- Lincoln Financial (Sacramento, CA)
- …Role at a Glance** We are excited to bring on highly motivated STAT / PFL Claims Specialists to staff our ever-growing claims organization. As a STAT / PFL ... initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations....diploma or GED + 1-2 years of experience in claims , leaves or customer service + Strong written and… more
- J&J Family of Companies (Santa Clara, CA)
- At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, ... today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com **Job Function:** R&D Operations… more
- Aston Carter (Corona, CA)
- Top manufacturing company looking for a Chain Claims Assistant to support their team! Great role to kick-start your accounting degree as no professional experience ... invoices. + Provide customer service and support to the Claims team, internal departments, and MEC sales staff as...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- Cognizant (Sacramento, CA)
- …or requested; and other duties as assigned. Maintain and particpate in all Mass Health forums to understand, translate and implement Mass Health guidelines to ... and in a team environment + Extensive knowledge of Massachusettes Medicaid Mass Health laws required + Experience with Mass Health governing policies and… more
- CVS Health (Sacramento, CA)
- …position and can be based anywhere in the United States.** ** The Behavioral Health (BH) Medical Director (Special Investigations Unit) will be responsible for ... At CVS Health , we're building a world of health around...performing reviews of BH medical records and/or CPT code/HCPCS codes of known or suspected acts… more
- LA Care Health Plan (Los Angeles, CA)
- …is responsible for planning audits and audit work programs that address appropriate claims and financial compliance criteria for specialty health plans. These ... Senior Health Care Audit Analyst Job Category: Accounting/Finance Department:...also LA Care contractual agreements. The position handles DMHC claims data submissions for LA Care and its Plan… more
- Sharp HealthCare (San Diego, CA)
- …for identifying Potential Quality Issues. + Supervises Physician Reviewer(s) and Medical Directors including Behavioral Health Medical Directors.Shares ... Senior Medical Director position provides critical management and oversight for Sharp Health Plan's (SHP) physicians ( Medical Directors (both medical and… more
- City and County of San Francisco (San Francisco, CA)
- …billing, claims processing and/or collecting healthcare service reimbursements or medical claims from Medi-Cal (Medicaid), Medicare, insurance, third party ... process when candidates are referred for hiring. + Thorough knowledge of medical claims processing procedures, including Medicare, Medicaid and insurance billing… more
- Sharp HealthCare (San Diego, CA)
- …practices. **What You Will Do** Working with the Chief Medical Officer, oversees medical care for Sharp Health Plan (SHP) products and services and oversees ... management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan...Reports all issues of clinical quality management to the health plan Chief Medical Officer. To ensure… more
- Scripps Health (San Diego, CA)
- …and Thoracic Surgery Center (SCTSC) * SHPS also adjudicates some institutional claims for Mercy Physicians Medical Group (MPMG), Primary Care Associates ... in 4S Ranch/Rancho Bernardo. You will enjoy comprehensive benefits that cover health & wellness, career development, and retirement options among other benefits.… more