Lead Claims Specialist

1 week ago


Anaheim, California, United States Providence Service Full time

Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, directs and implements claims training programs for the organization, to include adaptations to changes in policies, procedures and technologies.

Providence caregivers are not simply valued theyre invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

Bachelor's Degree or equivalent education/experience.

10 or more years HMO claims processing and/or auditing experience in a managed care environment, preferably PMG/IPA setting within the last 7 years or any combination of education and/or experience which produces an equivalency.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of Know me, care for me, ease my way. Working at our family of organizations means that regardless of your role, well walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.

PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washingtons greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providences St. Johns Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID:

Company: Providence Jobs

Job Category: Claims

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 7520 CLAIMS PROCESSING CA HERITAGE SERVICES

Address: CA Anaheim 200 W Center St Promenade

Work Location: St Joseph Home Health-Anaheim

Pay Range: $ $42.71

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.



  • Anaheim, California, United States Carl Warren & Company Full time

    COMPANY OVERVIEW: Carl Warren & Company is a leading nationwide Third-Party Administrator (TPA) founded in 1944. Carl Warren has been a trusted partner specializing in property and casualty claims management, subrogation recovery, and litigation management for private and public sectors, insurance companies, and captives. Our clients count on us to care...


  • Anaheim, California, United States Carrington Holding Company, LLC Full time

    Job DescriptionCome join our amazing team and work onsite in Anaheim The Loss Mitigation Finalization Specialist will be responsible for the finalization, post-closing, and reporting processes related to Loan Modifications ("MOD") and/or Partial Claims ("PC"). Perform all duties in accordance with the company's policies and procedures, all US state and...


  • Anaheim, California, United States Oceania International Full time

    Company Overview and Job Description Summary: Founded in 2005, Oceania Inc. is a diversified company with business in e-commerce, advanced materials, and renewable energy. Our mission is to provide top-quality consumer products at great prices by merging innovative marketing with data-driven technologies. Since our establishment, Oceania has experienced...


  • Anaheim, California, United States L3Harris Technologies Full time

    Job Title: Specialist, Systems Engineering Job Code: 11119 Job Location: Anaheim, CA (Responsibilities must be performed on-site.)Job Schedule: 4/10 Work Schedule (Monday thru Thursday)Job Description: The Specialist, Systems Engineer is an intermediate professional with practical knowledge of job area. Works under general supervision to set objectives for...


  • Anaheim, California, United States Carrington Holding Company, LLC Full time

    Job DescriptionCome join our amazing team and work in Anaheim The Foreclosure Specialist I will be responsible for monitoring activities of foreclosure vendors relative to the accuracy and timeliness of residential mortgage loans within foreclosure in accordance with applicable Federal, state, and/or Investor requirements. Effectively collaborates and...


  • Anaheim, California, United States Reborn Cabinets Full time

    Overview Reborn Cabinets has been in business for nearly 40 years and is the leading provider of kitchen and bathroom remodeling services with locations throughout the West Coast. We are looking for an experienced Warranty Coordinator to join our award-winning team and assist with our national expansion Responsibilities Accept inbound claims via the call...


  • Anaheim, California, United States Carrington Holding Company, LLC Full time

    Job DescriptionCome join our amazing team and work onsite in Anaheim The Pre-Foreclosure Specialist I will be responsible for monitoring vendors and CMS activities during the breach process, processing of an eligible foreclosure referral, and referral validation process. Effectively collaborate and communicate with support groups within servicing to ensure...


  • Anaheim, California, United States TEKsystems Full time

    This role will lead our marketing efforts and drive the success of our product lines. The ideal candidate will have a strong understanding of marketing strategies, product management principles, and market dynamics. They will be responsible for developing and executing marketing plans, conducting market research, and collaborating with cross-functional teams...


  • Anaheim, California, United States Oceania International Full time

    About Us:In the last few years OMTech Laser has grown tremendously in the Laser engraving and cutting space. We are leading the markets with our strong brand and recognition by the Laser Engraving Community. We serve the biggest user community here in the USA. Here at OMTech Laser, we have a dynamic and passionate team that thrives on being proud of our...


  • Anaheim, California, United States North Country Academy Full time

    This isn't just another daycare job. It's a rewarding journey where you have the opportunity to learn, grow, and play a part in children's lives every day. Join our team as a Teacher at a child care center where you can make a difference and inspire young minds to become lifelong learners.As a Teacher, you are:Caring: Follow guidelines and company standards...

  • Valet Attendant

    1 week ago


    Anaheim, California, United States Wincomehospitality Full time

    Posted October 11, 2021 > DISCOVER WHAT IT MEANS TO RISE At The Westin Anaheim Resort, discover a place where youre given a choice to not just get up and go to work, but to RISE. To work together to enhance the well-being of our guests and our communities. Apply today. ** Valet Attendant** **GENERAL DESCRIPTION**: Responsible for greeting guests, parking...


  • Anaheim, United States Providence Health & Service Full time

    Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated h Claims, Claims Specialist, Processing, Specialist, Lead, Insurance, Healthcare


  • Anaheim, United States Providence Health & Service Full time

    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 k Claims Specialist, Claims, Specialist, Senior, Processing, Healthcare

  • Claims Specialist

    2 weeks ago


    Anaheim, United States Elbi of America Full time

    Elbi of America, a tank manufacturer and plumbing materials wholesaler, is looking for a Claims Specialist for its California facility, located in Anaheim, CA. - Opportunity to be a key member of a rapidly growing company, part of an international Group with 3 locations in the United States. - Exposure to new process re-engineering. - Competitive salary and...


