Claim processor jobs in Clovis, CA - 403 jobs

A leading technology firm in San Francisco is looking for a Senior Product Marketing Manager to lead the marketing of insurance products. The ideal candidate will have 5-7 years of B2B SaaS experience, strong storytelling abilities, and be able to translate complex product functionalities into compelling narratives. The role entails collaboration across various teams and requires a deep understanding of customer challenges. Competitive salary and equity are offered along with comprehensive benefits. #J-18808-Ljbffr

The WESTERN MUTUAL INSURANCE GROUP has been providing excellent customer service to homeowners throughout the Southwestern United States for over 80 years. We are rated A (Excellent) by A.M.Best Company and have been named among the Top 50 Property Casualty Insurers in the country by Ward's. Our constant endeavor in employee relations is to maintain a well-trained, enthusiastic and efficient group of employees who work together to make our business successful, thus enhancing the career goals of every employee. We have an immediate opening for a Senior Liability Claim Representative. We're looking for a professional, experienced, self-motivated individual to join our team in our Irvine, CA office. The Sr. Liability Claim Representative will be responsible for effectively investigating, evaluating, determining coverage, and settling liability claims from inception to close. Responsibilities and Requirements: 5 years' experience handling litigated liability claims Expert knowledge of property/casualty insurance coverages as well as the claim adjustment process and the ability to effectively explain it to insureds and other parties. Experience writing reservation of rights letters Understand and comply with company claim handling procedures as well as applicable department of insurance regulations In a professional and timely manner respond to inquiries and requests for assistance both verbally and in writing, from policyholders as well as departments of insurance; Experience handling subrogation claims Work closely with legal counsel on litigated files and attend mediations, arbitrations and/or trials when necessary Bachelor's Degree preferred Texas license preferred We offer a competitive salary and a full benefits package including a 401k Plan, Profit Sharing Plan and Bonus Plan. Please see our Privacy Notice For Job Applicants here:******************************************************************* NON SMOKING OFFICE

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims. This position is available for either remote or in office work. Minimum Requirements Three (3) years of claims management experience Bachelor's degree from an accredited college or university preferred. Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM. Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims. Duties and Responsibilities Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards. Prepare accurate and timely issuance of benefits notices and required reports within statutory limits. Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits. Ensure timely payment of benefits, bills and appropriate caseload and performance goals. Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data. Monitor, report, and assign claims for fraud potential and subrogation possibilities. Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws. Prepare and present claims summaries to clients during file reviews. Train and direct Claims Assistants to meet goals and deadlines. Review and approve priority payments and other documents from Claims Assistants. Performs other duties as assigned Knowledge, Skills, and Abilities Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions. Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits. Strong skills with use of general office administration technology, including Microsoft Office Suite and related software Excellent verbal and written communication skills Excellent interpersonal and conflict resolution skills Excellent organizational skills and attention to detail Excellent interpersonal, negotiation, and conflict resolution skills Strong analytical and problem-solving skills Ability to act with integrity, professionalism, and confidentiality, at all times The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. JT2 Integrated Resources provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

JOB TITLE: Senior Claims Examiner DEPARTMENT: Claims Services 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 public sectors, insurance companies, and captives. Our clients count on us to care for their needs when the unexpected happens. Our culture is derived from the people that create it. We are not different in what we do. We are different in how we do it. Our culture helps us collaborate, unite, and create a diverse workforce. Our people are at the core of our purpose, vision, mission, and values. We offer competitive compensation and a comprehensive benefits package: • 401k + employee match • Medical, dental, vision, life, and disability insurance • Paid Time Off (PTO) • Paid Holidays • Paid Sick leave • Professional development programs • Work-life quality and flexibility Visit us online at ****************** RESPONSIBILITIES • Executes client/Carl Warren strategies to achieve claims quality, customer service, and operational objectives. • Proactively work claims to ensure file quality meets Carl Warren & Company Claim Handling Guidelines and client requirements. • A high level of productivity measured according to the age and complexity of the assigned caseload. • Maintains a timely diary of claims. • Consistently achieves audit scores of 90% and above. • Focuses on providing the client with an outstanding work product. • Provides excellent customer service to internal and external customers. • Develops strategies for claims resolution with file notes reflecting clarity, focus, control/management, and momentum. • Identifies/utilizes vendors and effectively manages the vendors to achieve satisfactory results on both the expense and indemnity costs. • Up to 25% travel for field work and court appearances. QUALIFICATIONS • Four or more years handling auto and/or general liability claims for a standard auto and/or general liability insurance carrier • Two or more years' experience handling litigated claims with a well-developed understanding of the litigation process • College degree preferred • Strong claim evaluation skills with the ability to identify the issues involved, formulate an action plan, assess liability, evaluate the damages involved, and put a settlement number on the claim and explain why • Strong negotiation skills • Must be able to function and support others in a team environment • High level of personal responsibility and pride in work product

