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Supervisor of Medical Claims
3 weeks ago
Inland Empire Health Plan California, United StatesThe Supervisor, Claims Processing – Medi-Cal provides daily oversight of claims staff, business processes and inventory management. Ensures the claims team follows state/federal regulations and standard operating procedures. Develops best practices to optimize claim processing qu ...
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CA Medical Only Claims Specialist
2 weeks ago
CorVel Corporation California, United States OTHERThe Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers' compensation claims under close supervision, supporting the goals of claims department and of CorVel. · This is a remote job opportunity. · ESSENTIAL FUNCT ...
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Medical Only Claims Examiner I
2 weeks ago
ICW Group California, United States OTHERAre you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about w ...
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Sr. Medical Malpractice Claims Manager
2 days ago
Providence California, United States Paid WorkDescription · Providence caregivers are not simply valued – they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retai ...
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Staff Physician
2 weeks ago
Watts Healthcare Corporation , CA, United StatesJob description · With over 50 years of service, our goal is to improve the health of the community we serve by creating easier access to quality clinical, preventative, and specialty healthcare services. Watts Healthcare Corporation is deemed by the Bureau of Primary Health Care ...
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Occupational Health Nurse
2 weeks ago
SPECTRAFORCE , CA, United StatesPosition Title: EW-Occupational Health Nurse · Location: South San Francisco , CA · Work Hours: Standard business hours (8-5 PST) · Duration : 1+ years · Position Description: · The Occupational Health Nurse's primary purpose is to ensure the health, safety, and productivity of s ...
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Ultimate Staffing California, United StatesEstablished organization is seeking a Bilingual Spanish Workers' Comp Claims Rep for direct hire Pay: $70-103k DOE · Investigate and assess the validity of workers' compensation claims by gathering information from various sources, including claimants, witnesses, medical records, ...
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Claims Adjuster
3 weeks ago
Comptech Associates California, United StatesJob Title: Claims Adjuster - Workers Compensation · Duration: 3+ Months (CTH) · Location: Los Angeles, CA · No. of Positions: 2 · Job schedule-40 hours on site · Job hours-8:00-4:30 · Interview process-WEBEX prescreen/Then in-person interview · Summary: The main function of a Wor ...
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Employee Relations Business Partner
1 week ago
AppleOne Employment Services California, United StatesJob Overview: The Employee Relations Business Partner (ERBP) is a strategic advisor and consultant responsible for fostering a positive work environment, guiding performance management, and ensuring compliance with company policies and legal requirements. The ERBP will support Am ...
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Claims Adjuster-Workers Compensation
2 weeks ago
TSR Consulting Services, Inc. California, United StatesOur client, an established insurance company is in search of a Claims Adjuster to join their team on a W2 contract in Los Angeles, CA. · Summary: · The main function of a Workers' Compensation Claims Adjuster is to investigate, analyze, and determine the extent of insurance compa ...
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Workers Comp
4 weeks ago
Brown & Brown Insurance California, United StatesBuilt on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. · Brown & Brown is looking for a Claims Manager to join our team in Irvine, CA · SUMMARY: · Works independently and in conjunction with Prod ...
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Claims Analyst
5 days ago
Stellar Consulting Solutions, LLC California, United StatesResponsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports. Responds to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding require ...
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Commercial Lines Account Manager
1 week ago
Wraith Scarlett & Randolph California, United States Full time: This position is responsible for managing an assigned book of business while providing excellent customer service to our clients. We prefer someone who could work on-site or hybrid schedule (1 day a week) but would consider remote. Wages and Benefits: Competitive salary with t ...
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Coverage Attorney
6 days ago
Atheria Law California, United StatesAtheria Law was founded on October 1, 2019, as a modern law firm dedicated to representing global insurance and reinsurance clients. Our team has broad experience representing insurers in all lines of insurance, with a focus on professional liability, technology, privacy, and cyb ...
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Finance Supervisor/Manager
2 weeks ago
Addison Group California, United StatesThe Finance Manager will over the team of Analysts, oversee and develop SOP's and financial solutions, create and package financial products, lead transition of accounting functions and financial reporting into ERP system. · Responsibilities: · Identify cost drivers and drill dow ...