  • Anaheim, United States Providence Service Full time

    Description Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, directs and...


  • Anaheim, United States Providence Health & Service Full time

    Description Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, directs...


  • Anaheim, United States Providence Service Full time

    Description Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs,...


  • Anaheim, United States Providence Health & Service Full time

    Job Description Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative contractual agreements. Designs, plans, directs...

  • QC/Claims Processor

    1 week ago


    Anaheim, United States Ultimate Staffing Full time

    Plumbing materials manufacturer and wholesaler (piping, fittings, water tanks) in Anaheim seeking a strong QC/Claims Processor. The individual will primarily be interfacing with attorneys, insurance adjustors, our customers, property owners, and other claims specialists. This communication will take place primarily by emails and phone calls. They'll be...

  • QC/Claims Processor

    1 week ago


    Anaheim, United States Ultimate Staffing Full time

    Plumbing materials manufacturer and wholesaler (piping, fittings, water tanks) in Anaheim seeking a strong QC/Claims Processor. The individual will primarily be interfacing with attorneys, insurance adjustors, our customers, property owners, and other claims specialists. This communication will take place primarily by emails and phone calls. They'll be...

  • Support Specialist

    4 weeks ago


    Anaheim, United States Carl Warren Full time

    **Join Venbrook**: Our people are equipped with the tools—including enriching professional experiences, coaching, timely and productive feedback, and high-quality learning and development opportunities—to deliver against our commitment to you each day. We are committed to building lasting relationships with you and delivering value to your career...


  • Anaheim, United States ALFEL RESOURCES INC Full time

    Job DescriptionJob DescriptionBenefits/PerksCompetitive CompensationGreat Work EnvironmentCareer Advancement OpportunitiesJob SummaryAre you looking to launch a career in medical billing? Whether you're an experienced medical biller or a newcomer to the field, if you have a strong eagerness to learn, we want to hear from you!We are seeking a motivated...


  • Anaheim, United States ALFEL RESOURCES INC Full time

    Job DescriptionJob DescriptionBenefits/PerksCompetitive CompensationGreat Work EnvironmentCareer Advancement OpportunitiesJob SummaryAre you looking to launch a career in medical billing? Whether you're an experienced medical biller or a newcomer to the field, if you have a strong eagerness to learn, we want to hear from you!We are seeking a motivated...


  • Anaheim, United States ALFEL RESOURCES INC Full time

    Job DescriptionJob DescriptionBenefits:401(k) matchingCompetitive salaryHealth insurancePaid time offBenefits/PerksCompetitive CompensationGreat Work EnvironmentCareer Advancement OpportunitiesJob SummaryAre you looking to launch a career in medical billing? Whether you're an experienced medical biller or a newcomer to the field, if you have a strong...


  • Anaheim, United States ALFEL RESOURCES INC Full time

    Job DescriptionJob DescriptionBenefits:401(k) matchingCompetitive salaryHealth insurancePaid time offBenefits/PerksCompetitive CompensationGreat Work EnvironmentCareer Advancement OpportunitiesJob SummaryAre you looking to launch a career in medical billing? Whether you're an experienced medical biller or a newcomer to the field, if you have a strong...


  • Anaheim, United States Carrington Mortgage Holdings, LLC Full time

    **Come join our amazing team and work onsite in Anaheim! The Loss Mitigation Finalization Specialist will be responsible for the finalization, post-closing, and reporting processes related to Loan Modifications (“MOD”) and/or Partial Claims (“PC”). Perform all duties in accordance with the company’s policies and procedures, all US state and federal...


  • Anaheim, United States Carrington Mortgage Holdings, LLC Full time

    The Post Close Team Lead is responsible for providing support and guidance to Post Close Specialist. Audit loan files that require a 2 nd level review or challenged files that require escalation to prepare for submission to agencies for endorsement/guarantee & loans salability. Work with Post Close Management team to maximize quality and production. Perform...


  • Anaheim, United States Carrington Holding Company Full time

    Come join our amazing team and work onsite in Anaheim! The Loss Mitigation Finalization Specialist will be responsible for the finalization, post-closing, and reporting processes related to Loan Modifications (“MOD”) and/or Partial Claims (“PC”). Perform all duties in accordance with the company’s policies and procedures, all US state and...


  • Anaheim, United States INNOVATIVE INTEGRATED HEALTH INC Full time

    Description: **WHO WE ARE**: Are you interested in working for an organization whose mission it is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible? Orange County Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants...


  • Anaheim, United States KPC GLOBAL MEDICAL CENTERS INC. Full time

    Job DescriptionJob DescriptionHybrid $2,000 Sign-on BonusPatient Account Specialist I (Hospital or Healthcare Exp Req)Performs account follow up from third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other...


  • Anaheim, United States KPC GLOBAL MEDICAL CENTERS INC. Full time

    Job DescriptionJob DescriptionHybrid $2,000 Sign-on BonusPatient Account Specialist I (Hospital or Healthcare Exp Req)Performs account follow up from third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other...