- Corporate Office Location (Murrieta, CA)
- The Risk & Safety Compliance Specialist is responsible for the protection and management of risk for all property, personnel and guests of Beshay Enterprises. This ... relating to handling of Worker's Compensation, Liability, Property and EPLI claims . o Implements all matters of the program including claim Investigations,… more
- ICW Group (Woodland Hills, CA)
- …everyday! Learn more about why you want to be here! **PURPOSE OF THE JOB** This Claims Specialist is responsible for handling complex claims with a focus on ... claims to an equitable resolution within Company standards. The Claims Specialist works with a sense of urgency, understands insurance coverage concepts, and… more
- Sedgwick (Long Beach, CA)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Claims Specialist , Professional Liability **PRIMARY PURPOSE** **:** To analyze ... complex or technically difficult medical malpractice claims ; to provide resolution of highly complex nature and/or severe injury claims ; to coordinate case… more
- Philadelphia Insurance Companies (Mission Viejo, CA)
- …of Ward's Top 50 and rated A++ by AM Best. We are looking for a Claims Specialist to join our team! Summary: Investigate, evaluate and settle more complex first ... and third party commercial auto insurance claims . A typical day will include the following: Thoroughly...investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Travel is… more
- Carrington (Anaheim, CA)
- **Come join our amazing team and work remote from home!** The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses ... identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as… more
- ICW Group (Woodland Hills, CA)
- …and workflows for Audit & Compliance program. + Works closely with training specialist and claims management staff to correct deficiencies and address technical ... purpose of this job is to supervise functions of claims internal controls and to monitor team activities with...is responsible for the development and execution of the Claims audit program, identifying trends and promoting continuous improvement.… more
- Prime Healthcare (Anaheim, CA)
- …imaging. For more information visit www.westanaheimmedctr.com. Responsibilities The Patient Account Specialist is responsible for submitting claims to the ... when assigned. Under the supervision of the Director, the Patient Account Specialist is also responsible for accurate and timely payment analysis of managed… more
- Prime Healthcare (Ontario, CA)
- …members to join our corporate team! #LI-JV1 Responsibilities The Patient Account Specialist is responsible for submitting claims to the appropriate ... when assigned. Under the supervision of the Director, the Patient Account Specialist is also responsible for accurate and timely payment analysis of managed… 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
- Polaris Pharmacy Services, LLC (Covina, CA)
- Prior Authorization Specialist Job Details Job Location Polaris Specialty Pharmacy LLC - Covina, CA Salary Range $19.00 - $23.00 Hourly Job Category Pharmaceutical ... advancement to all our team members. JOB SUMMARY: The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy… more
- University of Southern California (Newport Beach, CA)
- The Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient ... other infused treatments as needed in assigned service line. The Specialist will be instrumental in obtaining written documentation, submitting tracking, reporting… more
- TEKsystems (Canoga Park, CA)
- JobTitle: Retro Claims Reviewer Location: West Hills/Canoga Park 91304 Compensation: LVN $38-$40 hourly RN $45-$50 hourly Overview: The Retro Claims Reviewer is ... responsible for auditing and reviewing medical claims to ensure accuracy, regulatory compliance, and proper adjudication. This role is ideal for a Licensed… more
- Otsuka America Pharmaceutical Inc. (Irvine, CA)
- …everyday health. In its evolved customer engagement model, a Neuroscience Specialist engages healthcare providers (HCPs) using in-person, virtual, and digital tools, ... patient care and provide a superior experience. The Neuroscience Specialist will report directly to the respective Area Business...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- CDM Smith (Irvine, CA)
- …40509BR **Business Unit:** FSU **Job Description:** The Disaster Program Delivery Specialist : * Collects, coordinates and/or reviews applicant data to determine ... expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs… more
- Belcan (North Hollywood, CA)
- Contracts Administrator Specialist Job Number: 360078 Category: Administrative Description: Job Title: Contracts Administrator Specialist Pay Rate: $50 /hr DoE ... analyzes and responds to complex issues including the validity of customer claims and development of Parker assertions. * Provides support to assigned programs,… more
- UIC Government Services and the Bowhead Family of Companies (Corona, CA)
- …AI/ML & LLM (AR/PA IT) Bowhead seeks a Sr. Data Scientist - AI/ML & LLM Specialist to join our team supporting the AR/PA IT Program at Naval Surface Warfare Center - ... California. The Sr. Data Scientist - AI/ML & LLM Specialist will work directly with the client analyzing complex...characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq.,… more
- BluePearl (Irvine, CA)
- **BluePearl Pet Hospital is hiring for an Employee Relations Specialist - Veterinary for our** **West** **Division!** **Pay: $84,302 - $114,900** Under the direction ... of the Manager of P&O, West Division, the Veterinary Associate Relations Specialist is primarily responsible for advising and guiding managers, advocating our… more
- Emanate Health (Covina, CA)
- …the oversight of HCC Program and STAR measures coding related functions. The coding specialist will work with the IPA Director, Health Plan, and MSO personnel on HCC ... achieves or improves upon 4.0 STAR rating. The coding specialist is responsible for education to external physician offices... will be responsible to review medical records and claims data to ensure external physicians are documenting correctly… more
- 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 for ... Responsibilities: + Perform detailed utilization reviews for inpatient and outpatient claims . + Prepare medical records for medical directors and provide… more
- Walgreens (Murrieta, CA)
- …and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), ... for non-returnable ABC overstock. Verifies posting of all pharmacy/ prescription claims . + Completes execution of all pricing activities including price changes,… more
