- US Tech Solutions (Whittier, CA)
- **Duration: 3+ months contract** **Responsibilities:** + Review , adjudicate, and process medical claims for HMO patients + Work closely with affiliated ... medical groups and hospitals + Evaluate provider reimbursement terms...provider reimbursement terms and flag non-contracted providers + Ensure claims are processed accurately and timely per policy guidelines… more
- Guardian Life (Sacramento, CA)
- …Communicate claim status and decisions via telephone and in writing + Prioritize and review new claims to adhere to established departmental turnaround times + ... As the ** Claims Case Manager I** , **Supplemental Insurance,** you...investigation and draft adverse determination letter if applicable + Review claim documentation to determine benefits available against policy… more
- Lincoln Financial (Sacramento, CA)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll… more
- UCLA Health (Los Angeles, CA)
- …for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of ... + High school diploma, GED or equivalent + Four or more years of medical claims payment experience in an HMO environment + Experience with CPT-4, ICD-9CM, RBRVS,… more
- Kemper (Chatsworth, CA)
- …Adjuster, is responsible for the investigation, evaluation, and handling of complex to claims to conclusion. This role will have advanced claim handling skills and ... a cohesive team. **Position Responsibilities** : + Primarily handles claims with a high complexity and large injury severity....with a high complexity and large injury severity. + Review each claim to ensure that all coverage and… more
- Sedgwick (Orange, CA)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Manager | Dedicated Account | Hybrid (Orange, CA) Are you looking for an ... client, ensuring consistent service delivery and performance monitoring. + Leads quality review processes, reporting monthly on both company and client standards. +… more
- Conduent (Los Angeles, CA)
- …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 ... audit pharmacy claims for accuracy?** **About the Role** Conduent Payment Integrity...professional and respectful manner. + Using prescription knowledge to review pharmacy submitted documentation against submitted claim data. +… more
- Humana (Sacramento, CA)
- …help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Robert Half Office Team (San Diego, CA)
- …place to advance your career in medical billing. Key Responsibilities: + Claims Submission: Prepare, review , and submit Medicaid and Medicare claims ... Description Are you an experienced medical billing professional looking to grow your career...billing data, reconcile accounts, and resolve discrepancies in Medicaid/Medicare claims and payments. + Compliance Management: Ensure adherence to… more
- Sedgwick (Sacramento, CA)
- …cases accordingly. + Interviews practitioners involved in medical malpractice claims . + Participates in follow-up review and investigation as directed ... Professional Liability **PRIMARY PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure.… more