Claim Processor Jobs in Cudahy, CA

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.

The Commercial Claims Examiner III reviews, evaluates and processes complex commercial insurance claims and makes recommendations for resolution. Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other records to determine insurance coverage, ensuring payment recommendations and settlements have been made correctly. PRINCIPAL DUTIES & RESPONSIBILITIES * Manage a caseload of commercial property claims from assignment through resolution. * Examine commercial claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims. * Review and adjust commercial loss reserves, correspondence, reports, verify coverage and authorize payments submitted by independent adjusters. * Collaborate with internal personnel and/or legal counsel on claims involving litigation. * Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims. * Oversee independent adjuster files to ensure they have followed CFP IA Guidelines. * Verify and analyze data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures. * Maintain compliance with the Department of Insurance and Company procedures. * Identify fraud or illegal activity indicators and follow internal processes to refer the claims to the appropriate personnel for follow up. * Promptly negotiates settlements ensuring the settlement reflects the insured losses while confirming the insurer is protected from invalid claims . ADDITIONAL DUTIES & RESPONSIBILITIES Commercial Claims Examiner III: The Commercial Claims Examiner III role will focus on Claims over $500,000 but may receive smaller claims as needed. KNOWLEDGE & SKILL REQUIREMENTS * Bachelor's degree or equivalent. * 5+ years of property claims adjusting experience, including 2+ years commercial property claims preferred. * Excellent oral and written communication skills. * Working experience with MS-Office (especially Word and Excel). * Comprehensive understanding of policy contract/statutes and claims processes. * Certified in CEA and Fair Claims Settlement Practices preferred. ADDITIONAL REQUIREMENTS (PRIOR EXPERIENCE) Commercial Claims Examiner III : 4 years Commercial Experience, 2 years claims over $500k Location Los Angeles, California (Remote) Minimum Experience Experienced Compensation $85,000-$95,000

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! Job Description Intro: Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you have claims adjudication or facility claims experience in healthcare? 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! Daily Responsibilities: Conducts claims payment analyses to identify root cause of claims issues/deficiencies. Adjudicates medical claims Verifies patient account, eligibility, benefits and authorizations. Prioritizes assigned claims according to regulatory timelines. Requests additional information for incomplete or unclean claims; follows up with provider as necessary. Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes. Corresponds with IPAs/Medical Groups regarding misdirected claims. Qualifications Requirements: 2-5 years medical claims examining experience, Minimum typing speed of 45 WPM and use of Ten-Key by touch Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements Additional Information If you are interested, PLEASE CONTACT Tyler AT 407-478-0332 EXT 117

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 The Claims Examiner III performs advanced administrative/operational/customer support duties that require independent initiative and judgement. This position is responsible for analyzing the adjudication of medical claims as it relates to managed care, performs payment reconciliations and/or adjustments related to retroactive contract rates and fee schedule changes, as well as identifies root causes of claims payment errors and reports to Management. This position is responsible for responding to provider inquiries/calls related to claims payments and collaborates with other departments and/or providers in successful resolution of claims related issues. Minimum Requirements 1. HS Diploma or GED required. 2. Minimum of 5 years of Claims Processing experience in a managed care environment required. 3. Must be knowledgeable of Medi-Cal regulations. 4. Ability to process both professional and institutional claims. Compensation $26.13 - $32.55 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.

