-
Supervisor of Medical Claims
1 week 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 ...
-
CA Medical Only Claims Specialist
1 week 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 ...
-
Medical Only Claims Examiner I
1 week 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 ...
-
Occupational Health Nurse
4 days 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 ...
-
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, ...
-
Employee Relations Business Partner
2 days 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 ...
-
Claims Adjuster-Workers Compensation
1 week 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 ...
-
Supervisor, Claims Processing
1 week ago
Inland Empire Health Plan , CA, United StatesWhat 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 ...
-
Claims Adjuster
1 week 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 ...
-
Staff Physician
5 days 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 ...
-
Workers Comp
2 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 ...
-
Commercial Lines Account Manager
1 day 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 ...
-
Finance Supervisor/Manager
1 week 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 ...
-
Senior Claims Specialist
1 week 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 ...
-
CA Claims Specialist
1 week 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 ...
-
Senior Liability Claims Specialist
1 week 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 ...
-
Telephonic Nurse Case Manager
1 week ago
Pinnacle Case Management Solutions, LLC. California, United StatesCompany Description · Pinnacle Case Management Solutions, LLC provides nurse case management services to employers, third-party administrators, and insurance carriers in the Workers' Compensation industry. Our dedicated team of nurses support all parties involved in the recovery ...
-
Field Nurse Case Manager
1 day ago
Pinnacle Case Management Solutions, LLC. California, United StatesCompany Description · Pinnacle Case Management Solutions, LLC provides nurse case management services to employers, third-party administrators, and insurance carriers in the Workers' Compensation industry. Our dedicated team of nurses support all parties involved in the recovery ...
-
Senior Claims Specialist
2 weeks ago
CorVel Corporation California, United States OTHERCorVel is seeking a CA Workers Compensation Sr. Claims Specialist. The CA Workers Compensation Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to det ...
-
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 ...
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.CalPERS retirement
Generous 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.