We understand that the world we want tomorrow starts with how we do business today, and that's why we're inspired to make A Better World for Pets. Antech is comprised of a diverse team of individuals who are committed to each other's growth and development. Our culture is centered on our guiding philosophy, The Five Principles: Quality, Responsibility, Mutuality, Efficiency and Freedom. Today Antech is driving the future of pet health as part of Mars Science & Diagnostics, a family-owned company focused on veterinary care. Current Associates will need to apply through the internal career site. Please log into Workday and click on Menu or View All Apps, select the Jobs Hub app, then click the magnifying glass to Browse Jobs. **Work Shift:** **11pm-7:30am Monday - Friday and rotating Saturday 10pm-6:30am** **The Target Pay for this position is $20.24 an hour. At Antech, pay decisions are determined using factors such as relevant job-related skills, experience, education, training and budget.** **Job Purpose/Overview** Specimen Processors are responsible for receiving, preparing, and processing most samples that come into the department. **Essential Duties and Responsibilities** _To perform this job successfully, an individual must be able to satisfactorily perform each essential function. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions_ + Receives and prepares samples for laboratory analyses. + Accurately process standard requisitions per approved procedures at expected rates. + Removes specimens from transport bags, enter patient data, label samples and aliquot as needed for multiple testing + Keep inventory of samples after testing has been completed by scanning into storage racks. Search lab for any samples not scanned into storage racks. + Sort samples for distribution throughout the lab (Coggins, cytology, etc.). + Scan tubes into storage racks and enter specimen data into database to verify the accuracy of information + Accession various sample types for processing + Check all trash containers within the Specimen Processing department when assigned + Assists other lab personnel with specimen storage + Ensure Turn Around Times (TAT's) are met + Follows applicable Standard Operating Procedures (SOP's), including safety and quality procedures. Maintains clean and organized work area. Restocks supplies as needed + Consult with senior peers on non-complex specimen processing tasks to learn through experience. + All other duties as assigned We share a collaborative obligation to ensure that we conduct ourselves in the utmost ethical manner and that we hold each other accountable to the values and standards of the organization. Every Associate is responsible for asking questions, seeking guidance, and reporting concerns and/or violations of company policy or ethical standards. Antech Diagnostics has several processes in place to communicate with leadership and expects that Associates will have a commitment to integrity and uncompromising values. **Education and Experience** + High school diploma or equivalent required, with science related classes + 0-1 years related work experience preferred **Knowledge, Skills, and Abilities** + Attention to detail and organized with the ability to multi-task in a fast-paced environment + Reasoning and analytical skills to resolve issues + Communication skills, both verbal and written + Proficiency in the English language which allows for participation in team meetings, accurate entry of data into company systems and understanding of written directions + Attention to detail and organized with ability to multi-task in a fast-paced environment + Positive, can-do attitude + Data Entry skills + Personal computer skills, including strong typing ability and proficient use of Microsoft Office **Working Conditions** + Stationary Position- must be able to remain in a stationary position for up to 2 hours. + Constantly operates a computer and other lab equipment accurately and efficiently. + Occasionally required to bend, kneel, stoop, or crouch + Required to lift, move, and carry up to 50 lbs. + Extended hours may be needed + Laboratory environments with potential biohazards present that are mitigated by the mandatory use of PPE + Work under close to moderate supervision. + Potential for exposure to agents known to cause zoonotic disease in humans and use of potentially hazardous chemicals as defined by the National Hazard Communication Standards. A complete list of such chemicals is available from department supervision. **About Antech** Antech is a leader in veterinary diagnostics, driven by our passion for innovation that delivers better animal health outcomes. Our products and services span 90+ reference laboratories around the globe; in-house diagnostic laboratory instruments and consumables, including rapid assay diagnostic products and digital cytology services; local and cloud-based data services; practice information management software and related software and support; veterinary imaging and technology; veterinary professional education and training; and board-certified specialist support services. **Benefits** Antech offers an industry competitive benefits package and continues to invest in and evolve benefits programs that meet the health, wellness and financial needs of our associates. _Benefits eligiblity is based on employment status._ + Paid Time Off & Holidays + Medical, Dental, Vision (Multiple Plans Available) + Basic Life (Company Paid) & Supplemental Life + Short and Long Term Disability (Company Paid) + Flexible Spending Accounts/Health Savings Accounts + Paid Parental Leave + 401(k) with company match + Tuition/Continuing Education Reimbursement + Life Assistance Program + Pet Care Discounts **Commitment to Equal Employer Opportunities** We are proud to be an Equal Opportunity Employer - Veterans / Disabled. For a complete EEO statement, please see our Career page at Antech Careers (************************************************************** . **Note to Search Firms/Agencies** Antech Diagnostics, Inc. and its subsidiaries and affiliates (Antech) do not compensate search firms for unsolicited assistance unless they have a written search agreement with Antech and the requisition is position-specific. Any resumes, curriculum vitae, and other unsolicited assistance from search firms that do not have a written search agreement or position-specific requisition submitted to any Associate of Antech will be deemed the sole property of Antech and no fee will be paid in the event the candidate is hired by Antech.

