Claims analyst Jobs in Santa Clara, CA
Last updated: 7 hours ago
The Claims Auditor performs analysis and monitors trends identified through the audit process.This individual will take the lead to ensure accurate and timely adjudication of claims, as well as ide...Show moreLast updated: 30+ days ago
Claims Loss Reporting Specialist.Auto Club Enterprises is seeking full-time, motivated Claims Loss Report Specialist to join our industry leading Claims Contact Center.
Training is approximately 3 w...Show moreLast updated: 7 hours ago
Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.Develop...Show moreLast updated: 8 days ago
Job Title : Claims Adjuster - Workers Compensation.Duration : 3 Months (Possibly Extension).Min 3 Years of CA claims handling experience required.
If candidate is from other state, 3 years of CA Claim...Show moreLast updated: 9 days ago
A company is looking for a Claims Defects Analyst.Key ResponsibilitiesSupport the Nasco to Facets migration project by managing daily tasks on the Nasco platformReview and interpret benefit documen...Show moreLast updated: 3 days ago
First Review of Applications is Scheduled for March 11, 2025.Open continuous recruitment until sufficient applications are received.
This recruitment may close at any time without further notice.Joi...Show moreLast updated: 7 days ago
For 70 years George Hills has offered our clients unparalleled service and innovative excellence in claims administration and offered our employees a positive and collaborative culture that builds ...Show moreLast updated: 13 days ago
Associate should have 2+ years of experience with Claims Adjudication.Should have the knowledge in manual pricing with the following types of claims.
Medicare inpatient hospital claims, outpatient h...Show moreLast updated: 30+ days ago
Argo Group is a leader in specialty insurance with a vibrant culture built on respect, equality, wellness and opportunity.
We're an innovative organization that's small enough to be agile and big en...Show moreLast updated: 7 hours ago
Join a team that puts its People First! Since 1889, First American (NYSE : FAF) has held an unwavering belief in its people.
They are passionate about what they do, and we are equally passionate abou...Show moreLast updated: 2 days ago
The expected pay range is based on many factors, such as experience, education, and the market.The range is subject to change.
Supervisor or Manager of Claims.GENERAL DESCRIPTION OF POSITION.The Cla...Show moreLast updated: 20 days ago
The Los Angeles County Metropolitan Transportation Authority (LACMTA) requires a Workers' Compensation Claims Analyst Assistant, who has experience in workers' compensation claims handling in accor...Show moreLast updated: 8 days ago
Los Angeles | Hybrid (In-Office Preferred, Remote Optional) | Claims.Onward Insurance is a growing and dynamic auto insurance company dedicated to providing exceptional service and comprehensive co...Show moreLast updated: 9 days ago
Waymo is an autonomous driving technology company with the mission to be the most trusted driver.Since its start as the Google Self-Driving Car Project in 2009, Waymo has focused on building the Wa...Show moreLast updated: 14 days ago
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 moreLast updated: 6 days ago
Rancho Cordova, CA(Hybrid / Remote).The Claims Examiner I is in daily contact with team members, clients and providers.This position reports to the Claims Supervisor.
A cheerful, competent and compass...Show moreLast updated: 30+ days ago
Senior Claims Adjuster I - California.Make sure to apply with all the requested information, as laid out in the job overview below.
With minimal oversight, the Senior Claims Adjuster I is responsibl...Show moreLast updated: 3 days ago
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, celebrat...Show moreLast updated: 1 day ago
Alliant Insurance Services is one of the nation's largest and fastest-growing insurance brokerage and consulting firms.We operate through a network of specialized national platforms and local offic...Show moreLast updated: 2 days ago
Claims Auditor
Prospect MedicalCA, United StatesFull-time
- Promoted
- New!
