Claim processor jobs in Baldwin Park, CA

Work directly with regional Claims Managers to supervise employees in the assigned claims office. This includes assisting with recruiting, hiring and management of required staff. Supervise, evaluate, train, discipline and support staff. Ensure that supervised staff follows policies and procedures to ensure company compliance with regulatory standards, company policies and procedures, and best practices. Assist the manager in the day to day operations of the assigned office. Must be able to handle multiple jurisdictions with strong California experience or knowledge. RESPONSIBILITIES: Monitor the production and measure the performance of claims staff for full compliance with procedure manual and adopted best practices. Assign new claims and when necessary transfer existing claims to appropriate adjusters based on expertise of adjuster. Assist claims manager with training in claims related topics. Address claims related concerns and issues directly with the claims manager. Complete regular claim reviews for each assigned employee and address any concerns that may be identified, including but not limited to: timely determinations, accurate calculations of wages and benefits, statutory and regulatory compliance, reserve adequacy, subrogation, claim investigations, surveillance, litigation management, subsequent injury fund, reinsurance/excess insurance reporting and assist adjusters in addressing all topics. Assist in the development and implementation of work performance standards for claims adjusters. Ensure claims adjusters are responding to telephone calls, e-mails and correspondence timely and effectively. Complete annual performance evaluations of each assigned adjuster in accord with adopted procedures and best practices. Work directly with clients, brokers, agents, and employers in the explanation of claims related services for policy holders. When required, work directly with state regulators to address claims questions, complaints, and audits to ensure full compliance with applicable laws, regulations and directives from the regulator(s). Timely address concerns with injured workers, medical providers and employers. Other related assignments as assigned. Eligible for remote or hybrid work arrangement. QUALIFICATIONS: High school diploma or GED required Bachelor's degree or equivalent experience preferred Minimum of 5 years claims management experience. Insurance industry knowledge required Excellent technical skills associated with claims management Strong organizational skills Strong oral and written communication skills

DETAILS Assistant Claims Examiner Department: Workers' Compensation Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 6 Career Ladder: Next step in progression could include Future Medical Examiner or Claims Examiner Trainee ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers' Compensation department and can be located in Southern California, however, employees who live less than 26 miles from the Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday - Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in SouthernCalifornia. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Process new claims in compliance with client's Service Agreement Issue all indemnity payments and awards on time Process all approved provider bills timely Prepare objection letters to providers for medical bills; delayed, denied, lacking reports. Answer questions over the phone from medical providers regarding bills Contact treating physician for disability status Contact employer for return-to-work status or availability of modified work. Contact injured worker at initial set up Send DWC notices timely Issue SJDB Notices timely Request Job Description from Employer Handle Medical Only claim files Calculate wage statements and adjust disability rates as required Keep diary for all delay dates and indemnity payments Documents file activity on computer Update information on computer, i.e., address changes, etc. Schedule appointments for AME, QME evaluations Send appointment letters, issue TD/mileage, send medical file Schedule interpreter for appointments, depositions, etc. Request Employer's Report, DWC-1, Doctor's First Report if needed Verify mileage and dates of treatment for reimbursement to claimant Subpoena records File and serve documents on attorneys, WCAB, doctors Serve PTP's with medical file and Duties of Treating Physician (9785) Request PD ratings from DEU Draft Stipulated Awards and C&R's Submit C&R, Stipulated Awards to WCAB for approval with documentation Process checks - stop payment, cancellations, void, journal payments Handle telephone calls for examiner as needed Complete penalty calculations and prepare penalty worksheets Complete MPN, HCO and/or EDI coding Complete referrals to investigators Complete preparation of documents for overnight delivery Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners Contact with clients, injured workers, attorneys, doctors, vendors, and other parties Provide updates of claims status to Senior Claims Examiners and Athens management Prepare professional, well written correspondence and other communications ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required 2+ years' Claims Assistant experience supporting a workers compensation examiner or team preferred Medical Only Adjuster designation required Continuing hours must be current Mathematical calculating skills Completion of IEA or equivalent courses Administrators Certificate from Self-Insurance Plans preferred Knowledge of workers compensation laws, policies, and procedures Understanding of medical and legal terminology Must demonstrate accuracy and thoroughness in work product Ability to sit for prolonged periods of time Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

