- Humana (Sacramento, CA)
- …to lead cross-functional initiatives, apply your expertise in healthcare claims , and shape the future of operational excellence in a dynamic, mission-driven ... help us put health first** As a Process Improvement Lead , you'll play a key role in analyzing and...+ 2+ years of demonstrated expertise in end-to-end healthcare claims operations, including claim ingestion, processing , system… more
- Dignity Health (Bakersfield, CA)
- …procedures. - Monitor and respond to regulatory changes that impact claims processing and research activities. - Schedule and lead meetings with all affected ... all claim types - Perform an analysis of the claims processing by reviewing contract, system configuration,...the organization to ensure customer resolution is complete - Lead investigations into claims overpayments, underpayments, and… more
- Golden State Foods (Irvine, CA)
- …and oversees claims handling procedures and program enhancements to streamline claims processing and mitigate loss + Manage quarterly claim review with ... or university. + 5-7+ years of progressive experience as an Insurance Claims Adjustor, TPA Team Lead , or Corporate Risk Manager with a high acuity for workers… more
- BrightSpring Health Services (Union City, CA)
- …Prior supervisory experience. Skills/Knowledge: + Required: Knowledge of Medicaid claims regulations and processes. Basic understanding of drugs, medication ... Identifies and resolves issues of denials or follow-up of claims . + Maintains current knowledge of Medicaid claim regulations...+ Produces reports and keeps management informed of unpaid claims and claims pending follow-up. + Understands… more
- Molina Healthcare (San Diego, CA)
- …test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- Lead Prior Authorization Specialist Job Details Job Location Polaris Specialty Pharmacy LLC - Covina, CA Salary Range $28.00 - $29.00 Hourly Job Category ... for career advancement to all our team members. JOB SUMMARY: The Lead Prior Authorization Specialist is responsible for managing and identifying a portfolio… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …visible leadership position has been designed for an executive marketing professional to lead the US Centanafidine launch, a novel treatment for ADHD. The compound ... launch that results in significant contribution to overall brand growth and lead commercial team members responsible for creating and implementing brand strategy… more
- Highmark Health (Sacramento, CA)
- …progressions, and treatment efficacy? Highmark Health is seeking a groundbreaking Lead Data Scientist, Research & Development, specializing in Graph Intelligence, ... insights in healthcare. This is a premier R&D position where you will lead the charge in inventing and proving out transformative graph-native analytical solutions.… more
- Humana (Sacramento, CA)
- …and processes + Solid understanding of healthcare operations, particularly around claims processing , enrollment, provider data management and clinical ... of our caring community and help us put health first** The Medicaid Lead , Technology Solutions builds strategic partnerships and manages relationships between IT and… more
- Astrix Technology (San Bernardino, CA)
- **QA Technician ( Lead )** Laboratory San Bernardino County, CA, US Pay Rate Low: 20 | Pay Rate High: 23 + Added - 12/08/2025 Apply for Job We are seeking a **Quality ... and warehouse areas. + Collect and log production and processing samples. + Ensure non-conforming products are placed on...including FDA, COOL, Prop 65, nutritional warnings, and health claims . + Experience using **ESHA Genesis** for NLEA labeling… more