We have other current jobs related to this field that you can find below
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Hospital Risk Claims Specialist
5 days ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewThe Hospital Risk Claims Specialist plays a crucial role in managing hospital-related risk claims, ensuring compliance with external regulations and the contractual commitments of Health Plans and/or Hospitals/IPAs. This position involves thorough research, review, and communication with provider services to resolve claims-related issues...
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Senior Claims Adjustment Specialist
6 days ago
Los Angeles, California, United States Motion Picture Industry Pension & Health Plans Full timePosition Overview:We are seeking a meticulous and experienced Senior Claims Adjustment Specialist to join our dynamic Medical Claims Department. This role is essential in ensuring the accurate and timely processing of medical claims adjustments.About the Organization:The Motion Picture Industry Pension & Health Plans (MPI) is a distinguished multi-employer...
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Senior Accounting Specialist
5 days ago
Los Angeles, California, United States MedPOINT Management Full timeSenior Accounting Specialist Position at MedPOINT ManagementThe Senior Accounting Specialist is integral to the Finance department at MedPOINT Management, delivering vital accounting and revenue verification assistance to key personnel such as Financial Analysts, Finance Managers, and the Chief Financial Officer. This role involves ensuring the timely and...
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Claims Operations Support Specialist
5 days ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewPosition Summary:The Claims Operations Support Specialist plays a crucial role in facilitating the daily functions of the claims department. This position is designed to assist various sub-departments within Claims Operations, ensuring seamless workflow and efficiency.Key Responsibilities:• Digitally archive claims and relevant documents into...
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Senior Claims Adjustment Specialist
6 days ago
Los Angeles, California, United States Motion Picture Industry Pension & Health Plans Full timeThe Motion Picture Industry Pension & Health Plans (MPI) is seeking a meticulous and organized Senior Claims Adjustment Specialist to enhance our Medical Claims Department within the Adjustments Team. Position Overview:This role is essential for ensuring the precise and timely processing of medical claims adjustments. Key Responsibilities:Evaluate and test...
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Managed Care Claims Specialist
1 hour ago
Los Angeles, California, United States Avispa Technology Full timeClaims Assessment Specialist - Managed Care Providers Avispa Technology is currently seeking a Claims Assessment Specialist to join a leading hospital and healthcare organization. This role involves conducting thorough reviews of claims and billing processes, managing denial resolutions, and processing various payer types including Medicare and...
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Claims Review Specialist
5 days ago
Los Angeles, California, United States MedPOINT Management Full timePosition Overview:We invite you to explore an exciting opportunity with MedPOINT Management as a Claims Examiner. This role is essential for ensuring the accurate processing and evaluation of provider specialty claims.Role Summary:The Claims Examiner will be responsible for the meticulous review, input, and adjudication of provider specialty claims,...
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Claims Assessment Specialist
2 days ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewSummary:Effectively manage, evaluate, and process provider specialty claims, including UB04 forms, in accordance with external regulations, internal protocols, and contractual obligations. A solid grasp of medical terminology is essential. Extensive knowledge of Commercial, Medicare, and Medi-Cal coding is required. Basic computer proficiency is...
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Hospital Claims Auditor
2 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionSummary:A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Research, reviews and contacts provider services for problem claims and issues, as needed....
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Hospital Claims Auditor
2 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionSummary:A Hospital Claims Auditor is responsible for the overall quality of claims processes as well as compliance, in accordance with outside regulations and the contractual obligations of the Health Plans and/or Hospital Clients. Research, reviews and contacts provider services for problem claims and issues, as needed....
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Healthcare Claims Quality Auditor
3 hours ago
Los Angeles, California, United States MedPOINT Management Full timeJob OverviewPosition Summary:A Healthcare Claims Quality Auditor plays a crucial role in ensuring the integrity of claims processing and adherence to regulatory standards, in alignment with the contractual commitments of Health Plans and Hospital Clients. This position involves investigating, reviewing, and liaising with provider services regarding claims...
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Claims Assessment Specialist
5 days ago
Los Angeles, California, United States Avispa Technology Full timeClaims Assessment Specialist - Managed Care Providers Avispa Technology is looking for a skilled Claims Assessment Specialist to join our team. This role involves performing thorough reviews of claims and billing processes, managing denial resolutions, and processing various payer types including Medicare and Commercial Payers. The ideal candidate will...
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Claims Assessment Specialist
5 days ago
Los Angeles, California, United States Preferred IPA of California Full timePOSITION SUMMARYThe Claims Assessment Specialist plays a crucial role in ensuring the precise and prompt evaluation of both paper and electronic claims submitted in CMS 1500 and UB-04 formats. This role involves processing all claims and relevant correspondence in alignment with Medicare and Medi-Cal regulatory standards, contractual obligations, and...