**Duration: 3+ months contract** **Responsibilities:** + Review, adjudicate, and process medical claims for HMO patients + Work closely with affiliated medical groups and hospitals + Evaluate provider reimbursement terms and flag non-contracted providers + Ensure claims are processed accurately and timely per policy guidelines **Experience:** 2+ years of experience in claims adjudication (HMO, IPA, or hospital environment) **Skills:** + Claims reimbursement knowledge + Experience working with DOFR (Division of Financial Responsibility) + Hands-on experience processing lab claims + Familiar with UB-92 and HCFA-1500 forms + Understanding of provider contracts, Medi-Cal, commercial, and senior plan claims + Strong knowledge of timeliness, payment accuracy, and compliance standards + Basic computer and data entry skills **Education:** High school diploma, GED, or higher **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Create Music Group is currently looking for a Youtube Publishing Administrator to join our Publishing Department. This role is responsible for ensuring complete delivery of our publishing content, as well as maintaining internal systems and metadata to company standards. This is a full-time position located in our Hollywood office. YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for artists and labels. REQUIREMENTS: 1-3 years work experience Excellent communication skills, both written and verbal Internet culture and social media platforms, especially YouTube Conducting basic level research Organizing large amounts of data efficiently Proficiency with Mac OSX, Microsoft Office, and Google Apps PLUSES: Strong understanding of the online video market (YouTube, Instagram, TikTok) Bilingual - any language, although Spanish, Mandarin, and Russian is preferred RESPONSIBILITIES: Watching YouTube videos for several hours daily Content claiming Uploading and defining intellectual assets Administrative metadata tasks Researching potential clients Staying on top of accounts for current client roster You are required to bring your own laptop for this position. BENEFITS: Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included. TO APPLY: Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview A Provider Dispute Claims Examiner is responsible for analyzing and the adjudication of medical claims as it relates to managed care. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or from claims incident/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and Incidents. Collaborates with other departments and/or providers in successful resolution of claims related issues. Minimum Requirements * HS Diploma or GED * 2+ years of Claims Processing experience in a managed care environment. * Must understand to read and interpret DOFRs and Contracts. * Must have an understanding of how to read a CMS-1500 and UB-04 form. * Must have strong organizational and mathematical skills. Compensation $26.91 - $33.53 hourly Compensation Disclaimer Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives. Benefits & Career Development * Medical, Dental and Vision insurance * 403(b) Retirement savings plans with employer matching contributions * Flexible Spending Accounts * Commuter Flexible Spending * Career Advancement & Development opportunities * Paid Time Off & Holidays * Paid CME Days * Malpractice insurance and tail coverage * Tuition Reimbursement Program * Corporate Employee Discounts * Employee Referral Bonus Program * Pet Care Insurance Job Advertisement & Application Compliance Statement AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Cash/Claims Processor needs 3 years vision billing experience Cash/Claims Processor requires: Vision claims coding and billing and cash apply Hybrid Interview onsite Knowledgeable in continuous improvement and problem solving Cash/Claims Processor duties: Manage the flow of processes completed by Cash Processors to ensure all cash is applied in a timely manner to outstanding invoices and provide Cash Supervisor for daily updates. Document and track stats of all processes within Cash and report results to Cash Supervisor Train associates on how to process transactions, which include researching and applying cash for both Payers and Members, identifying and documenting partial payments and denials and scanning completed batches into Filebound Complete and submit applications and documentation necessary for setting up EFTs (report any issues to Cash Supervisor) Provide a point of contact for any questions/issues regarding Cash for other areas of Assignment Provide a point of contact for any questions/issues regarding Filebound Attend meetings and or conference calls at the request of Cash Supervisor to provide insight on Cash processes for internal or external customers

Kelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be placed as a Chemical Finished Product Operator or a Polymers Packaging/Warehousing/Shipping Operator on a long-term, indefinite assignment. You will be working with chemicals and should be comfortable doing such - either with previous experience or the willingness to learn. Job Description Able to handle more complex claims. Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology. Good working knowledge of claims and products, including the grievance and/or re-consideration process. Excellent knowledge of the various operations of the organization, products, and services. Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement. Researches and analyzes claims issues. Responds to inquiries, may involve customer/client contact. Must meet production and quality standards. Claims processing accuracy of 99% and above and the ability to process 120 or more claims per day. Proficient in claims adjudication and knowledge of Medicare. Qualifications EDUCATION/EXPERIENCE: Requires a HS diploma or equivalent; 2-5 years of claims processing experience; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalent background. Claims adjudication experience a must. Experience with Medicaid, Medicare and/or Medi-Cal claims highly preferred. Knowledge of contracts, CPT, HCPCs, ICD-9/10 and Medicare billing guidelines. High School diploma or any combination of education and experience, which would provide an equivalent background. SKILLS: Ability to effectively apply knowledge gained in training. Detail oriented. Good PC skills including MS Word and MS Excel. Good oral and written communication skills. Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials. Good time management skills. Maintains positive and cooperative working relationships with co-workers and other associates Additional Information All your information will be kept confidential according to EEO guidelines.

