- Adjudicates complex professional and institutional claims.
- Responsible for meeting performance measurement standards for productivity and accuracy.
- Adjudication of claims adjustment.
- Follow all appropriate Federal and State regulatory requirements and guidelines applicable to HealthPlan operations or as documented in company policies and procedures.
- Maintain required levels of production and quality standards as established by management.
- Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
- Maintains regular and consistent attendance.
- Adheres to Compliance Plan and HIPAA regulations.
- Takes on special projects as needed.
- Performs other duties as assigned.
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Claims Adjuster/claim Examiner
1 week ago
DB Insurance Anaheim, United StatesCompany and Position Overview · DB Insurance Co Ltd (US Branch) is looking for a full-time LIABILITY CLAIMS ADJUSTER/EXAMINER who has experience handling Commercial General Liability/Auto BI Liability claims. · **About DB Insurance** · DB Insurance Co., Ltd. Is one of the largest ...
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Medical Claims Examiner
1 week ago
The Principle Group Whittier, United States**Description**: · **JOB TITLE**: Claims Examiner - Days · **LOCATION**: 9557 Greenleaf Avenue, Whittier, CA · **SHIFT**: Monday - Friday - 07:00am - 03:30pm · **DURATION - 13 weeks(extend)** · ** 2 YEARS EXPERIENCE REQUIRED - MUST BE ABLE TO VERIFY HS DIPLOMA or GED or HIGHER ED ...
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Claims Examiner
4 days ago
BCforward Sierra Madre, United StatesBCForward is currently looking for Claims Examiner - Workers Compensation in Pasadena, CA 91107 · Job Title: Claims Examiner - Workers Compensation · Location: Pasadena, CA 91107 · Duration: 6 Months · Pay-Rate: $46/Hr. on W2 · PRIMARY PURPOSE: To analyze complex or technica ...
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Claims Examiner Iii
4 days ago
Advanced Medical Management, Inc. Long Beach, United States**Claims Examiner III** · **Role Insights** · **Primary Responsibilities** · - Audit claims processing quality, develops, maintains and runs standard reports · - Assist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural) ...
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Claims Examiner Iii
1 week ago
TRISTAR RISK MANAGEMENT Signal Hill, United States**This position requires the employee to be bilingual English/ Spanish.** · ***:Under mínimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. · This position requires considerable interaction w ...
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Claims Examiner III
1 week ago
Imperial Health Plan of California, Inc. Pasadena, United StatesJOB SUMMARY: Is responsible for adjudicating complex claims which include high dollar claims. Responsible for accurate manual/auto pricing of claims. Identify provider billing issues that impact claims processing. Works closely with the Supervisor to identify any reporting or tra ...
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Medical Claims Examiner
1 week ago
SCUFCW Trust Fund Anaheim, United StatesJob Description · Job Description***This position is located in Cypress, CA · Southern California United Food & Commercial Workers Unions & Food Employers Joint Benefit Funds Administration, LLC (The Funds) were created more than 40 years ago as a result of collective bargaining ...
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Claims Examiner
1 week ago
D3 Search Los Angeles, United StatesD3 Search is actively seeking the following Claims Examiner II - Cyber candidate for a highly respected global insurer with a long-standing office located in Encino, CA · Position Title: · Claims Examiner II - Cyber · Location | Map: · Encino, CA · Employer Work Model: · Flexib ...
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Insurance Claim Examiner
1 week ago
cesna Anaheim, United StatesJob Description · Job Description[Position] · Claims Examiner for Insurance Industry. · [About Our Client] · One of the largest non-life insurance companies based in South Korea. We currently writes all lines of property and casualty insurance in CA, NY, OH, IN, PA, TX and HI Sta ...
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Claims Examiner
1 week ago
D3 Search Los Angeles, United StatesD3 Search is actively seeking the following Claims Examiner II - Cyber candidate for a highly respected global insurer with a long-standing office located in Encino, CA · Position Title: · Claims Examiner II - Cyber · Location | Map: · Encino, CA · Employer Work Model: · Fl ...
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Claims Examiner
5 days ago
TotalMed Staffing Los Angeles, United States*Position Title * Claims Examiner - Workers Compensation · *Address * Remote CA · *Pay*: $45 - $48.57 · *Hours * Monday-Friday 8:00am-5:00pm · *Vaccine Requirement * not required · *Position Purpose:* · The Claims Examiner - Workers Compensation analyze complex or technical ...
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Claims Examiner
2 days ago
MedPOINT Management Los Angeles, United StatesJob Description · Job Description Summary: · Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. S ...
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Senior Claims Examiner
1 week ago
Carl Warren & Company Anaheim, United StatesCOMPANY OVERVIEW: · Carl Warren & Company is a leading nationwide Third-Party Administrator (TPA) founded in 1944. Carl Warren has been a trusted partner specializing in property and casualty claims management, subrogation recovery, and litigation management for private and publ ...
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Claims Examiner
2 days ago
Total Medical Staffing Los Angeles, United StatesJob Description · Job DescriptionPosition Title – Claims Examiner - Workers Compensation · Address – Remote CA · Pay -- $40/HR · Start date – ASAP · Hours – 8a-5p · Required Skills & Education: · • 2+ years workers comp claims experience · • Bachelor's degree required · • P ...
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Claims Examiner
2 days ago
North American Staffing Group Montebello, United StatesJob Description · Job DescriptionPosition Type: Direct HireLocation: Montebello, CA (Hybrid after initial training onsite is completed)Hourly Rate: $24 - 30/HR depending on years of experienceSchedules Available: 6AM - 3PM, 7AM - 4PM, 8AM - 5PM · Requirements:Minimum 2 - 3 years ...
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Claims Examiner
1 week ago
Innovative Management Systems Incorporated City of Industry, United States:The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Com ...
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Claims Examiner
6 days ago
Innovative Management Systems Incorporated City of Industry, United States:The Position. · We are looking for a detail-oriented individual that can accurately review, research, and analyze professional claims to determine and calculate the type and level of benefits based on established criteria and provider contracts. Experience in adjudication of Com ...
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Claims Examiner
1 week ago
TEKsystems Whittier, CA, United StatesJoin a large hospital here in the Whittier Area · Job Description: · The claims examiner reports directly to the claims manager. · They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received ...
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Claims Examiner
1 week ago
Rose International Long Beach, United StatesDate Posted: 05/09/2024 · Hiring Organization: Rose International · Position Number: 463794 · Job Title: Claims Examiner · Job Location: Long Beach, CA, USA, 90806 · Work Model: Hybrid · Employment Type: Temporary · Estimated Duration (In months): 8 · Min Hourly Rate ($): ...
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Claims Examiner
1 week ago
CMJobPoster Long Beach, United StatesJob Title: Claims Examiner - Workers Compensation · Location (On-site, Remote, or Hybrid?): Long Beach, CA (Remote) · Contract Duration: Contract until 10/31/2024 · Work Hours: 08:00 AM - 04:30 PM · ...
Claims Examiner II - Pasadena, United States - Imperial Health Plan of California, Inc.
Description
ESSENTIAL JOB FUNCTIONS:
MARGINAL JOB FUNCTIONS: