Sr. Quality & Training Specialist…

    Trustmark (Sacramento, CA)
    …communities. **About the role** This role is a dedicated training position for Claims that resides in the Knowledge Management & Customer Experience group. The ... primary function of this role is to train and audit new and existing staff in all products including...claim handling process and procedures and experience in handling claims appropriately in accordance with the corporate claim philosophy,… more
    Trustmark (06/04/25)
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