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Senior Claims Specialist
10 hours ago
Virgin Pulse Los Angeles, United StatesWho are you? We are seeking an experienced and highly skilled Senior Claims Specialist to join our claims processing team. As a Senior Claims Specialist, you will play a pivotal role in ensuring the accurate and efficient processing of healthcare cla Claims Specialist, Claims, Sp ...
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EDI Claims Specialist
4 weeks ago
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Claims Documentation Specialist II
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L.A. Care Health Plan Los Angeles, United States Full timeJob Summary · The Claims Documentation Specialist II is responsible for creating, editing and updating documents that will provide an in-depth record of the procedures, policies and workflows used by L.A. Care's business units in their day-to-day functions. This role is responsi ...
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Claims Specialist
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Claims Specialist
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Sr. EDI Claims Specialist
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MedPOINT Management Los Angeles, United StatesJob Description · Job DescriptionThe Senior EDI Claims Specialist is responsible for overseeing the retrieval, processing, validation, and posting of electronic claim data files into MPM's core system, EZ-CAP. Serving as a subject matter expert, the Senior EDI Claims Specialist w ...
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ESIS Claims Specialist, WC
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Senior Claims Specialist
3 weeks ago
Virgin Pulse Los Angeles, United StatesOverview · Now is the time to join us · Virgin Pulse and HealthComp are now Personify Health. The industry's first personalized health platform company combines health, wellbeing, and navigation solutions to deliver powerful outcomes to businesses and their people. At Personify H ...
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Senior Claims Specialist
2 weeks ago
Virgin Pulse Los Angeles, United StatesOverview · Now is the time to join us · Virgin Pulse and HealthComp are now Personify Health. The industry's first personalized health platform company combines health, wellbeing, and navigation solutions to deliver powerful outcomes to businesses and their people. At Personify ...
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Senior Claims Specialist
3 weeks ago
PROVIDENCE, INC. Los Angeles, United States**Description** · The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of ...
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Los Angeles USD Los Angeles, United StatesLos Angeles Unified School District (LAUSD) is the 2nd largest public school district in the United States. The school district consists of Los Angeles and all or portions of several adjoining Southern California cities. LAUSD educates and empowers all students as future leaders. ...
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Chubb Los Angeles, United StatesJob Description · Chubb is currently seeking a Workers' Compensation Lost Time Senior Claim Specialist for our West / Pacific Region. The successful applicant will be handling claims from California, Arizona, Colorado, and Utah. The position will report to a Claim Manager and re ...
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Claims Review Specialist
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Global IT Resources Los Angeles, United StatesOverview: · We are seeking a highly organized and detail-oriented Claims Specialist to join our team. As a Claims Specialist, you will be responsible for processing and managing insurance claims, ensuring accuracy and compliance with relevant regulations and policies. This is a v ...
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Claims Review Specialist
2 days ago
Global Healthcare IT Los Angeles, United States**99% remote, only the orientation will be onsite and a few meetings when necessary.** · **CPC-H, CPC, or CCS coding certification required.** · Job Summary: · **Responsibilities**: · - Review and process medical claims for accuracy and completeness · - Verify insurance coverage ...
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Medical Claims Specialist
2 weeks ago
CEDENT Los Angeles, United StatesRequired: · Ability to operate PC-based software programs or automated database management systems. · Strong communication skills with excellent analytical and problem solving skills. · Ability to self-manage in a fast-paced, detail-oriented environment. · Extensive knowledge ...
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Claims Specialist I
4 weeks ago
C2PM Los Angeles, United States**About C2PM**:C2PM stands at the forefront of the construction consulting landscape, offering a full spectrum of program management, construction management, and specialized engineering services. We pride ourselves on tackling public works infrastructure, transportation, aviatio ...
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Claims Review Specialist
1 week ago
Diversified Technologies Inc. (DTI) Los Angeles, United States**Location: Los Angeles, CA This will be 99% remote, only the orientation will be onsite and a few meetings when necessary)** · - Bachelor's degree in business, finance or related field · - CPC-H, CPC, or CCS coding certification · - Five or more years of experience with hospital ...
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Claims Documentation Specialist II
2 weeks ago
L.A. Care Health Plan Los Angeles, United StatesSalary Range: $77, Min.) - $100, Mid.) - $123, Max.) · Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operat ...