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Claims Auditor
5 days ago
Russell Tobin California, United StatesTitle: Claims Compliance Auditor · Start: ASAP · W2 Contract Duration: 6 months · Location: Remote · Hours per Week: Flexible for Part-Time or Full-Time; 20-40 hours/week · Pay Range: $75-95/hr · Skills required: · Significant healthcare claims experience and health claims reven ...
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Supervisor, Claims Processing
2 weeks ago
Inland Empire Health Plan California, United States OTHERWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience · The Supervisor, Claims Processing – Medi-Cal provides daily oversight of claims staf ...
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Senior Liability Claims Specialist
2 weeks ago
CorVel Corporation California, United States OTHERCorVel in is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Auto and General Liability claims. Additionally, the Specialist will work within delegated authority to best possible ou ...
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Senior Claims Specialist
2 weeks ago
CorVel Corporation California, United States OTHERWe are seeking a Sr. WC Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits ...
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CA Claims Specialist
2 weeks ago
CorVel Corporation California, United States OTHERThe Claims Specialist manages within company best practices lower-level, non-complex and non-problematic indemnity claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims depa ...
Supervisor of Medical Claims - California, United States - Inland Empire Health Plan
Description
The Supervisor, Claims Processing – Medi-Cal provides daily oversight of claims staff, business processes and inventory management. Ensures the claims team follows state/federal regulations and standard operating procedures. Develops best practices to optimize claim processing quality. Resolve claim payment issues and quality oversight. Assist in hiring and training new team members in their job responsibilities. Monitors individual and team performance to ensure quality and performance objectives are met. Assist in employee performance evaluation, coaching and professional development activities to improve performance efficiency.Supervise day-to-day claims operations tasks in accordance with established policies and procedures, standard operating procedures, and job aids to ensure optimal performance results.
Monitor and track claim inventory / workflow through the entire claim life cycle to ensure timely processing of claims based on regulatory and contractual compliance requirements.
Oversight of all aspects of departmental monitoring tools and controls to promote operational excellenceResponsible for driving team results based upon established departmental quality and production performance metrics.
In collaboration with the Claims Quality Assurance and Training teams, review audit results to evaluate opportunities for staff development, training, and remediation needs to maximize claim outcomes.
Identifies and implements process improvement opportunities that focus on customer value.Serve as a subject matter expert and liaison with internal and external customers to address claim issues in an expeditious, accurate method.
Select and build strong, professional functional teams through training reinforcement, coaching, motivation, and performance management. Complete and track effective performance evaluations and maintain ongoing dialogue with team members regarding development opportunities.Assist Claims Management in identifying, creating, and implementing policies and procedures, standard operating procedures, and desk top references.
Make recommendations to leadership on changes and additions to department procedures through innovative thinking with an emphasis on automation.
Attend regulatory audits for assigned line-of-business and actively participate as a claims SME on processes and procedures for the claims department.
Stay current with changes mandated by the regulatory agencies and industry standard processes.Serve as a support to the Claim Operations Manager for absences, spike claim receipts, etc.
Any other duties as required to ensure IEHP operations are successful.
Commitment to Quality:
The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
CalPERS retirementGenerous paid time off- vacation, holidays, sick
Medical Insurance with Dental and Vision
Short-term, and long-term disability options
Flexible Spending Account – Health Care/Childcare
Four (4) years medical claims processing experience, at least two (2) years of experience in a supervisory capacity leading a team.
Experienced in benefit and financial matrix interpretation.Bachelor's degree from an accredited institution preferred.
A thorough understanding of claims industry and customer service standards. Knowledge in CMS, DHMC and DHCS regulatory guidelines including AB1455. Solid understanding of the DHCS, DMHC and CMS rules and regulations governing claims adjudication practices and procedures desired.
Principles and techniques of supervision and training.
Knowledge of medical terminology and understanding of healthcare claims.
Analytical skills with emphasis on time management, data base maintenance, spreadsheet manipulation, and problem solving.
Strong writing, organizational, project management, and communication skills proficiency required.