To evaluate and determine the appropriate path and to assist in the expedited processing of all claims, special projects and escalated reconsiderations originating from various internal and external sources and to serve as the first level of telephonic and written response for such issues. Essential Duties and Responsibilities include the following: Maintain the workflow of all departmental projects. Provide reports and on-going updates to Claims management. Assist in the processing of claims, special projects and medical records from all sources. Oversees staff activities to maintain high level of productivity. Monitor claims related functions to ensure health plan and regulatory compliance. Participate with training determined by unit Supervisor regarding claims adjudication issues discovered in audit or through appeals. Perform audits of claims activities such as turnaround time for acknowledgement, forwarding of claims to correct payer, and processing timeframes. Provide primary support to the Supervisor of the Institutional unit including special projects. Recommend process improvements based on appeal tracking and trending reports. Support Claims management in other company functions such as Medical Review management. Handle and document resolution to escalated telephone and written claims. Implement and coordinate issue resolution processes. Liaison for department with outside providers and internal departments. Provide supervisory coverage for Claims unit as needed. All other duties as directed by management. The pay range for this position at commencement of employment is expected to be between $28 - $30 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors. As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success. Full Time Position Benefits: The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life. Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options. Health and Wellness: Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement: 401k Retirement Savings Plan Income Protection Insurance Other Benefits: Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance. Requirements Education and / or Experience: High School Diploma and 3 years adjudication experience in a managed care setting. Knowledge of CPT-4, HCPCS, Hospital Revenue, and ICD-9 coding. Knowledge of HMO, DHS, DMHC, and CMS claims processing guidelines. Strong knowledge of Microsoft Windows environment such as Word and Excel. Self-starter, willing to take on multiple tasks. Must meet minimal claims adjudication production standards. Strong knowledge of Coordination of Benefits (COB) applications. Must be able to interpret health plan benefits. Must be able to review, interpret and apply contract rates. Ability to communicate effectively orally and written typing 35 words per minute. Strong organizational skills with emphasis on prioritizing and attention to details

Founded in 1888, the Santa Ana Unified School District (SAUSD) is the second largest school district in Orange County serving approximately 36,000 students and the 2nd largest employer in Santa Ana, providing job opportunities to approximately 5,000 employees. SAUSD is comprised of 34 Elementary, 6 Intermediate, 4 Alternative Educational Options, 6 High Schools, 1 dependent charter, 1 child development center, 2 early childhood education programs and 1 Deaf and Hard of Hearing Regional Program K-6. SAUSD is committed to providing each of its students with a high-quality education, rigorous and advanced programs, and a nurturing, safe environment with state-of-the-art facilities, 21st century learning and technology, and a direct pathway to college upon graduation. Our district proudly boasts one of the highest graduation rates in the state of California. SANTA ANA UNIFIED SCHOOL DISTRICT CLAIMS EXAMINER BASIC FUNCTION: Under direction of the Director of Risk Management, receive and administer claims made against the District's self-insurance program, including workers' compensation claims, liability claims and property claims. Direct investigations, pursue subrogation opportunities, calculate and pay benefits, direct attorneys representing the District on litigated claims, pay appropriate amounts to medical providers and vendors, maintain a pro-active settlement program. DISTINGUISHING CHARACTERISTICS: Has highly developed written and oral communication skills in handling casualty and property claims. Possesses an in-depth knowledge of relevant law (including statutory, case, and regulatory law) and extensive medical knowledge. Works competently in the administration of a large number of litigated and complex claims. Proficiency in written and oral Spanish as well as English is highly desirable. REPRESENTATIVE DUTIES: Determine District's legal obligation to claimant. E Investigate questionable claims. E Defend against false and fraudulent claims. E Calculate and authorize payment of work comp benefits. E Select and mail appropriate benefit notices. E Adjust and authorize bills for payment. E Establish and maintain proper work flow. E Prepare reports, memos, and letters. E Identify safety hazards. E Maintain a file diary. E Perform related duties as required. CLAIMS EXAMINER: (Continued) KNOWLEDGE AND ABILITIES: KNOWLEDGE OF: Workers' compensation law and procedures. Liability and property law. Civil litigation procedures. Medical terminology and procedures as they relate to casualty claims. Computer claim software and word processing software. KNOWLEDGE AND ABILITIES (CONTINUED) ABILITY TO: Establish rapport and communicate articulately with others. Work with minimal supervision to solve problems and settle claims. Interpret and apply statutes, regulations, and case law. Understand and rate medical reports. Set realistic case reserves. Meet schedules and time lines. Operate computers, fax machines, and other office equipment. Take accident and injury reports. Perform the essential functions of the job. EDUCATION AND EXPERIENCE: Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases. WORKING CONDITIONS: ENVIRONMENT: Office environment with heavy phone traffic. Constant interruptions. PHYSICAL ABILITIES: Hearing and speaking to accurately exchange information in person or on the telephone. Seeing to read a variety of materials. Sitting for extended periods of time. Dexterity of hands and fingers to operate a computer keyboard. Bending at the waist, kneeling or crouching to file materials. Lifting or moving objects, normally not exceeding twenty (20) pounds. Accommodation may be made to enable a person with a disability to perform the essential functions of the job with or without reasonable accommodation. Board Approved: (8/99 5/01) 5/05 EDUCATION AND EXPERIENCE:Graduation from high school and two years' experience as a claims examiner adjusting lost time and litigated cases.Please complete the online EDJoin application and attach copies of the following documents:ResumeHigh School Diploma (Please scan a copy of High School Diploma and attach it to your application.) In lieu of the High School Diploma we will accept the following:Proof of BA Degree (Attach copy of degree or transcripts with degree posted) THE DOCUMENT SPECIFIED MUST BE ATTACHED IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED FOR EMPLOYMENT.We will NOT accept ANY faxed or e-mailed attachments.This position requires a valid High School Diploma or valid equivalency established by an accredited institution/agency within the United States. Applications that do not include a valid degree will not be considered. If you would like to receive credit for a foreign degree, you may submit your foreign degree to an approved education evaluation service. Any cost of evaluation is the candidate's responsibility. For your convenience, you may visit our website at ************ under the Human Resources link for a list of approved education evaluation services. The District provides this list only as information to prospective job candidates and makes no endorsement on any of the companies listed.