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Claims Processing Specialist
5 days ago
Los Angeles, California, United States Preferred IPA of California Full timePOSITION SUMMARYThe Claims Processing Specialist is tasked with ensuring the precise and prompt evaluation of claims submitted in CMS 1500 and/or UB-04 formats. This role involves managing all claims and related correspondence in compliance with Medicare and Medi-Cal regulations, contractual obligations, and established operational protocols. The Specialist...
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Claims Review Specialist
3 weeks ago
Los Angeles, United States Avispa Technology Full timeJob DescriptionJob DescriptionClaims Review Specialist - Managed Care Providers 2600101 One of the most prestigious hospital and health care systems is seeking a Claims Review Analyst to conduct claims and biliing reviews, handle denials management and process Medicare, Medi-Cal and Commercial Payers. The ideal candidate has 3+ years previous experience...
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Senior Construction Claims Consultant
5 days ago
Los Angeles, California, United States AXA Group Full timeSenior Construction Claims Consultant At AXA Group, we pride ourselves on our commitment to excellence in claims management. Our Construction Defect Claims team is integral to our operations, handling intricate and high-stakes claims with expertise and precision. As a Senior Construction Claims Consultant, your primary responsibility will be to manage...
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Claims Examiner
1 month ago
Los Angeles, United States MedPOINT Management Full timeJob Description Summary: Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with ability to...
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Claims Evaluation Specialist
5 days ago
Los Angeles, California, United States Avispa Technology Full timeJob OverviewClaims Review Specialist - Managed Care ProvidersA leading healthcare organization is in search of a Claims Review Specialist to perform comprehensive reviews of claims and billing processes, manage denial resolutions, and oversee transactions involving Medicare, Medi-Cal, and various Commercial Payers. The ideal candidate will possess over three...
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Claims Examiner
4 weeks ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionPlease ensure you read the below overview and requirements for this employment opportunity completely. Summary: Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical...
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Claims Examiner
3 months ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob Description Summary:Accurate review, input and adjudication of provider specialty claims, including UB04s, in accordance with outside regulations, internal production standards and the contractual obligations. Knowledge of medical terminology necessary. Strong knowledge of Commercial, Medicare and Medi-Cal codes. Basic PC knowledge with...
Senior Claims Specialist, Management Liability_
2 months ago
This is your opportunity to join AXIS Capital – a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry. At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process. Under limited supervision, acts as highest level individual contributor directly reviewing primary and excess Financial Institutions and Management Liability claims to determine nature of loss, coverage provided, and scope of claim and to make recommendations regarding settlement/disposition of claims. Responsible for severity inventory. ***Please note this role can be based in any Axis office locations, including NYC, Short Hills, NJ, Red Bank, NJ; Princeton, NJ; Alpharetta, GA; Chicago, IL*** Hybrid work - 3 days in the office required. KEY DUTIES & RESPONSIBILITIES: • Highest level individual contributor directly responsible for inventory of complex, severity Financial Institutions and Management Liability claims. • Excels in a best practices claim environment, thoroughly documenting the claim process. • Responsible for the timely evaluation, reserving and disposition of assigned claims • Documents coverage, investigation, damages, reserve rationale, negotiations, etc. associated with claim. • Experience working with internal and external business partners on severity matters, including presentations to senior leaders within Claims and Underwriting. • Makes effective recommendations for settlement/disposition of claims; works successfully with senior Claims and Underwriting leadership to assess and resolve severity losses. • Identifies and appropriately navigates complicated coverage issues including allocation. • Prepares required reports and authority requests to senior management. • Travels to mediations or settlement conferences on behalf of Company as needed (approximately 10%). • Other duties as assigned. REQUIRED EDUCATION/TRAINING & EXPERIENCE: • Juris Doctorate or equivalent relevant work experience. • Typically requires 7 to 10 years of relevant claims handling experience or equivalent private practice experience; legal experience at an insurance defense or coverage law firm a plus. • Proficient in independently analyzing coverage, identifying issues and preparing coverage correspondence. • Experience handling Complex Professional Liability claims, including Public Company or Executive Risk claims, Private Company D&O, Private Equity and Bankers Professional Liability products. • Proficient in drafting coverage correspondence, experience writing coverage letters and handling complicated coverage issues such as allocation. • Excellent communication skills. OTHER DESIRED SKILLS & CHARACTERISTICS: • Proficiency in Microsoft Office suite applications (Outlook, Word, Excel, PowerPoint and OneNote) and Share Point. • Strong writing and oral communication skills. • Good negotiation and analytical skills • Team player • Adjuster’s license. For this position, we currently expect to offer a base salary in the range of New York, NY//Red Bank, NJ $110 - $150K; Short Hills, NJ $100 -$140K; Chicago, IL $90 - $130K; Alpharetta, GA $85 - 120K. The specific salary offer will be based on an assessment of a variety of factors including the experience of the successful candidate and their work location. In addition, all employees are eligible for competitive incentive targets, with awards based on overall corporate and individual performance. On top of this, we offer a comprehensive and competitive benefits package which includes medical plans for employees and their families, health and wellness programs, retirement plans, tuition reimbursement, paid vacation, and much more.
