Claims Audit Manager
5 days ago
Advanced Medical Manage is seeking a highly skilled Claims Audit Manager to join our team. As a Claims Audit Manager, you will be responsible for ensuring the accuracy and compliance of claims processing in accordance with AMM policies and procedures.
Key Responsibilities:- Prepares and coordinates the completion of complex regulatory and compliance reports for submission.
- Assists in audit preparations, analyzes information, identifies deficiencies, and tracks corrective action for completion.
- Query, analyze, and interpret data for ad hoc analyses.
- Apply Medicare Claim Payment rules and requirements, including the application of National Coverage Decisions, Local Coverage Decisions, and National Correct Coding requirements to claims received for payment.
- Gather information needed for compliance related activities.
- Participates in quality assurance process for all new department related system/application/process changes.
- Perform pre-payment audits and post payment audits to validate claims for appropriate coding and documentation and validate accurate claim adjudication rules and fee schedules were applied.
- Ability to understand, work with and organize data from various systems and databases: facts, figures, narratives, and data analysis.
- Demonstrate attention to detail and accuracy in work product. Support all levels of claims staff regarding Medicare Commercial, and Medi-Cal, adjudication and coding rules and requirements.
- Locate and download all coding sources for system updating.
- Must have excellent verbal and written communication skills.
- Minimum of five years' experience in healthcare claims processing, or an equivalent combination of education, training, and experience.
- Medi-Cal and Medicare claim processing experience preferred.
- Strong understanding of claims processing workflow and payment rules.
- Detailed knowledge of electronic billing processes and universal billing forms.
- Knowledge of CMS pricers and vendor pricing software.
- Strong written skills to accurately complete required documentation within the time frames specified.
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Claims Audit Manager
4 weeks ago
Long Beach, California, United States Advanced Medical Manage Full timeJob Title: Claims Audit ManagerJob Summary:Advanced Medical Manage is seeking a highly skilled Claims Audit Manager to join our team. As a Claims Audit Manager, you will be responsible for ensuring that incoming claims are processed in accordance with policies, procedures, and guidelines, as outlined by Advanced Medical Manage and contractual agreements.Key...
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Claims Audit Manager
4 weeks ago
Long Beach, California, United States Ultimate Staffing Full timeJob SummaryWe are seeking a highly skilled Claims Audit Manager to join our team at Ultimate Staffing. As a Claims Audit Manager, you will be responsible for ensuring that claims are processed in accordance with company guidelines and contractual agreements, within set time limits, and according to provider contract rates.Key ResponsibilitiesPrepare and...
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Claims Manager
2 weeks ago
Long Beach, California, United States Molina Healthcare Full timeJob Title: Claims ManagerAt Molina Healthcare, we are seeking a highly skilled Claims Manager to join our team. As a Claims Manager, you will be responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation.Key Responsibilities:Monitor and control the backlog...
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Claims Examiner III
4 weeks ago
Long Beach, California, United States Advanced Medical Manage Full timeJob Description**Role Overview**The Claims Examiner III is a critical position within the Advanced Medical Manage organization, playing a vital role in the Claims Department. This role requires collaboration with the Claims Team to meet productivity goals and ensure quality. The ideal candidate will possess claims knowledge, prioritization skills, and the...
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Medical Claims Auditor
4 weeks ago
Long Beach, California, United States Advanced Medical Manage Full timeJob Description**Role Overview**The Claims Examiner III is a critical position within the Advanced Medical Manage organization, playing a vital role in the Claims Department. This role requires collaboration with the Claims Team to meet productivity goals and ensure quality. The ideal candidate will possess claims knowledge, prioritization skills, and the...
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Claims Examiner III
5 days ago
Long Beach, California, United States Advanced Medical Manage Full timeJob DescriptionRole OverviewThe Claims Examiner III is a critical role within the Advanced Medical Manage team, responsible for ensuring the quality and accuracy of claims processing. This position requires a strong analytical mind, excellent problem-solving skills, and the ability to work effectively in a fast-paced environment.Key ResponsibilitiesAudit...