Description CookieYes sets this cookie to remember users' consent preferences so that their preferences are respected on subsequent visits to this site. It does not collect or store any personal information about the site visitors. Description Google Analytics sets this cookie to store and count page views. Description Google Analytics sets this cookie to calculate visitor, session and campaign data and track site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognise unique visitors. Description The \_omappvp cookie is set to distinguish new and returning users and is used in conjunction with \_omappvs cookie. Description Description YouTube sets this cookie via embedded YouTube videos and registers anonymous statistical data. Description Youtube sets this cookie to track the views of embedded videos on Youtube pages. Description YouTube sets this cookie to measure bandwidth, determining whether the user gets the new or old player interface. Description Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. Description YouTube sets this cookie to register a unique ID to store data on what videos from YouTube the user has seen. Description YouTube sets this cookie to register a unique ID to store data on what videos from YouTube the user has seen. Description Description is currently not available. **Claims Examiner** Job ID# 1008627 - Posted 2/24/2023 - Los Angeles, CA **Position Description** The Claims Examiner II is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes: Processing claims for all lines of business. Process all claims type as needed. Monitoring itemized billings for excessive charges, duplications. Ensuring that all work meets quality guidelines and is performed within acceptable time frames. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Meeting and exceeding performance measurements for Claim Examiners as required by the department to meet regulatory compliance. Assisting management with onsite training as needed. Assist Claims Examiner III as needed for special requests. **Skills Required** Ability to operate PC-based software programs or automated database management systems. Strong communication skills with excellent analytical and problem solving skills. Ability to self-manage in a fast-paced, detail-oriented environment. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge. Moderate knowledge of Microsoft Word and Excel. **Experience Required** At least 0-2 years of healthcare claims processing experience in a managed care environment. Previous Medi-Cal or Medicare claims processing experience and knowledge of AB1455 regulations **Education Required** High School Diploma **Education Preferred** Associate's Degree

Responsible for consistently and accurately adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy. Process claims according to all CMS and DMHC guidelines. Review, research and process complex claims. Handle recalculation of claims due to incorrect claim payments or where additional information has been received. Investigate and complete open or pended claims. Meet production and quality standards. Minimum Education: High school diploma or equivalent required. Minimum Experience: Three to five (3-5) years prior medical claims processing experience required. Knowledge of general claims processing principles, CMS claims coding, and UB-04 claims coding, based on at least three to five (3-5) years experience in claims processing preferably in a managed care environment (IPA,MSO) Req. Certification/Licensure: None. Enter claims information from CMS 1500 (professional) and UB-04 (facility) claims into the IDX claims system. Process all level of claims including Professional, COB, surgery, skilled nursing, lab, Home Health, ER, hospital (in and outpatient), DME, Pharmacy and radiology claims by applying Prospect's policy and procedures and all claim payment criteria. Analyze complex claim issues and handle all adjustments for corrected claims or when additional information previously requested is received. Identify and pend claims that require referrals to all support areas (eligibility, Medical management etc) for evaluation or correction of data, tracking these claims to ensure that they are returned and resolved within regulatory guidelines. Achieve stringent quality goals of 98% administrative accuracy and 99% financial accuracy to contribute to achieving client performance expectations. Achieve stringent productivity goals of 80/10 claims per day/hr. Initiate recovery of overpaid claims. Also any other duties as requested.

