- Insight Global (Burbank, CA)
- …implementing solutions; addressing unresolved problems - Review and research incoming healthcare claims by navigating multiple computer systems and platforms ... Fund. The Senior Participant Service Specialist/Analyst will process health insurance claims and answers calls from the customer (participant, providers, physicians,… more
- Molina Healthcare (San Diego, CA)
- …trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... test assumptions through data, but lead with contextual knowledge of claims processing, provider contracts, and operational realities. + Creates succinct summaries… more
- Centene Corporation (Sacramento, CA)
- …Finance, Healthcare or equivalent experience preferred. + 2+ years claims compliance experience, preferably with State or Federal managed care programs required. ... PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations. Completes retrospective claims… more
- CVS Health (Sacramento, CA)
- …. 3+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance carrier, third party ... . 5+ years of experience handling complex druggist and professional medical malpractice claims with either a healthcare company, insurance carrier, third party … more
- Evolent (Sacramento, CA)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... public health, biology) + At least 5 years of professional experience in claims -based healthcare analytics with a payer, provider, vendor, managed care,… more
- Evolent (Sacramento, CA)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …based on compliance-related issues and trends * Senior leadership experience in healthcare , risk management, claims management, insurance and/or other relevant ... is directly accountable for contributing to audit functions, business continuity, claims management, insurance, physical security, integrated risk management and all… more
- Providence (Irvine, CA)
- …(law firm experience is a plus), including experience with general liability, healthcare -related claims , or commercial litigation. + Ability to manage multiple ... and case strategy. This role works closely with Risk Management, Compliance, Claims , and operational leaders to protect the organization's interests while advancing… more
- Conduent (Los Angeles, CA)
- …Conduent Payment Integrity Solutions performs in depth pharmacy audits on behalf of our healthcare payer clients. As a Pharmacy Claims Auditor CPhT, you will ... where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?**...pharmacy claim data. This is to ensure billed pharmacy claims are being accurately submitted. You will also be… more
- University of Southern California (Los Angeles, CA)
- …as lead programmer and technical specialist on research projects that use administrative healthcare claims data. SAS is required. The programmer is an integral ... on research projects. + Experience with health data, including large administrative healthcare claims data from Medicare or private health insurance plans.… more