Claim processor jobs in Fresno, CA - 438 jobs

Job Title - Claims Processor Hourly Pay - $30/hr Shift - Day 5x8-Hour (07:00 - 15:30) Job Description - SPECIFIC SKILLS NEEDED Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills. Required: Formal training will be indicated by a high school diploma or equivalent; Four years medical claims processing. DUTIES AND RESPONSIBILITIES 1. Safeguards and preserves the confidentiality of patient's protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies. 2. Ensures a safe patient environment and adherence to safety practices per policy. 3. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant other when administering care. 4. Assist the Claims Director in the training and education of the Claims department staff 5. Coordinate the generation and review of claims audit, status and pending claims reports ensuring authorized claims are paid in accordance with company guidelines 6. Investigate, process and track payment adjustments including refunds, overpayments and underpayments 7. Act as a confidential and professional resource for group providers and other staff. 8. Act as a resource for providers, members, insurance carriers, attorneys and co-workers, researching and responding to questions in a timely manner 9. Create, maintain and generate system reports 10.Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans

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

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.

Requisition ID JR1005137 Category Claims - Workers Compensation Type Regular Full-Time Responsible for the prompt and efficient examination, investigation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds and claimants, ensuring that company resources are utilized in a cost effective manner in the process. Those within a 50-mile radius of an AmTrust office will be expected to abide by a hybrid schedule Responsibilities Thoroughly investigating workers' compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable workers' comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. Reviewing and analyzing medical bills to confirm charges and treatment are workers' comp injury-related and in accordance with the treatment plan. Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statute Answer questions regarding the status of pending claims from claimants, policyholders and medical providers. Consult with attorneys regarding litigation management, settlement strategy and claim resolution. Qualifications 2+ years experience as a Workers Comp adjuster handling California claims Must be current on Continued Education Units MS Office experience (Work, Excel, Outlook) Effective negotiation skills Strong verbal and written communication skills Ability to prioritize work load to meet deadlines Ability to manage multiple tasks in a fast-paced environment Preferred: SIP license The expected salary range for this role is $39.66/hr-$44.75/hr. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Connect With Us! Not ready to apply? Connect with us for general consideration.

United Legacy is a privately owned alternative investment firm specializing in real estate-based investment opportunities. With offices in Del Mar, La Jolla, Honolulu, and Tampa, our mission- Funding Freedom -reflects our commitment to helping clients achieve long-term financial independence through transparency, precision, and trust. We're a fast-growing, high-performance firm built on accountability, collaboration, and results. Every team member plays an essential role in delivering an exceptional client experience. Position Summary The Investment Processor is a key operational role responsible for managing the documentation, coordination, and communication behind each client investment. This role ensures that every transaction-from initial paperwork to final funding-is handled with accuracy, professionalism, and efficiency. You'll work closely with Advisors, Custodians, and the Client Portfolio Manager (CPM) to ensure clients experience seamless service at every stage of the investment process. This position is full-time, onsite at our Del Mar office, reporting directly to the Client Portfolio Manager. Responsibilities Client Communication & Service Act as a liaison between clients, custodians, and internal departments. Provide timely updates and maintain professional, proactive communication. Support client calls, verification calls, and document coordination. Communicate exclusively through company-approved systems (Outlook, Zoom Phone, CRM, client portal). Transaction Processing Manage assigned transactions end-to-end, ensuring accuracy and compliance. Prepare and process subscription agreements, W-9s, KYC forms, and transfer documentation. Coordinate wires, ACH transfers, IRA transfers, and rollovers with custodians and clients. Set up IRA accounts for our clients using self-directed custodians such as Equity Trust Company and Midland Trust Company. Verify investment amounts, account allocations, and all supporting documentation. Complete and submit quality control checklists for every transaction. Compliance & Record Keeping Maintain accurate, organized records in CRM, SharePoint, and client portals. Use systems such as Platform Eleven, Wealthbox, and Agora. Log all communications and updates in real time to ensure audit-ready documentation. Send written recaps of all client and custodian communications. Uphold 100% compliance with company and regulatory standards. Team Collaboration & Training Work closely with Advisors, Client Portfolio Managers, and Operations staff. Participate in ongoing training, team meetings, and process improvement initiatives. Provide cross-departmental support during high-volume periods or special projects. This role offers hands-on mentorship and a clear growth path into client portfolio management or advisory operations. You'll receive ongoing training from senior team members and have direct exposure to real estate-backed investment transactions and private fund operations. United Legacy fosters a collaborative environment where team members are empowered to take ownership, contribute ideas, and continuously improve processes. Events & Travel Attend local United Legacy events, including seminars, client dinners, and masterclasses. Business travel may be required or expected based on company needs and event schedules. Qualifications Bachelor's degree not required; preferred fields include finance, economics, business, or related disciplines. 1-3 years of experience in financial services, consulting, asset management, or a related field. Exposure to private markets or alternative investments is a plus but not required. Strong written and verbal communication skills with excellent attention to detail. Ability to prioritize and manage multiple projects in a fast-paced environment. Collaborative mindset with a willingness to learn and contribute across teams. Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word); familiarity with CRM systems or data visualization tools is a plus. High level of professionalism, integrity, and accountability in all work performed. The Skills You Bring A strong understanding of financial planning concepts and a desire to help clients make informed investment decisions. The ability to understand client needs and identify appropriate solutions through effective communication. A relationship-driven approach with a genuine interest in serving clients and being their advocate. Motivation toward success and ownership of your responsibilities-you follow through and deliver results. Comfort with outbound communication, including client check-ins and follow-ups. A growth mindset and eagerness to develop within a dynamic, high-performing organization. Compensation & Benefits Base Salary: $68,640 annually Bonus: Discretionary, based on performance and company policy Benefits Include: 401(k) retirement plan Unlimited paid time off (PTO) - after 90 probation Sick days and paid holidays Comprehensive health coverage Schedule Hours: Monday-Friday, 9:00 AM - 5:30 PM Location: Fully onsite at United Legacy's Del Mar office