Job DescriptionDescription: Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Claims Examiner III to join our growing company with many internal opportunities. Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you'll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity. Align your career goals with Verda Healthcare, Inc. and we will support you all the way. Position Overview The Claims Examiner III performs advanced administrative, operational, and customer support duties that require independent initiative and sound judgment. This position is responsible for the analysis and adjudication of medical claims within a managed care environment. The role includes processing payment reconciliations and adjustments related to retroactive contract rates and fee schedule changes, as well as identifying root causes of claims payment errors and reporting them to management. The Claims Examiner III also manages provider inquiries and supports resolution efforts across departments. This position reports to: Claims Operations Manager. Responsibilities: · Analyze and adjudicate complex medical claims in compliance with CMS guidelines and health plan policies. · Review and apply appropriate fee schedules, contracts, and benefit plans. · Perform claim payment reconciliations and retroactive adjustments. · Identify patterns and root causes of payment discrepancies and escalate issues as needed. · Respond to provider inquiries and coordinate with internal teams for resolution. · Maintain documentation and track resolution outcomes. · Ensure compliance with regulatory, contractual, and internal policies. · Recommend process improvements based on claim trends and data analysis. · Support training initiatives for new staff and peers as subject matter experts. Requirements: Minimum Qualifications · High school diploma or GED required. Associate or bachelor's degree preferred. · Minimum of 3-5 years of experience in claims processing and adjudication, preferably within Medicare Advantage or managed care settings. · Knowledge of CPT, HCPCS, ICD-10 coding, and CMS regulations. · Strong analytical and problem-solving skills. · Proficient in claims systems (e.g., Plexis, Facets) and Microsoft Office tools. · Ability to handle confidential information in compliance with HIPAA. Professional Competencies · Strong attention to detail and accuracy · Excellent verbal and written communication · Customer service-oriented with a collaborative mindset · Ability to work independently and prioritize tasks · Commitment to continuous learning and quality improvement Verda cares deeply about the future, growth, and well-being of its employees. Join our team today! Job Type: Full-time Benefits: 401(k) Paid time off (vacation, holiday, sick leave) Health insurance Dental Insurance Vision insurance Life insurance Schedule: Full-time onsite (100% in-office) Hours of operations: 9am - 6pm Standard business hours Monday to Friday/weekends as needed Occasional travel may be required for meetings and training sessions. Ability to commute/relocate: Reliably commute or planning to relocate before starting work (Required) PHYSICAL DEMANDS Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds. * Other duties may be assigned in support of departmental goals.

We are seeking a Claims Processor to join a well-established sales and marketing firm that represents an international partner and serves as the liaison between overseas operations and customers across North America. This role is ideal for someone with strong analytical skills, attention to detail, and the ability to manage claims processes while maintaining excellent communication with multiple stakeholders. Essential Duties and Responsibilities Process all product claims, reviewing and analyzing new claims for accuracy and disseminating them to the appropriate insurance carrier. Act as a liaison with intercompany parties, insurance adjusters, and customers to resolve product claims. Evaluate claims submitted to insurance companies to determine eligibility standards. Research and resolve issues within the scope of the job. Maintain communication between corporate and field offices to gather information for timely responses to legal documents and claim losses. Draft written and oral correspondence related to claims processing. Report exposures, pending claims, and litigations that may impact company assets or goals. Perform additional office duties as assigned by the immediate supervisor. Competencies Strong attention to detail, organization, and thoroughness. Familiarity with general merchandise manufacturing processes, product parts, and plumbing industry standards. Knowledge of commercial insurance and claims processing. Excellent research, analytical, and problem-solving skills. Professionalism, collaboration, and strong communication skills (oral and written). Proficiency in Microsoft Office (Outlook, Excel, Word, PowerPoint) and Adobe. Travel Requirements Up to 25% travel required for offsite product inspections. Education and Experience Associate degree in business or related field. Minimum of two years of relevant work experience and/or training, or equivalent combination of education and experience. Language Skills Ability to read, analyze, interpret, and respond to general business correspondence. This will be a full-time, Non-exempt position with a salary of $22.00/hour. Monday to Friday from 8:00am to 5:00pm. KPG123