About the Company For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss. About the Role The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports. This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role. Key Responsibilities Case Management & Communication Receive, review, and manage assigned cases from start to completion. Communicate professionally with clients, claimants, witnesses, and other involved parties. Provide timely case updates and correspondence in accordance with company guidelines via CaseLink. Maintain objectivity and professionalism in all interactions. Investigative Field Work Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings. Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires. Perform scene and neighborhood canvasses, including walking on varied terrain. Meet with treating physicians and medical offices as required. Travel to designated locations, including overnight stays when necessary. Respond to rush cases within business hours when required. Documentation & Reporting Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis. Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired. Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements. Prepare and submit comprehensive investigative reports within 72 hours of final update submission. Evidence & Records Handling Retrieve records from agencies and entities both in-person and remotely. Take clear photographs and video when necessary and label all electronic files accurately. Securely collect, store, and maintain custody of evidence when required. Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure. Additional Responsibilities Identify and recommend additional investigative services outside the scope of the original assignment when appropriate. Work overtime as needed to meet case demands and deadlines. Maintain an efficient, safe, and organized telecommuter workspace. Physical & Work Environment Requirements Ability to sit for extended periods performing computer-based work and report writing. Ability to stand for extended periods while conducting interviews and canvasses. Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment). Ability to operate digital audio recording equipment. Qualifications Experience with workers' compensation claims and investigative processes. Strong written and verbal communication skills. Ability to work independently, manage time effectively, and meet strict deadlines. Willingness and ability to travel up to (but not limited to) 150 miles per assignment. Possession of a personal credit card with available balance for reimbursable business expenses. Proficiency with case management systems; CaseLink experience preferred. Access to a personal scanner for document upload and record handling. Preferred Qualifications Prior experience conducting recorded statements and field investigations. Experience with process service assignments. Familiarity with evidence handling and documentation standards. Background in insurance investigations or a related field.