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Claim Specialist
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State Farm Insurance Van Nuys, United StatesThis position is for a Property Field Inspection Claim Specialist, handling accidental and weather-related homeowners, commercial, and large loss claims. You will be the first point of contact to meet with our insureds, explain coverage, estimate dam Field, Inspection, Specialist ...
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Claims Specialist
3 days ago
CNA Financial Corporation Brea, United StatesInclude investigating and resolving claims under both occurrence based CGL policies and claims made E & O policies according to company protocols, quality and customer service standards. Position requires regular communication with customers and insu Claims Specialist, Claims, Co ...
Senior Claims Specialist - Los Angeles, United States - Virgin Pulse
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Description
Now is the time to join usVirgin Pulse and HealthComp are now Personify Health.
The industrys first personalized health platform company combines health, wellbeing, and navigation solutions to deliver powerful outcomes to businesses and their people.
At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters.
Together, were shaping a healthier, more engaged future.Who are you?
We are seeking an experienced and highly skilled Senior Claims Specialist to join our claims processing team.
As a Senior Claims Specialist, you will play a pivotal role in ensuring the accurate and efficient processing of healthcare claims, overseeing complex cases, and providing guidance to claims specialists.
In this role you will wear many hats, but your knowledge will be essential in the following:Claims Adjudication:
Lead the adjudication of complex and high-dollar claims, applying advanced knowledge of policies, procedures, and guidelines.
Claims Review:
Conduct in-depth reviews of disputed or escalated claims, collaborating with internal teams and external stakeholders to reach fair and timely resolutions.
Quality:
Ensure a high level of quality in claims processing by consistently achieving a financial accuracy rate of 99% and a procedural accuracy rate of 97%, adhering to established guidelines and procedures.
Documentation:
Ensure accurate claims information is recorded in claims and patient notes, including accurate indexing, and archiving of documents to facilitate easy retrieval.
Investigation:
Investigate and resolve discrepancies and issues related to claims, ensuring prompt and fair resolution. Provide feedback to leadership on how to prevent discrepancies from occurring on future claims.
Communication:
Provide timely and concise updates on the status of assigned claims, highlighting any potential issues or complex cases that may require additional attention or guidance as well as proposed solutions.
Process Improvement:
Identify opportunities for process enhancements, lead process improvement initiatives, and collaborate with cross-functional teams to streamline workflows.
Mentorship:
Provide guidance and training to claims specialists, fostering their professional development and ensuring consistent and accurate claims processing.
Policy Analysis:
Analyze and interpret complex contracts and benefit documents to ensure accurate claims processing and compliance.
Customer Escalations:
Handle escalated customer inquiries and complaints, demonstrating expert knowledge and exceptional problem-solving skills.
Stay Informed on Procedures:
stay up-to-date with company-wide processing procedures and group-specific processing requirements, ensuring that claims processing remains compliant and efficient with the latest industry and organizational standards.
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
What you bring to the Personify Health team:In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
Education:
High School diploma or general education degree (GED).
Experience:
A minimum of 3-5 years of progressive experience in medical claims processing.
You also take pride in offering the following Core Skills, Competencies, and Characteristics:
Expertise:
In-depth knowledge of healthcare insurance terminology, policies, and procedures, with a proven track record of handling complex claims.
Leadership:
Display leadership qualities by fostering a culture of teamwork, knowledge-sharing, and continuous improvement within the claims processing team.
Analytical Skills:
Advanced analytical and problem-solving abilities to tackle complex claims issues.
Communication:
Exceptional written and verbal communication skills, including the ability to communicate complex topics clearly.
Adaptability:
Demonstrated adaptability to evolving priorities, workflows, and regulations in the healthcare industry.
Team Player:
Collaborative attitude and willingness to work effectively in a team-oriented environment.
Technology:
Proficiency in relevant computer software and claims processing systems.
No candidate will meet every single desired qualification. If your experience looks a little different from what weve identified and you think you can bring value to the role, wed love to learn more about you
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges up to $23.00 per hour.
This position is eligible for [x%] target bonus/variable compensation as well as health, dental, vision, mental health and other benefits.
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