Under general supervision and direction, resolves moderately complex residential and commercial property claims by investigating losses, negotiating settlements, and presenting evidence in legal proceedings while maintaining adequate production levels. Responsibilities Examines claims forms, policies and endorsements, client instructions, and other records to determine co

Responsible for auditing and training claims staff on all Managed Care claims received from outside providers to ensure the Claims Examiners processed and adjudicated them accurately and consistently in accordance with outside Provider Contracts, State, Federal, CMS, DMHC and Health Plan contracts, internal departmental policies and procedures. Must maintain a productivit

Working under the direction of the Manager, Claims, this position has direct responsible for the supervision of staff and for overseeing the day to day operations of the Claims Processing and UM Denial Letter Units. Additional responsibilities include reporting functions to ensure compliance with AB1455, attention to CMS guidelines and department policy and procedures. Pr

IMA's Private Equity and M&A Practice provides buyers and targets with a range of insurance, benefits and retirement products and services designed to assist them throughout the life cycle of the M&A transaction. For M&A activity, IMA's in house Transactional Liability Practice, Project Managers and Due Diligence Specialists bring depth and experience to address financial

Manager, Claims Job Locations US CA Irvine Requisition ID 2024 16419 Category Claims Workers Compensation Position Type Regular Full Time Overview AmTrust Financial Services, a fast growing commercial insurance company, has an immediate need for a Workers' Compensation Claims Manager in Irvine, CA. The Workers Compensation Claims Manager is responsible to supervise activi

Clinical Investigator starting approx. July 2023 UCSF Division of General Internal Medicine at San Francisco General Hospital The Department of Medicine at the University of California San Francisco (UCSF) is recruiting for a Clinical Investigator (MD/DO or PhD/DrPH/ScD trained) to join the faculty as an Assistant, Associate, or Full Professor in the Division of General I

Property General Adjuster Requisition ID 2024 25240 Job Locations US CA Bakersfield | US CA Fresno Position Type Regular Full Time Category Claims Business Unit CUS_Loss Adjusting US Excellence In Everything We Touch Position Summary Under limited supervision, resolves all types of the most serious losses, heavy commercial property losses or other assigned losses by inves

The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non contracted provide

REQUIRED EXPERIENCE Take on a significant role within a world class health organization. Elevate the operational and financial effectiveness of a complex health system. Take your professional expertise to the next level. You will leverage your extensive theoretical revenue cycle knowledge as you take on a vast range of critical revenue issues. This will involve applying d

The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non contracted provide

The Claims Consultant will provide claim advocacy and oversight services for Tier 1, 2 & 3 clients for property and casualty and workers compensation losses including, but not limited to, assuring complete and sound claim settlements, legal reviews, and investigation, providing clients and/or carrier adjusters with leadership, direction, and problem resolution, as well as

Analyzes, configures, develops, tests, implements, supports and maintains Epic revenue cycle applications, solutions and business processes to meet operational and technical requirements. Obtains and maintains in depth knowledge of software functionality and acquires as well as utilizes knowledge of operational workflows to be implemented. Areas of responsibility may be H

Manages the assignment of losses to claims staff and provides technical direction and ongoing guidance through effective diary management. Ensures timely, accurate documentation of claim activity. Selects, trains, coaches and mentors unit personnel. Plans staff responsibilities and directs activities, utilizing staff resources effectively to meet department goals in accor

Claims Adjuster III, CA Job Locations US CA Irvine Requisition ID 2024 16316 Category Claims Workers Compensation Position Type Regular Full Time Overview The Workers' Compensation Adjuster III is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with ins