At the direction of the Claims Supervisor, Claims Manager, investigates, evaluates, disposes and settles moderately complex to complex/high exposure claims. Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves. You will be working with the Alternative Dispute Resolution Program (ADR) which encompasses mostly City of Fresno Police Officers. However, you will also be working with other employees of the Fresno Police Department. This position requires considerable interaction with the City of Fresno, claimants, providers, claims examiners, ADR ombudsperson and other Tristar staff. Therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position. DUTIES AND RESPONSIBILITIES: Processes moderately complex to complex or high exposure claims consistent with clients' and corporate policies, procedures and “Best Practices” and in accordance with any statutory, regulatory and ethics requirements. Independently analyzes claim exposure, determines a proper plan of action to appropriately mitigate and settle/close the claim working within established level of authority. Interacts with injured workers, client contacts and attending Physician(s) to ensure awareness and understanding of the Workers' Compensation process, requirements and entitlements. Interacts with disability and leave examiners' for coordination of non occupational benefits. Prepares and issues notices in accordance with mandated requirements and regularly reviews and stays abreast of applicable laws, rules and regulations that may impact how claims are processed. Establishes and maintains proper reserving throughout the life of the claim. Identify subrogation potential and pursue the process for reimbursement. Complies with carrier excess reporting and threshold requirements. Coordinates medical treatment for injured workers and provides information to treating physician(s) regarding the employee's medical history, health issues and job requirements. Fully understands Medicare reporting requirements as they relate to a Workers' Compensation claim. Facilitates early RTW through temporary, transitional, alternate, or modified work. Manages all medical aspects of a claim file with a focus on RTW and end of treatment. Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, conditional payments, etc. up to assigned authority. Monitors status and quality of work performed. Serves as a liaison between medical providers, employees, legal professionals, clients and vendors. Independently manages claims in litigation with regular and consistent communication with defense counsel to make recommendations and develop strategy. Enters and maintains accurate information in the claims management computer system. Clearly communicates concise action plans and present plans for moving the claim to resolution. Meets with clients to discuss on-going claims or review open claim inventory. Effectively controls expenses on all Workers' Compensation claims. Mentors first level WC Examiners. All other duties as assigned. EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire. Qualifications QUALIFICATIONS REQUIRED: Education: High School Diploma or GED required: Bachelor's degree in related field (strongly preferred) or equivalent combination of education and experience. Experience: Three (3) to five (5) years of Workers' Compensation Claims administration experience required working with self-insured and/or insured claims. Preferred Skills: Demonstrated experience working with complex, high exposure and litigated WC claims. Appropriately licensed and/or certified in all States in which claims are being handled. Multi-Jurisdiction experience is a (+). Bilingual Spanish is a (+) Able to work in a fast paced, high stress, changing environment. Strong analytical, critical thinking and problem solving skills required. Effective verbal and written communication skills required. Excellent planning, organizing and negotiation skills required. Attention to detail. Negotiation and interpretive skills necessary. Demonstrated knowledge of established claims strategy and mitigation techniques. Establishes and maintains effective working relationships with those contacted in the course of work. Proficiency with computers and technology - working knowledge of Microsoft Office application suite (MS Word, Excel, etc. and familiarity and experience using standard claims administration applications. Good interpersonal skills with an ability to work within a team environment. Able to effectively handle multiple priorities simultaneously. Works independently.

