Medical Claims Review Specialist

**99% remote, only the orientation will be onsite and a few meetings when necessary.** **CPC-H, CPC, or CCS coding certification required.** Job Summary: **Responsibilities**: - Review and process medical claims for accuracy and completeness - Verify insurance coverage and eligibility for claim submission - Ensure compliance with Medicare, HCPCS, ICD-10,...

Los Angeles Unified School District (LAUSD) is the 2nd largest public school district in the United States. The school district consists of Los Angeles and all or portions of several adjoining Southern California cities. LAUSD educates and empowers all students as future leaders. Job Summary Los Angeles Unified School District (LAUSD) Workers' Compensation...

Job DescriptionJob DescriptionThe Senior EDI Claims Specialist is responsible for overseeing the retrieval, processing, validation, and posting of electronic claim data files into MPM’s core system, EZ-CAP®. Serving as a subject matter expert, the Senior EDI Claims Specialist will support the EDI Claims Team through training, monitoring of workflows,...

Required Skills & ExperienceExtensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.Extensive knowledge of Plan benefits, group insurance, and Medicare principals.Knowledge of Coordination of Benefits rules.Considerable knowledge of basic math.Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Required Skills & ExperienceExtensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.Extensive knowledge of Plan benefits, group insurance, and Medicare principals.Knowledge of Coordination of Benefits rules.Considerable knowledge of basic math.Ability to maintain production standards in a detail‐oriented, quality‐conscious service...

Job Description Allied Universal® is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to...

MUST LIVE IN CALIFORNIA - ROLE IS REMOTE Must Have Must be a current resident of either CA or TX. Minimum of 5 years of claims management experience. Significant experience with CA auto claims, preferably non-standard auto. Must have a current CA adjusting license. Must have a valid passport and be willing to travel, including international travel. Selling...

The Claims Analyst is responsible for monitoring liability claims, verifying and updating information on submitted claims. Reviews contract information and policies to determine which charges are eligible for reimbursement. Ensures completeness and accuracy with claims processing in order to support the organization’s revenue cycle. •Reviews claims and...

**About C2PM**:C2PM stands at the forefront of the construction consulting landscape, offering a full spectrum of program management, construction management, and specialized engineering services. We pride ourselves on tackling public works infrastructure, transportation, aviation, maritime, federal, water, and wastewater projects with unmatched...

Job DescriptionJob DescriptionSummaryThe claims adjuster is responsible for the adjusting of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a...

Job Summary The Manager, Claims directs the efforts of others in the achievement of the strategic, regulatory and operational objectives of the Health Plan. Provides direct supervision to a team of claims examiners, data entry clerks and claims assistants and continuously monitors department for compliance with regulatory requirements. Ensures all work...

Salary Range: $102, Min.) - $132, Mid.) - $163, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

Job DescriptionJob DescriptionThe EDI Claims Specialist is responsible for retrieving, processing, validating, and posting electronic claim data files into MPM’s core system, EZ-CAP®. Reporting to the Supervisor, EDI Claims, the EDI Claims Specialist will ensure all files are processed timely and meet compliance regulations. Duties and Responsibilities...

Salary Range:  $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)   Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2...

Administer claims inclusive of receiving, reviewing, and approval of claims as submitted from claimants and/or distributors for payment. Identify liable carrier, filing of claim, collection of funds, and file maintenance. Interact with claimants, dis Claims Analyst, Claims, Marine, Analyst, Insurance

_**This is an open call for resumes from Veterans, **_**VRA eligible, 30% or more disabled, VA Training Program, and Military spouses**_**. This is not a guarantee of employment.**_ For consideration at SSA under non-competitive hiring authorities for veterans, please visit FedsHireVets.gov to learn more about opportunities for veterans. **Duties** -...

Salary Range: $55, Min.) - $69, Mid.) - $75, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...

Job DescriptionJob DescriptionOur client is looking for a strong claims adjuster with a background in either worker's comp or bodily injury claims. This position is entirely remote.Under general supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefits schedules and...

Chubb is currently seeking an AVP, Claims Manager to manage a team of examiners dedicated to handling litigated Employment Practices Claims and higher severity non-litigated claims. The team will be responsible for handling claims on behalf of Chubb Insureds across the United States. The position will be based in our Los Angeles, CA office and report to the...

Claims Data Entry Clerk II Job Category: Claims Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 10820 Salary Range: $45,760.00 (Min.) - $47,823.00 (Mid.) - $55,818.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of...