- WestCare Foundation (Fresno, CA)
- …DMC-ODS, Enhanced Care Management (ECM), and Community Supports. This position ensures claims are submitted accurately and timely directly to insurance carriers and ... ESSENTIAL JOB FUNCTIONS: + Prepare, submit and track CalAIM claims directly to Medi-Cal Managed Care Plans and insurance...billing. + Reconcile payments and denials; research and correct claim errors or rejections in coordination with fiscal and… more
- The County of Los Angeles (Los Angeles, CA)
- …Resources Workeris defined as identifies patients' financial resources to pay for medical and/or mental health care and services; and assists patients in making ... assignments for medical benefits and completes standardized billing forms based upon...steps to view correspondence, and we will not consider claims of missing notices to be a valid reason… more
- Highmark Health (Sacramento, CA)
- …requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- UNUM (Sacramento, CA)
- …Physical Medicine and Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across ... and efficient medical consultative services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal… more
- Sedgwick (Sacramento, CA)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more
- Molina Healthcare (CA)
- …and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Jacobs (Los Angeles, CA)
- …* Oversee the Owner Controlled Insurance program (OCIP)Timely administer claims , including investigation, evaluation, and negotiation/recommendation of claim ... in Los Angeles County and Orange County. In this claim management role, you'll play a pivotal part in...for services when required for prosecution or defense of claims , compliance issues, contract review and insurance coverage *… more
- Sedgwick (Sacramento, CA)
- …& Insurance Adjuster Regional Marine **PRIMARY PURPOSE** **:** To handle losses or claims regionally unassisted up to $10M, including having the ability to address ... and non-complex National Accounts. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines claim forms and other records to determine insurance coverage. +… more
- Sedgwick (West Hills, CA)
- …+ This role will be primarily responsible for **_Large Complex Property_** claims . **PRIMARY PURPOSE** **:** To investigate losses or claims internationally ... including handling accounting-based losses (business interruption and stock). + Examines claim forms and other records to determine insurance coverage. + Interviews,… more
- Sedgwick (West Hills, CA)
- …Coordinator **PRIMARY PURPOSE** **:** Analyzes reported leave requests including Family Medical Leave (FMLA), unpaid state, military and company-specific, to make ... based on client plans, state and federal regulations. Ensures that on-going claim management is within company service standards and industry best practices.… more