DETAILS Claims Supervisor Department: Workers' Compensation Reports To: Division Claims Manager FLSA Status: Exempt Job Grade: 14 Career Ladder: Next step in progression could include Division Claims Manager 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 a Claims Supervisor to support our California Workers Compensation department. Ideal candidates will reside in the Central Valley of California, however, management that lives less than 36 miles from the Concord or Orange, CA office AND have a direct report in the office, are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. Employee work a 37.5-hour work week with the ability to work a flex schedule with every third Monday or Friday off. As a Claims Supervisor, you'll play a pivotal role in leading and collaborating with Athens management to achieve exciting company goals, run insightful reports, and streamline processes. You'll make impactful daily claims decisions, review files for accuracy, and approve payments that exceed examiner authority. Additionally, you'll ensure top-notch file handling, accurate claims coding, and meet unit closing goals. You'll be the guiding force for your team, planning, organizing, delegating workloads, supervising daily activities, providing training, and offering valuable guidance. In client management, you'll address policy and claims issues, build and maintain strong relationships, attend key meetings, ensure compliance with client instructions, and document interactions, always acting in the client's best interest. Join us and make a difference every day! 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: Claims Leadership Work with Athens management to achieve company initiatives and performance goals Consistently strive to improve and streamline current processes Authorize release of payment and settlement Make daily claims decisions regarding plan of action, handling of payment, etc. Review claim files for accuracy Run various reports with an eye for accuracy and confidentiality Approve payments and reserve increases when they rise above Examiner's authority level Work collaboratively with internal and clients' senior management as well as with attorneys to draft settlements and assist with litigation strategies Provide timely information to clients, attorneys, doctors, investigators and injured workers with strong, professional communication Discuss appropriateness of medical treatment with medical case manager Assure consistent and accurate claims coding is occurring on the team Ensure quality file handling and resolution. This includes meeting unit closing goals, verifying proper reserves, providing thorough claims analysis and guiding to correct resolution Use flexibility when working in demanding and changing situations Employee Management Effectively plan, organize and delegate workload for optimal results and to ensure time commitments are met Supervise daily activities of the team by monitoring progress, ensuring compliance with policies, and promptly addressing any issues or conflicts Identify, coordinate, coach, and perform training with staff to improve performance and increase their growth and knowledge in claims Participate in the interview process, onboarding and training of new hires Provide general guidance to the team by offering support and advice on work-related issues, fostering a positive work environment, encouraging professional development, and reviewing performance through evaluations, feedback, goal setting, and identifying areas for improvement Provide direct feedback and use sound coaching techniques to solve disciplinary or workflow problems. Manage and document employee relations issues at all levels. Work in conjunction with Human Resources to ensure performance issues are managed in a timely and consistent manner Regularly lead organized and collaborative staff unit meetings, including both remote and on-site employees Maintain an open-door policy and an approachable attitude, and foster open communication with staff Client Management Work with clients with issues regarding policies, programs and/or claims Manage existing client relationships by being accessible, making regular service calls, and proactively identifying and solving potential problems Attend client meetings, internal meetings, and workers' compensation meetings both virtual and in-person Ensure notepads and diaries are set and completed timely in accordance with client handling instructions and Athens Best Practices and have meaningful action plans and information and are concise and well-written Obtain audit results meets or exceeds best practice standards of Athens and client Display integrity and always acts in the best interest of the client Document client meeting notes in appropriate shared location Supervisory Responsibilities Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisory positions. Provide direct supervision for 6-10 employees, typically consisting of Senior Claims Examiners, Future Medical Claims Examiners, Claims Examiners, Assistant Claims Examiners and Assistant Claims Examiner Trainees. Attend on-site Leadership Summit at Athens Concord headquarters every 18 months (including overnight) Fiscal Responsibilities Review and approve direct report's monthly expense reports Ensure that all expenditures are in the best interest of the Company Use effective monitoring and reporting mechanisms to control expenses without lowering quality Search for and implement hidden cost improvements Obtain, maintain, and demonstrate an understanding of wage and hour laws as applicable for employees Ensure timely, accurate review and approval of timecards for your staff on payroll processing days. 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 Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) Administrators Certificate from Self-Insurance Plans. If not already obtained, the Administrators Certificate from Self-Insurance Plans will be required within one year of employment Completion of IEA or equivalent courses Solid and in-depth knowledge of workers' compensation laws, policies, and procedures 3+ years' recent workers compensation claims handling experience at a high level 5+ years' experience in a Workers' Comp claims lead or supervisor position preferred At least 2 years Claims Supervisory experience required Municipality/4850 experience preferred Proficiency in determining case value and negotiating settlements Prior Third-Party Administrator (TPA) experience preferred Understanding of medical and legal terminology Strong attention to detail and organizational skills and the ability to research and resolve problems and meet multiple deadlines and to plan and effectuate short- and long-range Company and department objectives. Proficiency at applying business and technical acumen by understanding how the business works and how technology supports business initiatives. Leverages technology for self and staff to improve efficiency. Partnering with team to ensure on time task completion; done through delegation and leading by example, executing tasks rather than just instructing them to execute tasks Handles stressful situations and deadline pressures well Must demonstrate accuracy and thoroughness in work product Effectively influences people to achieve unit and organizational objectives Must be flexible, adaptable, and positive. Exhibit passion and energy to ensure that all employees are respected and treated in a manner consistent with Athens Values. Able to plan, prioritize and organize claims workload for a unit Skilled at presenting in small and large group settings Ability to create reports as required, using the report writing tools available or creating custom documents. Skilled at developing and maintaining effective relationships with others (co-workers, customers, vendors, management, and other key stakeholders) to achieve organizational goals Embrace the leadership role and can be counted on to help senior management drive towards the desired results and to exceed goals successfully. Able to interpret information from multiple sources and draw logical conclusions; consults others based on analysis of data; able to think strategically and use data findings to consult others for improved business results. Negotiating skills Mathematical calculating skills Exercise independent judgment and analytic ability in solving complex and sensitive problems Highly developed verbal and written communication skills with strong attention to detail Computer processing skills, including the ability to leverage technology for self and staff to improve efficiency Proficient in Microsoft Office Suite Ability to type quickly, accurately and for prolonged periods Ability to learn additional computer programs ClaimsXpress program experience preferred but not required 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. Valid Driver's license and availability for travel including in office file reviews and meetings 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