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.

As a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines. Responsibilities: Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) Alerts Supervisor and Special Investigations Unit to potentially suspect claims Ensures timely denial or payment of benefits in accordance with jurisdictional requirements Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure Negotiates claims settlements within granted authority Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition Works collaboratively with PMA nurse professionals to develop and execute return to work strategies Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome Maintains a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced Demonstrates technical proficiency through timely, consistent execution of best claim practices Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes. Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work. #LI-Remote Requirements: Requirements: Must possess CA License and experience Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required SIP certification preferred, ability to obtain required Associate in Claims (AIC) Designation or similar professional designation desired License required or ability to obtain license within 90 days of employment in mandated states Familiarity with medical terminology and/or Workers' Compensation Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details Compensation: PMA is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for this role is $71,300 to $82,600. Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within or below this range based on a variety of factors.

At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include: Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations. Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies. Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic. Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning. Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives. Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support. Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations. Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery. Continue developing technical, analytical, and consulting skills while building credibility with clients. Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement. Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team. What You Bring Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred. Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles. Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance. Epic Resolute or other hospital billing system experience preferred; Epic certification a plus. Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required. Additional certifications such as CHC, CFE, or AHFI preferred. Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization. Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred. Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act. Willingness to travel up to 25%, based on client and project needs. How You'll Thrive Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions. Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships. Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time. Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment. Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility. Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. en/careers/benefits The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.

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

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 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 the Provider Dispute Resolution (PDR) process or from claims incidents/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 the 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 is required. Experience in reading CMS-1500 and UB-04 forms is required. Compensation $26.91 - $33.53 hourly Compensation Disclaimer Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives. Benefits & Career Development Medical, Dental and Vision insurance 403(b) Retirement savings plans with employer matching contributions Flexible Spending Accounts Commuter Flexible Spending Career Advancement & Development opportunities Paid Time Off & Holidays Paid CME Days Malpractice insurance and tail coverage Tuition Reimbursement Program Corporate Employee Discounts Employee Referral Bonus Program Pet Care Insurance Job Advertisement & Application Compliance Statement AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

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.)