The Senior Claims Specialist will report directly to the Director of Risk Management. Duties include overseeing and monitoring the timely response and proper handling of General Liability, Auto and Property claims on behalf of Superior Grocers. Moreover, attendance of Small Claims court matters will be ensured as required. Position will have the autonomy and authority to make settlement decisions within a pre-determined range. Responsible for timely feedback/response and providing necessary documentation to insurance company/TPA, defense counsel and corporate office staff as instructed. Display and communicate an understanding of insurance concepts, internal practices and procedures. DAILY JOB DUTIES: 1. Claim documentation * Respond timely to incoming claims and monitor ongoing open claim inventory 2. Claim investigation as needed * Telephone and on-site investigation * Employee and customer interviews * Referrals to outside vendors 3. Review and oversee new and existing customer related claims * Accident Reports and related support documentation must be completed timely, thoroughly and objectively, thereafter provided to TPA/defense counsel/necessary parties. * Assist with determination of liability and corresponding/appropriate defense tactics * Ensure the timely logging of all new claims (delegate to Claims Assistant if necessary) and timely reporting to our Insurance Carrier, with guidance by the Dir of Risk Management 4. Review, oversee and manage legacy customer claims continuously and ongoing * Utilize TPA website/database (if appl.) or internal tracking system to review the status and monitor claims being handled by outside adjusters. * Review and approve the status of any claim, any reserve changes, and maintain communication with the adjuster handling the claim. * Vice-Versa the adjuster can communicate with Senior Claims Specialist for added information a. Authority requests are presented to the Director of Risk Management b. Other Samples of requests from adjusters * Coordinate employee recorded statements * Coordinate internal/external investigations of incidents * Copy and analyze video tapes * Provide information on employees; current and terminated a. When a claim is sent to our Attorney, same duties as above apply b. Follow instructions communicated to pass on to defense attorney c. Defense attorney is assigned in coordination with the Director of Risk Management * Be prepared with monthly status report (when requested) concerning any significant changes on our position of liability or damages * Calendar deposition appearances as necessary * Calendar hearings as necessary * Calendar Mediation or settlement conferences WEEKLY JOB DUTIES: 1. Maintain customer claim files in order * Systematically inspect and maintain the claims database to ensure all reported claims are accurately logged, properly classified according to protocols, and fully accounted for * Ensure all supporting evidence, including video footage and investigation reports, is collected on new claims, promptly updated as information becomes available, and efficiently forwarded to the assigned insurance adjuster * Manage the open claims inventory through disciplined diary maintenance, conducting a weekly review of all active files and utilizing a 45- to 60-day diary system to monitor case progression and address pending issues 2. Store Inspections * Store visits will be done as instructed by the Director of Risk Management Inspect for adverse liability conditions and/or store operations a. Report to manager my findings and discuss a solution b. Report to manager if a sweep compliance is unacceptable 3. Porter Inspections * Meet with a Store and Safety personnel as instructed * Review porter inspections * Review porter schedules for each store * Provide porter training on using scanners, the purpose for a sweep, and the need to be diligent in doing their job and in using the scanner 4. Insurance Certificate Program * Assist to Maintain up to date our Insurance Certificate Program a. Insurance certificates from vendors and contractors as needed. b. Requests are made as needed c. New Vendor Application process 5. Insurance Needs * Handle any General Liability Auto, and Property insurance needs a. Add new vehicles as instructed b. Add new stores as instructed MONTHLY JOB DUTIES: 1. Claims * Generate monthly reports, regarding frequency and location of customer claims a. Analyze report; recommend preventative measures share with store management * Review monthly billing and present to Director of Risk Management timely a. Check figures, claims, etc. ensuring reimbursement is appropriate b. Perform monthly store inspections as needed QUARTERLY JOB DUTIES: 1. Claims * Quarter end reports (same as monthly) * Participate in quarterly claim reviews with TPA YEARLY JOB DUTIES: 1. Assist where necessary regarding General Liability, Auto, and Property Insurance renewal * Administrative duties only Job Requirements: Education: * Bachelor's degree in business is preferred * In addition, attend insurance seminars and insurance classes with emphasis in insurance concepts, including, premises liability and related tort applicable to the position. Experience: * At least 5 years work experience in the field if no bachelor's degree Knowledge: * Working knowledge of Excel and Word. Skills and Ability: * Excellent verbal and written communication skills * Ability to multi-task * Bilingual (Spanish and English) helpful, but not mandatory Wage: $90,000 - $100,000 annually [1] Cal. Civ. Code § 1798.100 et seq . [2] Código Cal. Civ. § 1798.100 et seq.

Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $19.38 - $29.09/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program. Job Description At Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto. That's where you come in. We're looking for an Arbitrator I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again. Do you have the skills we're looking for? Keep reading for more details! Benefits * We all have lives and responsibilities outside of work. We have an exceptional work/life balance at Cox, with accommodating work schedules and flexible time-off policies. * We show our appreciation for our talent with a competitive salary package and top-notch bonus & incentive plans. * How does a great healthcare benefits package from day one sound? Multiple options are available for individuals and families. One employee-only plan could be FREE, if you participate in our health screening program. * 10 days of free child or senior care through your complimentary Care.com membership. * Generous 401(k) retirement plans with up to 6% company match. * Employee discounts on hundreds of items, from cars to computers to continuing education. * Looking to grow your family? You'll have access to our inclusive parental leave policies, plus comprehensive fertility coverage and adoption assistance. * Want to volunteer in your community? We encourage that, and even offer paid hours for you to do so. * We all love our pets-whether they walk, crawl, fly, swim or slither-and we're happy to supply insurance for them as well. At Cox, we believe in being transparent - please click on this link (Cox Benefits Overview) to learn more about our amazing benefits. What You'll Do From your very first day on the job, you'll receive guidance and coaching so you can learn the ropes. You'll work with everyone from buyers to sellers to dealers in coordinating and validating customer returns and claims. With Guidance, responsibilities include: * Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines. * Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision-making. * Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases. * Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution. * Uses appropriate levels/limits of financial approval authority to resolve cases. * Evaluate claims by obtaining, comparing, evaluating, and validating various forms of information. * Prepares and facilitates communication for resolution via telephone, email, and in-person discussion. * Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold. * Monitors and maintains accurate files for each arbitration case, verifying the accuracy of all required documentation, including invoices and settlement agreements. * Engages with supervisor/manager to determine if escalation is required. * Performs other duties as assigned. Who You Are You've got a knack for negotiation. You're ethical, dependable, and trustworthy. You're eager to learn. You also have the following qualifications: Minimum * A high school diploma or GED and less than 2 years of related experience. * Accuracy and attention to detail. * Organizational and time management skills. * The ability to adapt in a fluid and changing environment. Preferred * 1+ years of automotive or body shop experience. * Claims adjuster experience. Cox is a great place to be, wouldn't you agree? Apply today! Drug Testing To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited. Benefits Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship. Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship.

Job Description Job Details: Seeking a Claims Specialist for our Orange County office. This role involves handling technical and administrative responsibilities related to managing assigned claim files and taking on a larger caseload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members. Responsibilities: Manage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement. Manage increasingly complex cases with larger financial exposure. Investigate and evaluate claim files, including complying with the standards of performance, interviewing members, reviewing medical records, corresponding with plaintiff attorneys, obtaining preliminary expert evaluation/opinions, and preparing interview summaries. Prepare case evaluation reports for publication and presentation to the CRC and CSC. Prepare case evaluation reports for discretionary authority on selected cases. Manage and participate in all litigation activity, including discovery plan, mediation, MSC, and negotiation under supervision, as necessary. Monitor arbitrations, including daily progress reports to the member and defense attorney with support. Prepare claim file resolution documentation. Timely update of the claims database. Document all important case developments under the chronology tab. Code the claims file and update as relevant information is available. Timely review and index documents to the On Base system. Education and/or Experience: Bachelor's degree from a four-year college or university. Relevant legal and/or medical education background or the equivalent. 5 years of medical malpractice claims management experience or 3 years of claims experience

Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $19.38 - $29.09/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program. Job Description At Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto. That's where you come in. We're looking for an Arbitrator I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again. Do you have the skills we're looking for? Keep reading for more details! Benefits We all have lives and responsibilities outside of work. We have an exceptional work/life balance at Cox, with accommodating work schedules and flexible time-off policies. We show our appreciation for our talent with a competitive salary package and top-notch bonus & incentive plans. How does a great healthcare benefits package from day one sound? Multiple options are available for individuals and families. One employee-only plan could be FREE, if you participate in our health screening program. 10 days of free child or senior care through your complimentary Care.com membership. Generous 401(k) retirement plans with up to 6% company match. Employee discounts on hundreds of items, from cars to computers to continuing education. Looking to grow your family? You'll have access to our inclusive parental leave policies, plus comprehensive fertility coverage and adoption assistance. Want to volunteer in your community? We encourage that, and even offer paid hours for you to do so. We all love our pets-whether they walk, crawl, fly, swim or slither-and we're happy to supply insurance for them as well. At Cox, we believe in being transparent - please click on this link (Cox Benefits Overview) to learn more about our amazing benefits. What You'll Do From your very first day on the job, you'll receive guidance and coaching so you can learn the ropes. You'll work with everyone from buyers to sellers to dealers in coordinating and validating customer returns and claims. With Guidance, responsibilities include: Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines. Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision-making. Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases. Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution. Uses appropriate levels/limits of financial approval authority to resolve cases. Evaluate claims by obtaining, comparing, evaluating, and validating various forms of information. Prepares and facilitates communication for resolution via telephone, email, and in-person discussion. Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold. Monitors and maintains accurate files for each arbitration case, verifying the accuracy of all required documentation, including invoices and settlement agreements. Engages with supervisor/manager to determine if escalation is required. Performs other duties as assigned. Who You Are You've got a knack for negotiation. You're ethical, dependable, and trustworthy. You're eager to learn. You also have the following qualifications: Minimum A high school diploma or GED and less than 2 years of related experience. Accuracy and attention to detail. Organizational and time management skills. The ability to adapt in a fluid and changing environment. Preferred 1+ years of automotive or body shop experience. Claims adjuster experience. Cox is a great place to be, wouldn't you agree? Apply today! Drug Testing To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited. Benefits Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship.

Role and Responsibilities will identify, prevent, and mitigate potential penalties as well as assistant the claims department: Input date entry on all new claims Provide indemnity payment and cycles. Identify, prevent, and mitigate potential case penalties. Deliver 3-point contact ( Medical Only &/ or Indemnity files) to verify the mechanics of the injury, compensability, and discharge. - Calculate and pay mileage benefits. Verify lost time and waiting periods. Perform maintenance of current legal claims Identify issues requiring conversion to Indemnity to include supporting documentation. Input basic notes relating to claim, status and treatment. Process medical/legal bills daily to avoid penalty and interest. Return phone calls on a timely manner. Input status letters, delay letters, or any other required initial letters. Comply to subpoenas Interaction with nurse on case management regarding return to work status. New hires protocol Background checks Coordinating PPE supplies request. Assist safety team on identifying injury trends. Performs other related duties as assigned

Job Description Property Damage Claims Specialist Elite Sourcing is seeking an experienced Property Damage Claim Specialist to join a well-known Law Firm in Costa Mesa, CA. You will be responsible for investigating and evaluating property damage claims arising from automobile accidents, working closely with the demands team and clients to ensure fair compensation for damages. Responsibilities: Investigate property damage claims involving auto accidents, including reviewing police reports, witness statements, and damage assessments Evaluate claims and determine fair and reasonable settlements, considering policy coverage, damages, and other relevant factors Maintain accurate and detailed records of claims, investigations, and settlements Communicate effectively with customers, agents, and other stakeholders throughout the claims process Stay up-to-date with industry developments, regulations, and best practices to ensure compliance and minimize risk Collaborate with other adjusters, supervisors, and support staff to resolve complex claims and ensure efficient claims handling Requirements: 1+ years of experience as an auto claims adjuster or in CA personal injury law (preferred) Bilingual in Spanish (preferred) Strong understanding of CA insurance laws and regulations Ability to work in large teams and be computer savvy. Experienced with Microsoft Office Suite Excellent time management, communication, organizational, and analytical skills Experienced working in a paperless environment. Must be able to type at least 40 wpm Pay/Benefits: $50K-$70K DOE Medical, Dental, Vision 401K PTO