Our client, a large national insurance company, has an immediate need for a Property Claims Examiner to join the team in Anaheim, CA. This is a great opportunity to join a fast-growing organization with lots of growth potential. Responsibilities: Handle property Claims, involving damage to buildings and structures such as condo and HOA’s. Consult with accountants, architects, engineers to get expert evaluation. Participate in claims related audits and prepare reports related to claims. Qualifications: 1+ year experience in an insurance company regarding Commercial or Homeowner property claims. Bachelor degree or equivalent experience. Knowledge of Microsoft Office Suite as well as other business-related software. Compensation: Base salary up to 75k/year plus potential bonus. Medical, Dental, Vision, and 401k. Hybrid schedule after 3 months. **TO APPLY** Click Here for QUICK APPLY - Hassle Free & Easy #BPCINS321 #INDALL

] Claims Examiner for Insurance Industry. [About Our Client] One of the largest non-life insurance companies based in South Korea. We currently writes all lines of property and casualty insurance in CA, NY, OH, IN, PA, TX and HI State. Financial Ratings: - A.M. Best Rating: A+ (Superior) “Superior: A++ to A+ grade assigned to insurance companies that have superior ability to meet their financial obligations.” ? - S&P Rating: A+ (Stable) “The financial strength ratings reflect its very strong competitive position and lower adequate capital and earnings, excellent operating performance.” [Job Description] Handle Liability Claims, claims involving Commercial General Liability claims including Bodily Injury, Slip and Falls, Premise Liability and Auto Bodily Injury Liability, including litigation. Manage and supervise TPA adjusters and outside vendors who directly handle the case. Work proactively towards claims resolution with defense counsel Determine if coverage applies for claims reported Evaluate damages to ascertain compensation amount Respond to claims calls and e-mails from agents and claimants Negotiate claim settlements Participate in claims related audits Prepare detailed claim reports to management for additional authority or coverage issues with recommendation.? Effectively manage and control litigation and claim expenses [Qualifications] -Over 5 years experience in an insurance company with regard to Commercial auto liability claims or Commercial general liability claims. -Bachelor's degree or equivalent professional work experience. -Knowledge of Microsoft Office Suite as well as other business-related software. -Capability to build and maintain positive relationships through teamwork. [What's On Offer] We offer competitive salary plus benefit package that includes health, vision, and dental insurance with 401K. -Medical, Dental & Vision Insurance -401(K) -Paid Time Off Vacation -Paid Sick Days