At Fluor, we are proud to design and build projects and careers. We are committed to fostering a welcoming and collaborative work environment that encourages big-picture thinking, brings out the best in our employees, and helps us develop innovative solutions that contribute to building a better world together. If this sounds like a culture you would like to work in, you're invited to apply for this role. **Job Description** Fluor is seeking candidates for opportunities within our Program Delivery Support (PDS) team, working alongside the California High-Speed Rail Authority, to provide program delivery and program management services for one of the largest planned infrastructure projects in the U.S. The system will connect the 500-mile stretch between the Los Angeles region with the San Francisco Bay Area, with up to 24 stations. The first phase of the program is currently under construction in California's Central Valley. Under the general direction of the Director and Deputy Director of the PMO/forensics & Claims, this role is responsible for developing forensic analyses and providing oversight of the PCM's analysis as required to determine responsibility, merit and quantification of cost and time extensions. This role is also responsible for reviewing and analyzing Contractors' Time Impact Analyses and claims and assisting with the rebuttal responses. In addition to forensic analysis efforts, this role is responsible for assisting in areas such as estimating, takeoffs and design reviews. This role is within the Program Management & Oversight Branch of the Program delivery Office. - Perform forensic analyses and develop summary of findings; Develop causation reports documenting the chronology of events related to project delays; Present analysis finding to the Authority leadership team. - Coordinates and work with the regional Authority staff, PCMs and other consultants in providing planning, development, reporting, and maintenance of data program wide - Perform review and analysis of the construction schedule for risk identification, risk review, and risk assessments including providing recommendations on appropriate actions; - Assist with other scheduling and regional project controls assignments and activities, 10% Develop What-if schedules and scenario analysis providing reasonable and realistic schedule forecasts - Review Contractors' claims and assist with responses and potential rebuttals - Other duties maybe assigned **Basic Job Requirements** - Accredited four (4) year degree in Civil Engineering or Construction Science/Management or global equivalent in applicable field of study and ten (10) years of work-related experience or a combination of education and directly related experience equal to fourteen (14) years if non-degreed **Other Job Requirements** - Experience performing claims work. - Experience in developing expert reports quantifying impacts and apportioning quantum to responsible parties. - Work experience on large programs with proven track record. - Experience with analyzing, reviewing cost estimates, schedules and time impact analyses, and excellent negotiations skills. - Ability to produce oral and written presentations to client and other stakeholders. - Strong work experience with MS Office application. - Can communicate effectively with different disciplines to obtain scope of work and other information and manage the development and review of schedules. - Knowledge of principles and practices of all project controls functions for a large-scale construction project and ability to carry out cost, estimating, design, schedule, and risk analysis. - Must be a self-starter attitude with proactive, results-oriented focus. Proven accuracy, reliability and completeness in job accomplishment. Effective oral and written communication skills. - Required Knowledge of; analysis methodologies for complex construction projects'; claims management and support; construction contracts. - Ability to write project reports. Must be able to interface with a variety of people with different technical levels and educational backgrounds; must be detail-oriented and highly organized; and must be able to produce accurate and timely results while maintaining a customer-service attitude. **Preferred Qualifications** - Professional certification as professional engineer or Quantity Surveyor - Experience in developing expert reports quantifying delays and apportioning quantum to responsible parties \#LI-SI1 We are an equal opportunity employer. All qualified individuals will receive consideration for employment without regard to race, color, age, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, genetic information, or any other criteria protected by governing law. Benefits Statement: Fluor is proud to offer a comprehensive benefits package designed to promote employee health, wellness, and financial security. Our offerings include medical, dental and vision plans, EAP, disability coverage, life insurance, AD&D, voluntary benefit plans, 401(k) with a company match, paid time off (personal, bereavement, sick, holidays) for salaried employees, paid sick leave per state requirement for craft employees, parental leave, and training and development courses. Market Rate Statement: The market rate for the role is typically at the mid-point of the salary range; however, variations in final salary are determined by additional factors such as the candidate's qualifications, relevant years of experience, geographic location, internal pay equity, and prevailing market conditions for the specific role. Notice to Candidates: Background checks are carried out as part of any conditional offer made, including (but not limited to & role dependent) education, professional registration, employment, references, passport verifications and Global Watchlist screening. To be Considered Candidates: Must be authorized to work in the country where the position is located. Salary Range: $107,000.00 - $193,000.00

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.