CLAIMS LOSS REPORTING SPECIALIST
American Automobile AssociationCA, United States$18.67–$24.86 hourly
Full-time
- Promoted
CLAIMS ADJUSTER - WORKERS COMPENSATION
Cynet SystemsCA, United States$45.00–$50.00 hourly
Full-time
- Promoted
CLAIMS ADJUSTER - WORKERS COMPENSATION
eTeam, Inc.CA, United StatesFull-time
- Promoted
Claims Defects Analyst
VirtualVocationsSunnyvale, California, United StatesFull-time
- Promoted
RISK MANAGEMENT CLAIMS ANALYST
City of Pomona, CACA, United States$1,575.00 monthly
Full-time
- Promoted
CLAIMS ADJUSTER
George Hills CompanyCA, United States$66,560.00–$80,000.00 yearly
Full-time
Claims Auditor
ReqRouteSan Jose, CA, USRemote
- Promoted
- New!
WORKERS' COMPENSATION CLAIMS ADJUSTER
Argo GroupCA, United States$89,880.00–$105,840.00 yearly
Full-time
- Promoted
CLAIMS QUALITY CONTROL COORDINATOR
First American Financial CorporationCA, United States$22.98 hourly
Full-time
- Promoted
Temp Claims Analyst I
Santa Clara Family Health PlanSan Jose, CA, United States$53,055.00–$76,930.00 yearly
Temporary
- Promoted
WORKERS' COMPENSATION CLAIMS ANALYST ASSISTANT
LanceSoftCA, United StatesFull-time
- Promoted
CLAIMS ADJUSTER
Hankey Group ExternalCA, United States$55,000.00–$65,000.00 yearly
Full-time
- Promoted
Claims Manager
WaymoMountain View, CA, United States$155,000.00–$194,000.00 yearly
- Promoted
Claims Investigator -Experienced
Command InvestigationsSan Jose, CA, United StatesFull-time
Claims Examiner
Lucent HealthCA, US$20.00–$25.00 hourly
- Promoted
Senior Claims Ajuster
EmployersSan Jose, California, US$60,000.00–$85,000.00 yearly
Full-time
- Promoted
SENIOR CLAIMS COMPLIANCE SPECIALIST
AltaMed Health Services CorporationCA, United States$90,649.23–$113,311.54 yearly
Full-time
- Promoted
CLAIMS ADVOCATE TEAM LEAD
Alliant Insurance ServicesCA, United States$175,000.00 yearly
Full-time
Claims Auditor
Prospect MedicalCA, United States30+ days ago
Job type
- Full-time
Job description
The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and / or inquiry processing experience to audit and analyze simple to advanced-level claims processing procedures and workflows.
Job Responsibilities / Duties
- Apply claim processing experience to audit and analyze all levels of claims processing procedures and workflows. Requires the ability to audit claims accurately. Independently run reports on errors identified for potential error trends and report the results to Claims Management and Claims Trainer. Additionally assist in the processing of PDRs , Health Plan Cap Deducts, and claims processing.
- Handle special projects from external provider and internal departments. Must have the ability to accurately make the necessary adjustments for underpayments and review overpayment requests for Claims Recovery Specialist.
- Independently audit and analyze high dollar claims and checks prior to the issuance of funds. Must possess the ability to analyze Claims EOB and balance check amounts according to Claims processing guidelines.
- Analyze and prepare Health plan claims selections for Annual health plan audit. Review samples provider by clerical staff and ensure claims payments are accurate and all documentations required by the health plan auditor is present at the time of audit.
- Assist the Recovery Specialist in corresponding with external providers regarding Claims Overpayment requests. Requires the ability to communicate and analyze Claims processing methodologies according to CMS and DMHC guidelines.
Qualifications
Minimum Education : High School Diploma or Equivalent. BS / BA preferred.
Minimum Experience : Two to three (2-3) years previous experience as medical claims Auditor or 3-5 years previous experience examining medical Claims preferred. Preferably in an IPA, MSO, or Medical Group setting.
Req. Certification / Licensure : None