Claims examiner [h1.location_city]
[job_alerts.create_a_job]
Claims examiner • huntington beach ca
[last_updated.last_updated_variable_days]
Orange, CA is a premier healthcare provider specializing in Medicare and HMO services.With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize acc...[show_more][last_updated.last_updated_variable_days]
By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...[show_more][last_updated.last_updated_variable_days]
By joining Sedgwick, you'll be part of something truly meaningful.It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...[show_more][last_updated.last_updated_variable_days]
Property Damage Claims Specialist.Elite Sourcing is seeking an experienced Property Damage Claim Specialist to join a well-known Law Firm in Costa Mesa, CA.
You will be responsible for investigating...[show_more][last_updated.last_updated_30]
Seeking a Claims Specialist for our Orange County office.This role involves handling technical and administrative responsibilities related to managing assigned claim files and taking on a larger ca...[show_more][last_updated.last_updated_variable_days]
At DK Law, we don’t just represent our clients.We stand with them, all the way.We’re modern injury and accident attorneys who go all the way for every client, from every background.At the heart of ...[show_more][last_updated.last_updated_30]
Remote Residential Title Examiner.Insight Global is looking for a Remote Residential Title Examiner to work at an industry-leading title company.
This employee will be responsible for searching publ...[show_more][last_updated.last_updated_30]
A company is looking for an Experienced Claims Examiner - Remote.Key Responsibilities Review and adjudicate medical claims, ensuring accurate coding and data entry Verify patient eligibility and...[show_more][last_updated.last_updated_30]
This role involves handling technical and administrative responsibilities related to managing assigned claim files and taking on a larger caseload of highly complex claims.The Senior Claims Special...[show_more][last_updated.last_updated_variable_days]
If youve led estimating teams and obsess over accuracy, come scale something bigger.At Allied Public Adjusters, we dont just write scopeswe uncover the full truth behind every loss.Since 1997, weve...[show_more][last_updated.last_updated_30]
Manager's Note : Workers Compensation Claims Examiner.Preferred SIP Certification Medical facilities.PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to dete...[show_more][last_updated.last_updated_30]
Only qualified Workers' Compensation candidates located in California are eligible to be considered for this role • • •.Candidates must be located in the state of California.High School Diploma or equ...[show_more][last_updated.last_updated_30]
Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan.
We are committed to the idea that he...[show_more][last_updated.last_updated_30]
We are Hiring for Claims Specialist in Orange CA.Our client is seeking a Claims Specialist for their Orange County office.
This role involves handling technical and administrative responsibilities ...[show_more][last_updated.last_updated_variable_days]
Manage med-mal claims end-to-end; larger / complex caseload; guide defense counsel; CRC / CSC reports; discovery / mediation / trial monitoring.
mentor CS I / II.BA / BS; 5 years med-mal claims (or WC / Bodily I...[show_more][last_updated.last_updated_variable_days]
Job Description - Claims Specialist.Location : Orange CA United States 92859.Our client is seeking a Claims Specialist for their Orange County office.
This role involves handling technical and admini...[show_more][last_updated.last_updated_variable_days]
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE / COE, Auto, and Homeowners.
SIU experience is highly desired, but not require...[show_more][last_updated.last_updated_variable_days]
CAP seeks a Senior Claims Specialist for its Orange County office.This role involves handling technical and administrative duties to manage assigned claim files.
assumes increased workload of highl...[show_more][last_updated.last_updated_variable_days]
AZAD is seeking a Claims Specialist for a full-time, permanent employment position in Orange, California This position is full-time on-site, Monday to Friday.