The Claims Examiner is responsible for performing activities related to benefit analysis and system design, managing special projects, claim denials, and auto-adjudication applications, as it pertains to auditing and claims compliance. This includes oversight of all workflow, research, and documentation under limited supervision from Claims management. The incumbent identifies potential company risks, implements appropriate courses of action, and develops strategies to reduce adjudication errors. The role analyzes all relevant information to track and trend the outcomes of special projects, providing findings to the appropriate management. Skills HMO CLAIMS, Claim Denials, ezcap, Medicare Claims, CPT Codes, excel, Medicare Guidelines Top Skills Details HMO CLAIMS,Claim Denials,ezcap,Medicare Claims Additional Skills & Qualifications 2+ years working knowledge of claims processing and system configuration, preferably EZCap or like systems. Strong ability to collaborate with management and other project managers to define business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery results. Should exhibit a disciplined, process and data-driven approach and methodology. Knowledge of claims processing and regulatory agencies requirements preferred. Requires strong organizational, communication and written skills. Must be able to function with minimal supervision and be able to prioritize all work tasks. Demonstrated ability to conduct and interpret qualitative and quantitative analysis and problem-solving skills. Ability to work well with individuals in all levels of the organization; must be an effective team player. Demonstrated ability to exercise initiative, independent judgment and be a self-starter. Strong PC-based business software skills including MS Office suite (Access, Excel, PowerPoint, Word). Experience Level Intermediate Level #prioritywest Job Type & Location This is a Contract position based out of Canoga Park, CA 91304. Pay and Benefits The pay range for this position is $24.00 - $24.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully onsite position in Canoga Park,CA 91304. Application Deadline This position is anticipated to close on Feb 10, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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.

**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.

Company Details Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Client Segments: Small Business, Mid-Larger Businesses and Programs (Groups & Association Members). The company's distribution partners (agents & brokers) number 400 locations throughout the state. Preferred serves 11,000 policyholders and provides medical claims handling and claims management for policyholders as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company. Responsibilities The Associate Claims Examiner (ACE) utilizes general understanding of department's operation and objectives. They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation. The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player. This position requires particular attention to detail, and is often task-oriented. This position will require 120 hours of classroom training at Supervisor's direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification. Key functions include but are not limited to: Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods. Issue Benefit Notices as required with regards to the start, changing and ending of benefits. Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity. Transmit Second Report of Information (SROI) to the State of California as required. Gather and document information from medical providers on disability status of claimants. Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made. Refers cases as appropriate to management by setting an activity for review. Maintains professional client relationships. Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim. Coordinate and process void, stop pay, and reissue Indemnity payments. Offer and, if accepted, enroll claimants in our EFT program. Attend Examiner Certification training as directed by Supervisor. Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements. Assist technical and operations with other duties as needed and as time allows. Qualifications Bachelor degree from an accredited college or university preferred 2+ years of related administrative office work experience. Strong written and verbal communication skills, attention to detail and deadline structures. Ability to work both independently and collaboratively with all levels of staff. Proficient with MS Office software and PC applications and systems. Baccalaureate degree from an accredited college or university preferred Knowledge of workers' compensation principles and policies equivalent preferred. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $60,000-65,000 annually • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.

