- Humana (Sacramento, CA)
- … healthcare industry + 2+ years of demonstrated expertise in end-to-end healthcare claims operations , including claim ingestion, processing, system ... This is your opportunity to lead cross-functional initiatives, apply your expertise in healthcare claims , and shape the future of operational excellence in a… more
- Prime Healthcare (Ontario, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vice-president-of-health-plan- operations -and- claims ... to improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee...(7) to ten (10) years prior work experience in Claims Operations and Health Plan Strategy, in… more
- Sanofi Group (Los Angeles, CA)
- …detail-oriented problem solver with deep operational knowledge of the US healthcare system, including formulary operations , claims adjudication, ... **Job Title:** Associate Director, National Account Operations CVS - US Remote **Location:** Remote/Field Based...and contract performance tracking. We are an innovative global healthcare company, committed to transforming the lives of people… more
- Centene Corporation (Sacramento, CA)
- …5:30am PT to as late as 8:30am PT. **Position Purpose:** Perform regulatory claims compliance audits to support health plan operations . Completes retrospective ... as a Claims regulatory resource related to the health plan operations and compliance audits. + Maintain quality and productivity standards set by management.… more
- Providence (CA)
- …statements for services and take proper steps to pay vendors + Inform Senior Manager Operations of large or complex claims and claims with potential for ... empower them.** **Providence is calling a Sr. Professional Liability Medical Claims Manager who will:** **Investigate, evaluate, and manage professional, general,… more
- Cognizant (Sacramento, CA)
- …variety of business operations . We are seeking **Fully Remote US Based** Claims Processors to join our growing team. The **Medical** ** Claims Processor** is ... responsible for the timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to … 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 ... part of a culture where individuality is noticed and valued every day. **Pharmacy Claims Auditor CPhT** **Do you have a CPhT certification?** **Would you like to… more
- HCA Healthcare (Campbell, CA)
- …physician and ancillary agreements and Letters of Agreement + Working knowledge of claims operations , credentialing process and overall MSO operations + ... below midpoint of the range. **Introduction** Experience the HCA Healthcare difference where colleagues are trusted, valued members of...Team include the CEO, CFO, President of SCCIPA, AVP Claims and Manager of Network Operations . We… more
- Sharp HealthCare (San Diego, CA)
- …with State law, rules, and guidelines; provider and group agreements; Operations Manual; benefit matrices; and other administrative and medical guidelines, policies, ... for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible for non-clinical appeals and grievances.… more
- Sharp HealthCare (San Diego, CA)
- …with State law, rules, and guidelines; provider and group agreements; Operations Manual; benefit matrices; and other administrative and medical guidelines, policies, ... for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible for non-clinical appeals and grievances.… more