Every person deserves compassion, dignity, and the safety of a place to call home.” Homelessness is the largest social and public health crisis in California. Illumination health + home is a growing non-profit organization dedicated towards disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services and children's and family programs. IF currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County and the Inland Empire. Job Description The role of a Billing Claims Specialist involves overseeing the billing process for customers or patients, processing payments, maintaining financial records, and ensuring accurate billing and claims submissions. In addition, the Claims specialist is also responsible for keeping account receivables for CalAIM current, claim follow-up and escalation, and must have knowledge of billing codes and standard procedures. The pay rate for this role is $25-$27 per hour. The schedule for this role is a hybrid schedule with Monday/Thursday in office and Tuesday/Wednesday/Friday WFH. Responsibilities: CalAIM Billing and Follow up Reviewing data and creating Claims for services rendered Ensure claims meet the standards of our contracts and programs. Verifying authorizations via provider portals or authorization letters on Kipu prior to claim submission. Verifying eligibility prior to claim submission via provider or DHCS portals Review client records to extract applicable data necessary for billing purposes, including but limited to ICD 10 Diagnosis codes, CPT codes for services rendered etc. Review and follow up on outstanding account receivables Review any rejected or denied claims and conduct proper follow up procedures (Escalations/Appeals/Claim corrections) Monitor and maintain county aging and escalating trends, write offs, etc. Have knowledge in understanding, reading EOB's and Remittance Advice Posting payment accurately to claims and continuing with the claim close out process Assist supervisors in any projects related to billing that may come up Attend monthly team meetings or trainings at Corporate location Expectations: Communicate with tact and professionalism Be able to meet targets and work under pressure with a high volume of claims Maintain knowledge of industry standard CMS guidelines for Billing Must be motivated to work independently as well as in a group setting. Minimum Qualifications/Preferred Experience: High School Diploma or equivalent. 1-2 years' relevant experience. Basic computer skills, including the ability to send and receive emails and summarize data in spreadsheets. Prior experience work in Electronic Billing Platforms and EHR systems Prior experience working with claims and communication with health networks Proficiency in Microsoft (Mail, Word, Excel, Calendar). Associate's degree or higher Medical Billing Certificate Experience in Medical Billing and Primary Care Billing Benefits Medical Insurance funded up to 91% by Illumination Health + Home (Kaiser and Blue Shield), depending on the plan Dental and Vision Insurance Life, AD&D and LTD Insurance funded 100% by Illumination Health + Home Employee Assistance Program Professional Development Reimbursement 401K with Company Matching 10 days vacation PTO/year 6 days of sick pay/year Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans

Reports to: Claims Supervisor Employment Status: Full-Time FLSA Status: Non-Exempt We are searching for a diligent Claims Specialist to ensure the timely and accurate collection of medical claims. The specialist will work closely with insurance companies to rectify payment denials, settle disputes, and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims. Duties/Responsibilities: · Reviews and works on unpaid claims, identifying and rectifying billing issues. · Communicates with insurance companies regarding any discrepancy in payments if necessary. · Conducts research and appeals denied claims timely. · Reviews Explanation of Benefits (EOBs) to determine denials or partial payment reasons. · Provides detailed notes on actions taken and next steps for unpaid claims. · Collaborates with the billing team to ensure accurate claim submission. · Maintains a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements. · Resubmits claims with necessary corrections or supporting documentation when needed. · Tracks and documents trends related to denials and work towards a resolution with the billing team. · Assists patients with inquiries related to their insurance claims, providing clear and accurate information. · All other duties as assigned. Required Skills/Abilities: · Proficiency in healthcare billing software. · Strong analytical, organizational, and multitasking skills. · Excellent verbal and written communication abilities. · Ability to navigate payer websites and use online resources to resolve outstanding claims. Education and Experience: · High school diploma or equivalent required. · Experience in medical billing collections or a similar role in a Behavioral Health industry specializing in Substance Abuse and Mental Health is strongly preferred. · Knowledge of medical terminology, CPT and ICD-10 coding is a plus. · Knowledge of HIPAA and other healthcare industry regulations. Benefits · Health Insurance · Vision Insurance · Dental Insurance · 401(k) plan with matching contributions View all jobs at this company