Don't miss this amazing opportunity with one of our best employers in Fresno! Exciting Opportunity for a Medical Biller / Claims Processor in Fresno, CA! We are seeking a skilled Medical Biller or Claims Processor to join one of our top employers in Fresno, CA. This full-time, on-site position runs Monday to Friday from 7:00 AM to 4:00 PM, offering competitive pay ranging from $18 to $20 per hour, depending on experience. Ideal Candidate: The perfect fit for this role has at least 3 years of experience in medical billing or claims processing-especially if that experience includes working with a third-party administrator (TPA) within an insurance company. Prior TPA exposure is highly preferred due to the nature of this employer's group benefit processing. Job Requirements: High School Diploma or GED required Minimum of 3 years of experience in a computerized medical billing or claims processing environment Key Responsibilities: Manage claims across multiple groups with accuracy and speed Process CMS-1500 and UB-04 claims Accurately handle high-dollar claims Work with JAA/BlueCard claims Interpret group SPD's and apply benefits appropriately Perform zero-dollar adjustments and review flagged claims Maintain accurate reporting and resolve issues via FOGBUGZ Use tools like the Anthem Blue Cross website for claims verification Batch and scan correspondence Track spreadsheets for special projects Maintain excellent email communication and confidentiality If you're detail-oriented, passionate about claims or billing, and thrive in a fast-paced environment, apply today and take the next step in your healthcare career! #INDHP

PENNYMAC Pennymac (NYSE: PFSI) is a specialty financial services firm with a comprehensive mortgage platform and integrated business focused on the production and servicing of U. S. mortgage loans and the management of investments related to the U. S. mortgage market. At Pennymac, our people are the foundation of our success and at the heart of our dynamic work culture. Together, we work towards a unified goal of helping millions of Americans achieve aspirations of homeownership through the complete mortgage journey. A Typical Day The Quality Assurance (QA) Claims Processor will perform QA reviews in accordance with established procedures and complying with investor requirements and federal and state regulations. As the QA Processor, you will be responsible for reviewing the default timeline to verify that reported actions occurred as required by the applicable investor and insurer servicing guidelines. The QA Claims Processor will: Reconcile servicing expenses/corporate advances as required by MI, investor, insurer and internal guidelines including: foreclosure fees and costs, eviction requirements, property inspections and preservation, HOAs, taxes, hazard insurance and expenses during the default process Ensure reviews are performed in a timely manner in accordance with established procedures and investor guidelines Maintain and update various databases to meet departmental and QA requirements Assist in identifying error trends noted during the QA evaluation Achieve key metrics associated with the process and meet departmental monthly goals Perform other related duties as required and assigned Demonstrate behaviors which are aligned with the organization's desired culture and values What You'll Bring Mortgage default-related experience preferred Demonstrated aptitude for data, reporting, data reconciliation desired Familiarity with FHA, VA, USDA, MI and GSE Insurer servicing guidelines Must have experience with auditing and/or filing claims for FHA, VA and/or USDA adhering to the Investor/Insurer's guidelines Must be highly proficient in Excel and Word Why You Should Join As one of the top mortgage lenders in the country, Pennymac has helped over 4 million lifetime homeowners achieve and sustain their aspirations of home. Our vision is to be the most trusted partner for home. Together, 4,000 Pennymac team members across the country are guided by our core values: to be Accountable, Reliable and Ethical in all that we do. Pennymac is committed to conducting a business that makes positive contributions and promotes long-term sustainable growth and to fostering an equitable and inclusive environment, where all employees and customers feel valued, respected and supported. Benefits That Bring It Home: Whether you're looking for flexible benefits for today, setting up short-term goals for tomorrow, or planning for long-term success and retirement, Pennymac's benefits have you covered. Some key benefits include: Comprehensive Medical, Dental, and Vision Paid Time Off Programs including vacation, holidays, illness, and parental leave Wellness Programs, Employee Recognition Programs, and onsite gyms and cafe style dining (select locations) Retirement benefits, life insurance, 401k match, and tuition reimbursement Philanthropy Programs including matching gifts, volunteer grants, charitable grants and corporate sponsorships To learn more about our benefits visit: ********************* page. link/benefits For residents with state required benefit information, additional information can be found at: ************ pennymac. com/additional-benefits-information Compensation: Individual salary may vary based on multiple factors including specific role, geographic location / market data, and skills and experience as defined below: Lower in range - Building skills and experience in the role Mid-range - Experience and skills align with proficiency in the role Higher in range - Experience and skills add value above typical requirements of the role Some roles may be eligible for performance-based compensation and/or stock-based incentives awarded to employees based on company and individual performance. Salary $39,000 - $55,000 Work Model OFFICE

