Claims Jobs in Santa Clara, CA
Last updated: 13 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
Summary : This position involves handling property and casualty as well as workers' compensation claim-related issues.The following details a general list of duties...Show moreLast updated: 18 hours ago
Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safe...Show moreLast updated: 15 days ago
Senior Claims Adjuster I - California.With minimal oversight, the Senior Claims Adjuster I is responsible for the timely and accurate management of workers' compensation claims.This includes handli...Show moreLast updated: 2 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
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: 9 days ago
The Claims Senior Auto Adjuster supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and / or liability lines of insu...Show moreLast updated: 13 hours ago
The Contractor shall ensure that the temporary workers supplied to LAMCTA shall meet the qualifications in the job description in the scope of services.
The contractor shall ensure that the temporar...Show moreLast updated: 10 days ago
Grow your career at Cedars-Sinai!.Cedars-Sinai Medical Center has been named to the Honor Roll in U.News & World Report's Best Hospitals 2024-2025 rankings.
When you join our team, you'll gain acces...Show moreLast updated: 12 days ago
General office support for the Claims Department.Minimum bail knowledge (will train).Researching court files and documents for relevant issues.
Some court knowledge (not required, will train).Two to...Show moreLast updated: 30+ 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: 17 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
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: 22 days ago
A company is looking for a Claims Specialist I to resolve medical claims that are not automatically adjudicated.Key ResponsibilitiesProcess and resolve pended claims by entering data, reviewing con...Show moreLast updated: 22 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: 6 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: 3 days 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: 5 days ago
Claims Auditor
Prospect MedicalCA, United StatesFull-time
- New!
Claims Technician
Anansys Staffing LLCCA, United StatesFull-time
Quick Apply
- Promoted
ESIS CLAIMS REPRESENTATIVE, WC
ChubbCA, United States$58,900.00–$100,100.00 yearly
Full-time
Field Claims Adjuster
EAC Claims Solutions LLCMilpitas, California, United States 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 moreLast updated: 30+ days ago
- Promoted
SENIOR CLAIMS AJUSTER
EMPLOYERSCA, United States$60,000.00–$85,000.00 yearly
Full-time
Claims Auditor
ReqRouteSan Jose, CA, USRemote
- Promoted
RISK MANAGEMENT CLAIMS ANALYST
City of Pomona, CACA, United States$1,575.00 monthly
Full-time
- Promoted
- New!
CLAIMS SENIOR AUTO ADJUSTER
American Automobile AssociationCA, United States$28.19–$37.55 hourly
Full-time
- Promoted
WORKERS' COMPENSATION CLAIMS ANALYST
LanceSoftCA, United StatesFull-time
- Promoted
CLAIMS AUDITOR (MANAGED CARE) - REMOTE
Cedars SinaiCA, United StatesRemote
Full-time
Claims Administrative Assistant
Aladdin Bail BondsSan Jose, CA, US$17.00–$21.00 hourly
Full-time
Claims Investigator -Experienced
Command InvestigationsSan Jose, CA AOE / COE, Auto, or Homeowners Investigations.Writing accurate, detailed reports.Strong initiative, integrity, and work ethic.
Securing written / recorded statements.Possession of a valid driver’s licen...Show moreLast updated: 30+ days ago
- Promoted
Claims Manager
WaymoMountain View, CA, United States$155,000.00–$194,000.00 yearly
Claims Examiner
Lucent HealthCA, US$20.00–$25.00 hourly
- Promoted
Temp Claims Analyst I
Santa Clara Family Health PlanSan Jose, CA, United States$53,055.00–$76,930.00 yearly
Temporary
- Promoted
Claims Specialist
VirtualVocationsSunnyvale, California, United StatesFull-time
- 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