The Role We are seeking an experienced Claims Specialist - Liability & Damages to join our Pre-Litigation team in Costa Mesa, CA. This role is ideal for candidates with a background in insurance claims or personal injury who excel at evaluating liability, coverage, and damages. You will play a critical part in investigating claims, determining case value, and supporting negotiations that drive successful outcomes for our clients. Closing Statement We're excited to grow our team and are handling all hiring in-house. To be considered for this position, please apply directly through Indeed, LinkedIn, or our official company website. All updates, contact, or communication should come straight from our internal recruiting team. What You Will Do Investigate and evaluate liability and damages on personal injury claims Review police reports, witness statements, and client testimony to establish liability Analyze medical records and bills to assess injury-related damages Work closely with attorneys to prepare case strategy and determine claim value Support negotiations with insurance carriers to reach fair settlements Maintain accurate, detailed case documentation in a paperless environment Communicate with clients, providers, and carriers to ensure claims move efficiently Stay up to date on California insurance laws, coverage standards, and best practices Role may include other relevant duties as assigned. Required Qualifications: 2+ years of experience as an auto claims adjuster, bodily injury adjuster, or in California personal injury law Strong knowledge of insurance coverage, liability assessment, and damages evaluation Proficient in Microsoft Office Suite and case management systems Excellent time management, organizational, and analytical skills Strong written and verbal communication skills Must be able to type at least 40 WPM Comfortable working in large teams and fast-paced environments Preferred Qualifications: Bilingual in Spanish or Korean Experience negotiating settlements with insurance carriers Background in pre-litigation claims or personal injury law firm environment Familiarity with reviewing and summarizing medical records Experience using Filevine, Clio, Litify, or other legal case management systems

Schedule: Full-time | Monday-Friday, 8:00 a.m. - 5:00 p.m. Compensation: Starting $25.00/hour plus quarterly incentives About Us At TCI, we're committed to delivering outstanding logistics solutions with integrity, teamwork, and innovation. We're seeking a detail-oriented and motivated Claims Specialist to join our team. This is a great opportunity to work in a fast-paced environment where your organizational skills and problem-solving abilities will make a real impact. Position Overview: The Claims Specialist is responsible for investigating, evaluating, and resolving claims involving auto, bodily injury, property damage, freight, and subrogation. This role requires direct interaction with claimants, insurance carriers, attorneys, vendors, and internal stakeholders to ensure claims are handled efficiently, fairly, and in compliance with company policies. The claims specialist plays a key role in controlling costs while delivering responsive, customer-focused claims service. What You'll Do Investigate and evaluate claims by reviewing incident reports, inspecting damages, interviewing involved parties, and gathering supporting documentation. Determine liability and damages by assessing coverage, establishing responsibility, and calculating fair settlements for auto, property, bodily injury, and freight claims. Negotiate and resolve claims with claimants, attorneys, and carriers to reach fair and timely settlements. Communicate with stakeholders, including insurance carriers, internal departments, and external partners, throughout the claims process. Manage claim files by documenting all activities, maintaining detailed notes, and ensuring compliance with company requirements. Work with the team to approve repairs, determine fair market value, and manage asset salvage, disposal, or sale decisions. Respond to inquiries from claimants, vendors, and internal teams, providing updates and follow-up information. Prepare reports on claim activity, outcomes, and trends for management review. Support continuous improvement by identifying opportunities to improve claims handling processes and outcomes. What We're Looking For Strong administrative, organizational, and customer service skills. Excellent written and verbal communication. Ability to thrive in a fast-paced environment with accuracy and attention to detail. A team-oriented, flexible, and solution-driven mindset. High level of confidentiality and professional ethics. Preferred Skills & Experience Proficiency in Microsoft Excel, Word, Teams, Adobe, DocuSign, and Outlook Prior experience in transportation, logistics, or insurance claims adjusting Familiarity with freight and subrogation claim processes Why Join Us? Be part of a dedicated, supportive team in a growing company. Contribute directly to resolving claims and improving processes. Work in a culture that values innovation, accountability, and teamwork. Compensation: Starting at $25/Hourly plus quarterly incentives About Us: We are a family-owned company doing business since 1978. We are dedicated and committed to safety, each other, and our customers. Our team is positive and passionate and come to work each day with a "Can Do" attitude. We strive to be creative problem solvers who bring innovative thinking in all our work. Being ethical, transparent, and accountable has helped shape our team and how we do business. We are looking for more people that match our core values to join our team.