Expected start date December 28, ...[show_more][last_updated.last_updated_variable_days]
- [promoted]
Claims Examiner I
Astiva Health, IncOrange County, CA, United States[job_card.full_time]
Liability Claims Examiner - Auto & GL
Sedgwick Claims Management Services, Inc.Orange, CA, United States[job_card.full_time]
Liability Claims Examiner - Auto & GL
SedgwickOrange, CA[job_card.full_time]
Claims Specialist
Elite SourcingCosta Mesa, CA, US[job_card.full_time]
Claims Specialist - Legal
ScimaxconsultingOrange, CA, US[job_card.full_time]
Claims Specialist
The Law Offices of Daniel KimCosta Mesa, California, United States, 92626[job_card.full_time]
- [promoted]
Remote Residential Title Examiner (FL)
Insight GlobalSanta Ana, CA, US[filters.remote]
[job_card.full_time]
- [promoted]
Experienced Claims Examiner
VirtualVocationsCosta Mesa, California, United States[job_card.full_time]
Senior Claims Specialist-Permanent
estaffing IncOrange, California, USA[job_card.full_time] +1
Claims Estimating Manager
ALLIED PUBLIC ADJUSTERS INCNewport Beach, CA, US[job_card.full_time]
- [promoted]
Claims Examiner - Workers Compensation
StaffingOrange, CA, US[job_card.full_time]
Claims Examiner - Workers Compensation
Rose InternationalOrange, CA, USA[job_card.full_time]
Claims Examiner III
Verda Healthcare IncHuntington Beach, CA, US[job_card.full_time]
Claims Specialist
Talent MoversOrange, California, USA[job_card.full_time]
- [promoted]
Claims Specialist
MY HROrange, California, USA[job_card.full_time] +1
- [promoted]
Claims Specialist
NS IT SolutionsOrange, California, USA[job_card.full_time]
Claims Investigator - Experienced
Command InvestigationsOrange, CA, United States[job_card.full_time]
- [promoted]
Sr. Claims Specialist
Cooperative of American Physicians, Inc.Orange County, CA, United States[job_card.full_time]
Claims Specialist
AZAD Technology PartnersOrange, CA, US[job_card.full_time] +1
Claims Examiner I
Astiva Health, IncOrange County, CA, United States[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]Good knowledge of CPT / HCPCS / ICD-10, and Revenue Codes, including modifiers. Assist customer service as needed to assist in claims resolution on calls from providers. Research authorizations and properly selects appropriate authorization for services billed. Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be financial responsibility of another organization. Coordinate Benefits on claims for which member has another primary coverage Run monthly reports. Review pre and post check run. Regular and consistent attendance Other duties as assigned High School Diploma or GED required. 1 to 3 years of previous experience in a health plan, IPA or medical group. Strong understanding of the benefit process including member services or customer service. Demonstrated proficiency in MS Office (Excel, Word, Outlook, and PowerPoint). Able to navigate difficult situations with empathy, discretion, and professionalism. Strong understanding of Senior Medicare Advantage Health plans. Able to explain member benefits, answer questions and concerns using a “Customer Service First” attitude. Able to live our mission, vision, and values, Bilingual in another language (written and oral) preferred.
About Us : Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY : Under the direction of the Vice President of Claims, this position is responsible for manual input and adjudication of claims submitted to the health plan. The ideal candidate will need to interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts; as well as resolving customer service inquiries, status calls, andclaim tracers.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following :
- Data enter paper claims into EZCAP.
- Review and interpret provider contracts to properly adjudicate claims.
- Review and interpret Division of Financial Responsibility (DOFR) for claims processing.
- Perform delegated duties in a timely and efficient manner.
- Verify eligibility and benefits as necessary to properly apply co-pays.
- Understands eligibility, enrollment, and authorization process.
- Knowledge of prompt payment guidelines for clean and unclean claims
- Process claims efficiently and maintains acceptable quality of at least 95% on reviewed claims.
- Meets daily production standards set for the department.
- Prepares claims for medical review and signature review per processing guidelines.
- Identify the correctly received date on claims, with knowledge of all time frames for meeting compliance for all lines of business.
Maintains good working knowledge of system / internet and online tools used to process claims
QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and / or EXPERIENCE :