Position Type: Full Time Requisition ID: 11823 **Salary Range:** $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. **Job Summary** The Claims Examiner is responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines, which includes: * Processing claims for all lines of business, including complex claims * Monitoring itemized billings for excessive charges, duplications, unbundling, and medical coding * Determining prior authorization/precertification of services paid via system and/or health services * Requesting and reviewing medical records as needed for basic information to validate billing information * Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. *Meeting and exceeding performance measurements for Claim Examiners as required by department to meet regulatory compliance. **Duties** Process incoming claims: Determine correct level of reimbursement based on established criteria, provider contract, participating provider group, health plan and regulatory provisions. Process all claims eligible or ineligible for payment accurately and conforming to quality, production standards and specifications in a timely manner. Document provider claims/billing forms to support payments/decisions. Negotiate reimbursement amounts for out-of-network claims. Identify dual coverage, Potential third party savings/recovery. Maintain department databases used for report production and tracking on-going work. Claims are processed within the contractual and/or regulatory time frames within or less than 45 working days and as supported by the departmental policies. (60%) Perform special projects and ad-hoc reporting as necessary. Projects are complete and reports are generated within the specific time frame agreed upon at the time of assignment. (15%) Assist management with in-house and on-site training as offered to employees, contracted partners and providers. (5%) Work with internal departments to resolve issues preventing claims processing or enhancing processing capabilities. May assist in testing, changing, analyzing and reporting of specific enhancements. (5%) Attend meetings as required. Claims Department/Operations Division is represented at internal and external meetings. (5%) Perform other duties as assigned. (10%) **Duties Continued** **Education Required** High School Diploma/or High School Equivalency Certificate **Education Preferred** **Experience** **Required:** At least 6 months of healthcare claims processing experience in a managed care environment. **Preferred:** Previous Medi-Cal and EDI claims processing experience a plus. **Skills** **Required:** Ability to operate PC-based software programs or automated database management systems. Strong communication skills with excellent analytical and problem-solving skills. Ability to self-manage in a fast-paced, detail-oriented environment. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge. Moderate knowledge of Microsoft Word and Excel. **Preferred:** Knowledge of State Department of Health Services regulations. **Licenses/Certifications Required** **Licenses/Certifications Preferred** **Required Training** **Physical Requirements** Light **Additional Information** **Salary Range Disclaimer:** The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. **L.A. Care offers a wide range of benefits including** * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) **Nearest Major Market:** Los Angeles **Job Segment:** Claims, Medical Coding, Insurance, Healthcare

Chubb is currently seeking a Workers' Compensation Lost Time Claim Examiner for our Los Angeles office. The successful applicant will be handling claims for CA jurisdiction. The position will report to and reside in our Los Angeles office. Duties & Responsibilities: * Handles all aspects of workers' compensation lost time claims from set-up to case closure, ensuring strong customer relations are maintained throughout the process. * Reviews claim and policy information to provide background for the investigation. * Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with the insured, claimant, and medical providers. * Evaluates the facts gathered through the investigation to determine the compensability of the claim. * Informs insureds, claimants, and attorneys of claim denials when applicable. * Prepares reports on investigation, settlements, denials of claims, evaluations of involved parties, etc. * Timely administration of statutory medical and indemnity benefits throughout the life of the claim. * Sets reserves within authority limits for medical, indemnity, and expenses and recommends reserve changes to Team Leader throughout the life of the claim. * Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them. * Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered. * Works with attorneys to manage hearings and litigation * Controls and directs vendors, nurse case managers, telephonic case managers, and rehabilitation managers on medical management and return-to-work initiatives. * Complies with customer service requests, including special claims handling procedures, file status notes, and claim reviews. * File workers' compensation forms and electronic data with states to ensure compliance with statutory regulations. * Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized. * Works with in-house Technical Assistants, Special Investigators, and nurses Consultants, telephonic case managers, and Team Supervisors to exceed customer's expectations for exceptional claims handling service. Technical Skills & Competencies: * Lost Time Claim Examiner position with prior experience in workers' compensation lost time adjusting or as a medical only examiner or similar examiner experience in short-term / long-term disability, auto personal injury protection, medical injury, general liability, or as a claim technical assistant for lost time claims. * Requires knowledge of workers' compensation statutes, regulations, and compliance. * Ability to incorporate data analytics and modeling into daily activities to expedite the fair and equitable resolution of claims and claim issues. * Exceptional customer service and focus. * Ability to openly collaborate with leadership and peers to accomplish goals. * Demonstrates a commitment to a career in claims. * Exceptional time management and multi-tasking capabilities with consistent follow-through to meet deadlines. * Use analytical skills to find mutually beneficial solutions to claims and customer issues. * Ability to prepare and make exceptional presentations to internal and external customers. * Conscientious about the quality and professionalism of work product and relationships with co-workers and clients. * Willing to take ownership and tackle obstacles to meet Chubb's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation. * Superior verbal and written communication skills. Experience, Education, & Requirements: * Experience working in a customer-focused, fast-paced, fluid environment * Experience utilizing strong communication and telephonic skills * Prior experience requiring a high level of organization, follow-up and accountability * Prior workers' compensation claim handling experience is a plus but not required * Familiarity with claim handling (healthcare, short-term / long-term disability, auto personal injury protection, medical injury, or general liability) is a plus but not required * Prior insurance, legal or corporate business experience is a plus but not required * AIC, RMA, or CPCU-completed coursework or designation(s) is a plus but not required * Proficiency with Microsoft Office Products * Knowledge of medical terminology is a plus but not required * Knowledge of bill processing is a plus but not required * Claim adjuster licenses in Connecticut, New Hampshire, Rhode Island, and Vermont are necessary; however, they are not required at the time of posting for the position. * If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure. * Proficiency with Microsoft Office Products The pay range for the role is $84,000 to $105,800. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

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 $17.69 - $26.54/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 Automotive Claims Specialist 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, 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.

Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, directs and implements claims training programs for the organization, to include adaptations to changes in policies, procedures and technologies. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: Bachelor's Degree or equivalent education/experience. 10 or more years HMO claims processing and/or auditing experience in a managed care environment, preferably PMG/IPA setting within the last 7 years or any combination of education and/or experience which produces an equivalency. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

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 The Claims Examiner II is responsible for analyzing and the adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. May 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 payment. Collaborates with other departments and/or providers in successful resolution of claims related issues. Minimum Requirements HS Diploma or GED Minimum of 3 years of Claims Processing experience in a managed care environment. Experience in reading and interpreting DOFRs and Contracts, required. Experience in reading CMS-1500 and UB-04 forms required. Compensation $26.13 - $32.55 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.

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! Company Job Description/Day to Day Duties: -Reports to the Director of Claims -Responsible for the accurate and timely adjudication of all claims in accordance with applicable contracts, state and federal regulations, health plan requirements -Examiners are expected to produce a minimum of 30 claims per hour. -Examiners are expected to maintain 98 percent coding and financial accuracy. -Examiners must meet timeliness requirements for the product line(s) they are responsible for processing. This can be achieved by effectively managing pended items/claims on a daily basis (working them at least two times a day) and by meeting daily production goals. A. Medicare- 30 calendar days regardless of provider contract status. B. Medi-Cal- 30 calendar days regardless of provider contract status. C. Commercial- 60 calendar days regardless of provider contract status. Qualifications Minimum Education/Licensures/Qualifications: -HS/Diploma or GED/equivalent -1-3+ years of processing of managed care health claims -Strong knowledge of medical terminology -Strong Ten Key by touch -Ability to type at least 40- 45 wpm (if they are unsure of typing skills, please send prove it!) -Proficient with Microsoft Office/General office equipment experience (i.e. photocopier, fax, calculator, ability to operate a PC) -Strong working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes -Experience with different software and hardware systems for claims adjudication -Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims. -Must be able to accurately assess financial responsibility and liability for claims submitted by both members and providers. -Accurate input of data is required for claims adjudication including: diagnostic and procedural coding, pricing schedules, member and provider identification, and all other related information as required. Best Candidate: 3+ years of experience working on Managed Care claims 2nd Best: 1+ year experience as a Claims Examiner Additional Information Location: 15821 Ventura Blvd suite 600 Encino, CA 91436 If Contract, Length of Assignment: RTH Shift: Monday-Friday, 8am-5pm (There is a night shift, but as of now they are not looking to fill any night spots- if you have a candidate seeking a later shift, I am happy to present them) Start Date: As soon as all HR is back and clear Times/Interviewer: Phone interviews with hiring manager- Laura Saez, Claims Supervisor- possible for same day scheduling if not as soon as next day

