Claims Examiner II

Job Summary:We are seeking a skilled Claims Examiner II to join our team at Yoh. As a Claims Examiner II, you will be responsible for reviewing, researching, and resolving pended claims for Medi-Cal types, including medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims. You will also route claims to appropriate...

Job SummaryWe are seeking a skilled Workers Compensation Claims Examiner to join our team at Sedgwick Claims Management Services.Key Responsibilities:Analyze mid- and higher-level workers compensation claims to determine benefits due.Ensure ongoing adjudication of claims within company standards and industry best practices.Identify subrogation of claims and...

Job Summary:This position is open to Hybrid candidates in the greater Long Beach/Los Angeles area. We are seeking a skilled Medical Claims Examiner to join our team at Ultimate Staffing.Responsibilities:• Audit claims processing quality and develop standard reports• Assist the Claims Supervisor/Director in reviewing quality auditing tracking/reporting...

Responsibilities:Parameters of the provider's contract obligations.Audit claims processing quality, develops, maintains and runs standard reportsAssist the Claims Supervisor/Director in reviewing the quality auditing tracking/reporting (financial and procedural)Coordinating with various departments to resolve disputes or issuesMaintain the Claims department...

Our client, is in need of a Temporary Workers' Compensation Claims Examiner for their Irvine Office to work on a hybrid basis. The ideal candidate will have 3+ years of California Workers Compensation Experience.Any additional information you require for this job can be found in the below text Make sure to read thoroughly, then apply.Required...

Job Title: Claims Examiner/AdjusterCompany Overview:DB Insurance Co Ltd (US Branch) is a leading insurance company seeking a full-time Claims Examiner/Adjuster to handle Commercial General Liability/Auto BI Liability claims.About DB Insurance:DB Insurance Co., Ltd. is one of the largest non-life insurance companies based in South Korea. DB Insurance Co.,...

Job Summary: The PACE Claims Examiner/Data Specialist is responsible for processing professional and hospital capitated full risk claims in accordance with the individual provider contract and Medicare and Medi-Cal billing guidelines and processes claims. Initiates check run and performs standard reporting and ensuring audit readiness. Downloads and uploads...

Examination Role for Nurse PractitionerWe are seeking a skilled Nurse Practitioner to conduct medical examinations related to Veteran’s disability claims in Denton, TX. This is a full-time position requiring a male candidate.Key Responsibilities:Reviewing medical histories and conducting abstracted reviewsProviding examinations to support timely receipt of...

TITLE: Workers Compensation Claims Examiner IIITERM: Contract/possible Contract-to-Hire LOCATION: Las Vegas, NV | Salt Lake, UT OR Denver, CO (REMOTE)HOURS: Mon - Fri- 8:00 AM-5:00 PMHOURLY RATE: $33.65-36.06 (depending on experience)SummaryThe caseload will be between 130 worker comp files - It claims and administers benefits for medical treatment and...

Overview:AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Claims Adjuster II - WC. The adjuster is responsible for the prompt and efficient examination, investigation, settlement or declination of worker’s compensation insurance claims through effective research, negotiation and interaction with insures,...

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...

Casualty Claims Examiner – Lakeland, FLSalary Range: $51,000K - $95,000K commensurate with experience and location/job marketHybrid structure: Work schedule is 4 days in-office/month Training Schedule (4 – 6 weeks): Monday – Friday, 8am – 4:30pm; 4 days in office/1 day remote Work Schedule: Monday – Friday, 8:00am – 4:30pm; 4 days in...

POSITION RESPONSIBILITIES:Analyze first reports and promptly contact insured/claimants.Effectively evaluate contract language and identify coverage issues. Promptly and appropriately develop the file to provide accurate and timely investigation and loss analysis.Maintain an active file diary to move file toward resolution.Establish accurate and timely...

Country-Wide Insurance Company is seeking new employees for its upcoming claims training class. Our training program offers a rare opportunity for individuals to receive intensive, hands-on training from expert professionals that can be directly transferred to the field. We are looking for the next generation of exceptional leaders. Essential Functions and...

*Job Purpose*While professional experience and qualifications are key for this role, make sure to check you have the preferable soft skills before applying if required.Processes benefit claims for dental, vision, prescription, medical, retiree medical trust (RMT) benefits, and death benefits. Has knowledge of benefit plan provisions, exclusions, limitations,...

Position Purpose:Position can sit in Atlanta, GA or Orange, CAResponsible for defining, implementing and managing internal claims mediation program, incoming lawsuits and Third Party Claims Administrator (TPA) practices to manage quality and costs associated with bodily injury liability claims. Key Responsibilities:Leads day-to-day operations of a multiline...

At Sedgwick, we prioritize taking care of our colleagues and providing a culture of caring. This means offering flexibility and time for personal pursuits, as well as opportunities for growth and skill development. Our team is dedicated to making a positive impact on the world through our work with clients and communities.Key Responsibilities:Analyze and...

Overview:Find out more about this role by reading the information below, then apply to be considered.Workers' Compensation Claim Representative IITake your career to the next level at CCMSI, a nationally recognized, employee-owned leader in third-party administration for self-insurance services. We’re looking for a dedicated Workers' Compensation Claim...

The Automotive Claims Specialist II facilitates the resolution of customer claims and concerns (includes all physical and digital/online transactions) after a sale and is responsible for the timely and successful arbitration of vehicles between buyer and seller in accordance with auction and NAAA policies. The role will work to gain familiarity with...