Now Hiring: Impact Claims Negotiation Specialist - Inspire, Lead, and Transform! Are you a driven leader with a passion for empowering others and creating lasting impact? We are looking for ambitious individuals to join our team as Claims Negotiation Specialist, where you'll mentor, develop, and guide individuals toward financial success and leadership excellence. Who We're Looking For: ✅ Visionary entrepreneurs & business professionals ready to lead ✅ Mentors and coaches who thrive on helping others grow ✅ Licensed & aspiring Life & Health Insurance Agents (We'll guide you through licensing!) ✅ Individuals eager to inspire and drive meaningful success As a Claims Negotiation Specialist, you'll be at the forefront of mentoring, coaching, and leading high-potential individuals, helping them unlock new levels of success while also scaling your own leadership and financial growth. Is This You? ✔ Passionate about mentorship, leadership, and personal growth? ✔ A natural motivator who thrives on empowering others? ✔ Self-motivated, disciplined, and committed to success? ✔ Open to ongoing mentorship and leadership development? ✔ Looking for a recession-proof and scalable career opportunity? If you answered YES, keep reading! Why Become a Claims Negotiation Specialist? 🚀 Work from anywhere - Build a flexible, high-impact career. 💰 Uncapped earning potential - Part-time: $40,000-$60,000+/year | Full-time: $70,000-$150,000+++/year. 📈 No cold calling - Work with individuals who have already requested guidance. ❌ No sales quotas, no pressure, no pushy tactics. 🏆 Leadership & Ownership Opportunities - Build and scale your own team. 🎯 Daily pay & performance-based bonuses - Direct commissions from top carriers. 🎁 Incentives & rewards - Earn commissions starting at 80% (most carriers) + salary. 🏥 Health benefits available for qualified participants. This isn't just a job-it's an opportunity to create impact, lead with purpose, and build a lasting legacy. 👉 Apply today and take your first step as a Claims Negotiation Specialist! (Results may vary. Your success depends on effort, skill, and commitment to learning and execution.)

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities * Benefit interpretation and analysis of EOCs across multiple health plans * Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans * Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories * Analysis of authorization rules and Division of Financial Responsibility (DOFR) * Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators * Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation * Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution * Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary * Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) * Assist with maintenance of benefit requirements and configuration decisions and policies and procedures * Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems * Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems * Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance * Other duties as assigned Requirements * 5+ years of experience in benefits and claims in Managed Care, delegated model setting * Experience with benefit analysis and/or quality assurance * College degree in healthcare (preferred) or equivalent experience/knowledge * Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding * Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. * Experience with Epic Tapestry (preferred) * Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs * Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities * Knowledge of how benefit configuration relates to claims adjudication and payment processes. * Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. * Experience with testing, reviewing, and validating benefit plans * Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. * Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. * Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. * Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer

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 $19.90 - $29.81/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. No OPT, CPT, STEM/OPT or visa sponsorship now or in future.

What 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! Under the direction of the Covered California Claims (CCA) Manager, the CCA Claims Specialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The Claims Specialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Work effectively with other departments (i.e., Special Investigation Unit, Provider Payment Resolution team, and other departments/stakeholders) to investigate and identify fraud, respond to escalated provider inquiries timely, and support the claims process. Investigate and process complex and high-dollar claims determining accuracy and making timely decisions. Advise leadership and internal business units (as applicable) of findings and outcomes on identified claim issues. Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed in the Health Rules Processing system and other platforms. Research claims that may have been paid incorrectly and communicate findings for adjustment. Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts, etc.) ensuring that all relevant information is considered. Assist with internal and regulatory claim audits, reviewing claim accuracy. Identify trends and recommend improvements to IEHP's claim processing system. Analyze and investigate insurance claims to discover or prevent fraud. Be an active participant in the Claims Department's initiatives and participate in Claims Huddles, etc. Remain current with all claim processing changes/updates (i.e. internal processes, regulatory guidelines). Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred High school diploma or GED required Associate's degree from an accredited institution preferred Key Qualifications ICD-9/ ICD-10 and CPT coding and general practices of claims processing CMS/DMHC and Affordable Care Act regulations and guidelines Commercial line of business specifically Covered California/Exchange Excellent communication and interpersonal skills Excellent analytical, critical thinking, customer service, and organizational skills Ability to think critically with the capacity to work independently All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $25.90 - USD $33.02 /Hr.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.