- Sedgwick (West Hills, CA)
- …establish expectations for return-to-work timelines and accommodations.** **Manages complex disability claims with a focus on medical compliance, duration ... system documentation.** **Coordinates investigative efforts to ensure thorough and appropriate claim reviews.** **Identifies when claims require external support… more
- Sedgwick (West Hills, CA)
- …CA 91304 **PRIMARY PURPOSE** : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability ... and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations;… more
- Sedgwick (Sacramento, CA)
- …and review new claims and maintain data integrity in the claims system. + Conduct claim file activities including evaluations, investigations, litigation ... your adjuster knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. +...+ Prepare settlement documents and requests payment for the claim and expenses. + Work with external vendors and… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …accurate adjudication of claim for reimbursement. They will process claims correctly following contractual arrangements the Medical Practice Foundation (MPF) ... not limited to; Commercial, Medi-Cal and Managed Care professional claims . This position is responsible checking status of unpaid...edits and take necessary steps to send a corrected claim or appeal to payor for reprocessing of … more
- Sedgwick (West Hills, CA)
- …and/or independent medical evaluations; to negotiate settlements and to make claim payments and revisions within designated authority level; and to calculate and ... LTD Supervisor, LTD Manager, or Project Manager. + Negotiates settlement of appropriate claims within designated authority level. + Makes claim payments and… more
- TevisHR (CA)
- …This position is NOT remote. Job Summary: A Loss Consultant for insurance claims is responsible for evaluating the extent of damage to residential properties caused ... with policyholders, contractors, and other relevant parties to ensure fair and timely claim settlements. Overall, an estimator for a claim plays a critical… more
- GE Aerospace (San Francisco, CA)
- …eligibility requirements, and limitations + Strong preference for long term care insurance claim experience + Working knowledge of medical terminology and ... In this high-impact role, you'll deliver sharp insights, adjudicate complex claims , and collaborate across teams using advanced analytics and emerging technology.… more
- Highmark Health (Sacramento, CA)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level ... the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code submission, analysis of the … more
- City and County of San Francisco (San Francisco, CA)
- …Nurse Consultant, Nurse Manager, and/or Nurse Case Managers to review complex claims and establish medical protocols. 13. Advises the Occupational Nurse ... penalties to determine liability and authorizes payment. 10. Authorizes medical treatment for complex medical cases. 11.... clinic operations. 14. Provides ongoing system support to claims staff. 15. Accurately estimates the potential claim… more
- ICW Group (San Diego, CA)
- …or claim . + Understands the rules behind different types of claims per bureau specifications. + Updates claim information for non-compensable, subrogation, ... multiple departments and outside agencies. + Works closely with Claims department regarding claim rules and coding....* We offer a competitive benefits package, with generous medical , dental, and vision plans as well as 401K… more