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Claims adjuster • hayward ca

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Claims Research Analyst

Claims Research Analyst

Hill Physicians Medical GroupSan Ramon, CA, United States
[job_card.full_time]
We're delighted you're considering joining us!.At Hill Physicians Medical Group, we're shaping the healthcare of the future : actively managed care that prevents disease, supports those with chronic...[show_more][last_updated.last_updated_variable_days]
Python Engineer - AI, Customer Claims & Support

Python Engineer - AI, Customer Claims & Support

UrsusFremont, CA
[job_card.full_time]
Individual compensation is determined by skills, qualifications, experience, and location.Compensation details listed in this posting reflect the base hourly rate or annual salary only, unless othe...[show_more][last_updated.last_updated_30]
Independent Insurance Claims Adjuster in Castro Valley, California

Independent Insurance Claims Adjuster in Castro Valley, California

MileHigh Adjusters Houston IncCastro Valley, CA, United States
[job_card.full_time]
IS IT TIME FOR A CAREER CHANGE?.Independent Insurance Claims Adjusters NEEDED NOW!.Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is you...[show_more][last_updated.last_updated_1_day]
Product Manager with insurance claims : 24-03419

Product Manager with insurance claims : 24-03419

Akraya IncFremont, California, United States
[job_card.full_time]
[filters_job_card.quick_apply]
Primary Skills : Strategy-Advanced, Leadership-Expert, Data Analysis-Intermediate, Coordination-Advanced.Location : Fremont, CA 100% Onsite. This role seeks an experienced Product Manager ready to t...[show_more][last_updated.last_updated_30]
Remote Claims Adjusters, Examiners, and Investigators - AI Trainer ($60-$100 per hour)

Remote Claims Adjusters, Examiners, and Investigators - AI Trainer ($60-$100 per hour)

MercorFremont, California, US
[filters.remote]
[job_card.full_time]
Role Overview • •Mercor is collaborating with a top-tier AI research group to model real-world claims workflows for property and casualty insurance. We are seeking experienced independent contractors—...[show_more][last_updated.last_updated_variable_days]
Angular Front‑End Engineer — Build Claims Tools & UX

Angular Front‑End Engineer — Build Claims Tools & UX

Learn Beyond Consulting LLCFremont, CA, United States
[job_card.full_time]
A leading consulting firm based in Fremont, CA is seeking an Angular Developer to create user-friendly applications for their claims ecosystem. The role involves collaboration with backend teams and...[show_more][last_updated.last_updated_variable_days]
Field Claims Adjuster

Field Claims Adjuster

EAC Claims Solutions LLCHayward, California, United States
[job_card.full_time]
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency.Join us in delivering exceptional service while upholding the highest standards of professionalism and co...[show_more][last_updated.last_updated_30]
Expert(e) général(e) exécutif(ve) / Adjuster General Executive

Expert(e) général(e) exécutif(ve) / Adjuster General Executive

SedgwickRemote, CA
[job_card.full_time]
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague.A career at Sedgwick means experiencing our culture of caring.It means having fle...[show_more][last_updated.last_updated_30]
Front-End Engineer (Angular) – Claims UX & Tools

Front-End Engineer (Angular) – Claims UX & Tools

Delta System & Software, Inc.Fremont, CA, United States
[job_card.full_time]
A software development firm is seeking a Front-End Software Engineer proficient in Angular to enhance the user experience of their insurance claims ecosystem. The role involves building and maintain...[show_more][last_updated.last_updated_variable_days]
Transportation Claims Adjuster

Transportation Claims Adjuster

VirtualVocationsFremont, California, United States
[job_card.full_time]
A company is looking for a Transportation Claims Adjuster to manage claims for trucking and logistics operations.Key Responsibilities Oversee all aspects of claims management, including investiga...[show_more][last_updated.last_updated_variable_days]
Claims Research Analyst

Claims Research Analyst

Hill Physicians Medical GroupSan Ramon, CA, United States
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future : actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement :

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description :

Primarily responsible for researching Claims Research & Resolution Unit's (CRRU) incoming mail while identifying PDR's and adjustments. Also responsible for researching accurate and timely claims processing administration in accordance to Health Plan (HP) contracts and HPMG's policies.

Job Responsibilities

  • Screen and research all claims to ensure the following :
  • Claim contains pertinent and correct information for processing PDRs and adjustments.
  • Accurate final claims adjudication by using on-line computer claims payment system. This includes research on previously processed claims when needed.
  • Maintain 98% accuracy rate.
  • Maintain 100% productivity goal.
  • Utilize Epic to document PDRs / adjustments as needed.
  • Develop a CRM and generate letters as appropriate.
  • Complete special projects as assigned to meet department and company goals.
  • Identify billing patterns, processing errors, and / or system issues that inhibit the final adjudication of claims.

Required Experience

  • One year internal / external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO) or HP
  • Working knowledge of CPT codes, ICD-10 codes, Revenue Codes and HCPC codes
  • Medical terminology preferred
  • Must type at least 40 WPM on a personal computer / keyboard
  • Strong research, judgment, decision-making and problem-solving skills
  • Ability to work independently or as a team
  • Strong written- and verbal-communication skills including maintaining open lines of communication within all departments of the organization
  • Ability to work in a fast- paced environment
  • Ability to focus on repetitive claims sorting detailed information

    • Required Education

  • High School Diploma / GED required

    • Additional Information

    Salary : $23 - $26 Hourly

    Hill Physicians is an Equal Opportunity Employer