- TEKsystems (Canoga Park, CA)
- …to hire an experienced RN or LVN with an active license to help address claims retro review . This role focuses on reviewing inpatient and outpatient claims ... Position: Utilization Review Nurse Work Enviroment: Hybrid work schedule Schedule:...+ Perform detailed utilization reviews for inpatient and outpatient claims . + Prepare medical records for medical directors and… more
- Morley (CA)
- …case details? If so, this role could be a perfect fit for you! As a Legal Claims Analyst at Morley, you'll play a key role in managing small automotive claims ... to support the client's defense strategies, including lemon law claims + Serve as the "Person Most Knowledgeable" (PMK)...the time + Work in partnership with the California review team (located in Michigan), evaluating vehicle buyback requests… more
- Sedgwick (Sacramento, CA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Estimate Review Specialist **PRIMARY PURPOSE** **:** To review all estimates ... services. + Monitors, assists, tracks, and provides approval for all claims that are re-inspected by the Carrier. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES**… more
- Dignity Health (Bakersfield, CA)
- …III is an advanced-level role responsible for the detailed and accurate processing, review , and adjudication of complex healthcare claims . This position requires ... expert knowledge of claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most challenging cases, mentor junior staff,… more
- MyFlorida (Tallahassee, FL)
- MANAGEMENT REVIEW SPECIALIST - SES - 79000454 Date: Nov 24, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 865829 Agency: Business and Professional Regulations Working Title: MANAGEMENT REVIEW SPECIALIST - SES - 79000454 Pay Plan: SES Position… more
- TEKsystems (Canoga Park, CA)
- …Key Responsibilities + Perform comprehensive utilization reviews for inpatient and outpatient claims . + Prepare medical records for review by medical directors ... active license to join our team as a Utilization Review Nurse. In this role, you will conduct retrospective...you will conduct retrospective reviews of inpatient and outpatient claims to ensure medical necessity, compliance, and timely processing… more
- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... care for appropriate reimbursement. + Work with the physician advisor in review of patient medical records identified by RAC/MIC/QIO and other governmental or… more
- University of Southern California (Alhambra, CA)
- … Specialist " analyze, investigate, mitigate, and resolve all coding-related ' claims denials' and ' claims rejections,' specific to ICD-10-CM, ICD-10-PCS, ... the denial management process for coding-related denials, triage denied claims to distinguish coding-related denials versus clinical-related denials, evaluating … more
- The County of Los Angeles (Los Angeles, CA)
- Program Specialist III, CEO - Workers' Compensation Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/5097980) Apply Program Specialist III, ... The Opportunity We are pursuing qualified candidates to fill Program Specialist III, CEO positions within the Chief Executive Office's Workers' Compensation… more
- Access Dubuque (Dubuque, IA)
- …claims ; and to execute technical and jurisdictional requirements for accurate claims processing, benefit review and interpretation of regulations, financial ... Advocacy Coordination Team Specialist **Sedgwick** 1 Positions ID: R67996 Posted On...processing, and error correction of complex or high exposure claims . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and authorizes… more