The Claims Examiner II will process insurance claims for property losses based on coverage, appraisal, and verifiable damage. They will interact with independent adjusters and policy holders, review claim forms and other records to determine insurance coverage. The candidate will make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations. PRINCIPAL DUTIES & RESPONSIBILITIES * Investigate, evaluate, and resolve claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims. * Adjust reserves and provide reserve recommendations to ensure reserving activities are consistent with company policies. * Enter claim transactions, in a clear and concise manner. * Examine claims inspected by independent adjusters, including further investigation of questionable claims, verification of coverage, and timely issuance of payments to policyholders. * Conduct daily diary reviews on claim files to ensure status letters are sent to policyholders in accordance with Department of Insurance regulations. * Pay and process claims within designated authority level. * Supervise independent adjusters to ensure adherence to CFP IA Guidelines. * Maintain compliance with the Department of Insurance and Company policy and procedures. * Create correspondence to policyholders that is accurate and complete. Communicate with insureds and/or others involved to secure missing information. * Promptly negotiate settlements, making sure that the settlement reflects the actual insured losses while ensuring that the insurer is protected from invalid claims. * Confer with Claims Management and legal counsel on claims involving litigation. ADDITIONAL DUTIES & RESPONSIBILITIES Claims Examiner II : This role may include handling the entire claim (except inspection), or may be responsible for a specific coverage, such as Personal Property or Fair Rental Value. This role will focus on claims ranging from $100,000 to $300,000 in damages, but the Claims Examiner II may receive larger or smaller claims when necessary. EDUCATION AND EXPERIENCE * Minimum bachelor's degree or equivalent preferred. * Excellent oral and written communication skills. * Working experience with MS-Office (especially Word and Excel) is required. * 2 + years property claims experience and excellent customer service. * Certified in CEA and Fair Claims Settlement Practices preferred. ADDITIONAL REQUIREMENTS (PRIOR EXPERIENCE) Claims Examiner II: 3 years of total claims experience, 2 years handling Homeowners' claims up to $300,000 Location Los Angeles, California (Remote) Minimum Experience Experienced Compensation $56,965 - $120,049

Description CookieYes sets this cookie to remember users' consent preferences so that their preferences are respected on subsequent visits to this site. It does not collect or store any personal information about the site visitors. Description Google Analytics sets this cookie to store and count page views. Description Google Analytics sets this cookie to calculate visitor, session and campaign data and track site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognise unique visitors. Description The \_omappvp cookie is set to distinguish new and returning users and is used in conjunction with \_omappvs cookie. Description Description YouTube sets this cookie via embedded YouTube videos and registers anonymous statistical data. Description Youtube sets this cookie to track the views of embedded videos on Youtube pages. Description YouTube sets this cookie to measure bandwidth, determining whether the user gets the new or old player interface. Description Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. Description YouTube sets this cookie to register a unique ID to store data on what videos from YouTube the user has seen. Description YouTube sets this cookie to register a unique ID to store data on what videos from YouTube the user has seen. Description Description is currently not available. **Provider Dispute Resolution Claims Examiner** Job ID# 1008511 - Posted 2/24/2023 - Los Angeles, CA **Position Description** The Provider Dispute Resolution Claims Examiner is responsible for: - The accurate analysis and resolution determination of Provider Disputes from all sources. - Assist in the resolution of eligibility, benefit, contracting, and payment schedule issues. - Handle and document resolution to escalated telephone and written appeals. - Ensuring all PDR documents are processed timely with timely submission of all acknowledgement and resolution letters - Timely processing of complex PDR claims for all lines of business - Auditing claims for excessive charges, duplicates, unbundling, and medical up coding - Maintaining department databases used for report production and tracking on-going work - Assisting management with in-house and on-site training as offered to employees and providers. **Experience Required** - At least 1-2 years of healthcare claims processing experience in a managed care environment with at least one year working with provider disputes. - Experience processing PDR documents - Previous Medi-Cal or Medicare claims processing experience and knowledge of AB1455 regulations. - Ability to self-manage in a fast-paced, detail-oriented environment. - Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials(PDR, CPT, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge. - Moderate knowledge of Microsoft Word and Excel. **Education Required** Associate's Degree

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 The Claims Examiner III performs advanced administrative/operational/customer support duties that require independent initiative and judgement. This position is responsible for analyzing the adjudication of medical claims as it relates to managed care, performs payment reconciliations and/or adjustments related to retroactive contract rates and fee schedule changes, as well as identifies root causes of claims payment errors and reports to Management. This position is responsible for responding to provider inquiries/calls related to claims payments and collaborates with other departments and/or providers in successful resolution of claims related issues. Minimum Requirements 1. HS Diploma or GED required. 2. Minimum of 5 years of Claims Processing experience in a managed care environment required. 3. Must be knowledgeable of Medi-Cal regulations. 4. Ability to process both professional and institutional claims. Compensation $26.13 - $32.55 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.