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

Job DescriptionDescriptionThe Workers' Compensation Claims Representative serves as the primary connection between insured clients and workers' compensation insurance carriers. The representative is committed to supporting and advocating for insureds as they navigate the complex and ever-evolving California workers' compensation system. This position ensures that claims are handled efficiently, accurately, and in compliance with applicable laws and procedures. The representative acts as an advocate for insureds, facilitates effective communication, and provides technical support and education throughout the claims process. The goal of this role is to enhance client satisfaction, improve claim outcomes, and support the brokerage's service and retention objectives. Key ResponsibilitiesClient & Carrier Communication Serve as the main liaison between insured clients and workers' compensation insurance carriers. Facilitate timely communication regarding claim status, settlement decisions and action plans. Coordinate with adjusters, medical case managers, attorneys, agents, account manager and other involved parties to promote efficient claim resolution. Communicate carrier recommendations and decisions to clients in a clear, professional manner. Claims Oversight & Advocacy Monitor open claims for assigned accounts to ensure proper handling, timely deadlines and compliance with applicable regulations. Review loss runs and document for accuracy and new claims; identify trends, anomalies, and opportunities for improvement. Advocate on behalf of insured clients to ensure appropriate medical management and expeditious claim resolution. Collaborate with clients to implement return-to-work programs and cost-containment strategies. Schedule and conduct Zoom, Teams, or telephonic meetings with carriers and other involved parties to advocate on behalf of insured clients and injured workers regarding claim status, legal issues, medical treatment concerns, and/or inefficiencies impacting timely resolution or closure of claims. Client Support & Education Provide expert guidance to clients regarding workers' compensation reporting, claim filing and documentation requirements. Assist clients with claim submissions and ensure all necessary information is provided to carriers. Participate in client claim review meetings, stewardship presentations, and renewal strategy sessions. Educate clients on workers' compensation best practices, workplace safety, injury prevention and effective claims management. Collaborate with the company's Safety Department to identify injury trends and develop strategies or training initiatives to reduce future workplace incidents. Provide workers' compensation knowledge, insights, and recommendations to insured accounts not currently enrolled in the Claims Watch value added service, to enhance their understanding and engagement with claims management practices. Data Management & Reporting Maintain accurate and detailed claim documentation within the brokerage's claims tracking system. Prepare customized reports summarizing claim performance, open claim counts and cost trends. Analyze loss data to identify recurring issues and recommend targeted interventions. Provide internal management with reports to assist in account servicing and retention efforts. Maintain workflow spreadsheets to track individual and departmental productivity, and to provide data insights for management reporting and performance analysis. Complete experience modification projections and analysis to provide clients with a prognosis of their potential premium for the upcoming policy period. Monitor WCIRB notice alerts for experience modification initial worksheets or revisions, and communicate relevant updates or impacts to clients and internal agents and account managers. Prepare and provide insured with quarterly reports including claim status reports, loss runs new claims, no claim notices and claim closure reports, to ensure clients remain informed of claim activity and closed claims. Professional Conduct and Team Responsibilities Conduct themselves in a professional and respectful manner at all times. Communicate appropriately and refrain from using offensive or disrespectful language. Comply with all assigned tasks and directives from management. Attend all mandatory meetings and participate actively in team and company activities. Demonstrate a positive, professional attitude and contribute constructively to the team environment. Practice strict confidentiality at all times regarding company information, client data, and sensitive claim information. Skills, Knowledge and ExpertiseEducation and Experience: Associate's or Bachelor's degree in Business Administration, Risk Management, or a related field preferred. Minimum of 2-5 years of experience in workers' compensation claims handling, carrier relations, or client advocacy within a brokerage, carrier, or TPA setting. Comprehensive understanding of state workers' compensation statutes, medical case management practices, legal terminology and claims processes. Knowledge, Skills, and Abilities: Strong verbal and written communication skills with a client-service mindset, ability to resolve complaints and disputes. Proven ability to build and maintain effective professional relationships. Exceptional analytical, organizational, and problem-solving abilities. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and claims management or CRM software. Ability to manage multiple priorities and deliver results in a fast-paced environment. Certifications (Preferred): Associate in Claims (AIC), Workers' Compensation Claims Professional (WCCP), or similar industry designation. State adjuster license or Self-Insurance Administrator (SIP) certificate (if required by jurisdiction). Benefits Competitive Pay Great Benefits

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.