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Medical Claims Examiner
5 days ago
Long Beach, California, United States Ultimate Staffing Full timeJob Title: Medical Claims ExaminerThis is an exciting opportunity to join our team as a Medical Claims Examiner in the greater Long Beach/Los Angeles area. As a key member of our Claims department, you will play a crucial role in ensuring the accuracy and efficiency of our claims processing.Responsibilities:Audit claims processing quality and develop reports...
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Medical Claims Examiner
1 week ago
Long Beach, California, United States Ultimate Staffing Full timeJob Title: Medical Claims ExaminerWe are seeking a highly skilled Medical Claims Examiner to join our team at Ultimate Staffing. As a Medical Claims Examiner, you will be responsible for reviewing and processing medical claims to ensure accuracy and compliance with industry guidelines.Responsibilities:Review and process medical claims to ensure accuracy and...
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Warranty Claims Manager
3 weeks ago
Long Beach, California, United States DENSO International America , Inc. Full timeJob Summary:As a Warranty Claims Manager at DENSO International America, Inc., you will be responsible for overseeing the daily work of warranty claims administrators and analysts. Your primary goal will be to maintain, control, and improve the daily operations of the Warranty Claims department activities, processes, and systems.Key Responsibilities:Develop...
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Claims Team Lead
1 week ago
Long Beach, California, United States Sedgwick Full timeAbout SedgwickSedgwick is a leading provider of claims management and benefits services. We are committed to delivering exceptional results and exceeding our clients' expectations.Job SummaryWe are seeking a highly skilled Claims Team Lead to join our team. As a Claims Team Lead, you will be responsible for supervising a team of claims examiners and...
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Claims Unit Manager
7 days ago
Long Beach, California, United States American Automobile Association Full timeJob SummaryThis leadership role is responsible for overseeing the Claims business unit, ensuring effective loss and expense management, employee development, and succession planning. The ideal candidate will have a strong background in claims handling and operations, with a proven track record of managing teams and driving results.Key ResponsibilitiesManage...
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Claims Unit Manager
2 weeks ago
Long Beach, California, United States Automobile Club of Southern California Full timeJob SummaryThis leadership position is responsible for managing claims teams and ensuring effective loss and expense management, employee development, and succession planning. The ideal candidate will have a strong background in claims handling and operations, with experience in management and supervision.Key ResponsibilitiesManage claims teams to ensure...
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Claims Associate
1 day ago
Long Beach, California, United States Cynet Systems Full timeJob Description:Job Summary:Cynet Systems is seeking a skilled Claims Associate to join our team. As a Claims Associate, you will be responsible for processing low-level workers compensation claims, determining compensability and benefits due, and ensuring accurate reserve management.Key Responsibilities:Process low-level workers compensation claims,...
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Claims Specialist
1 day ago
Long Beach, California, United States Cynet Systems Full timeJob Title: Claims AssociateJob Summary:Cynet Systems is seeking a skilled Claims Associate to join our team. As a Claims Associate, you will be responsible for processing low-level workers compensation claims, determining compensability and benefits due, and administering action plans to resolution.Key Responsibilities:Process low-level workers compensation...
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Audit Manager
1 week ago
Long Beach, California, United States Jobot Full timeAbout the RoleWe are seeking a highly skilled and experienced Audit Manager to join our team at Jobot. As a key member of our finance department, you will play a pivotal role in ensuring the accuracy and integrity of our financial operations.ResponsibilitiesManage and oversee the daily operations of the assurance department, ensuring all financial operations...
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Claims Examiner
4 weeks ago
Long Beach, California, United States Sedgwick Full timeAbout the RoleSedgwick is seeking a highly skilled Claims Examiner to join our team. As a Claims Examiner, you will play a critical role in analyzing and processing workers' compensation claims to ensure timely and accurate resolution.Key ResponsibilitiesAnalyze and process claims through well-developed action plans to achieve timely resolution.Negotiate...
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Claims Assistant
2 weeks ago
Long Beach, California, United States Procom Full timeJob SummaryProcom is seeking a detail-oriented Claims Assistant to support the administration of workers' compensation claims. As a key member of our team, you will perform clerical and data entry tasks, ensuring accurate and timely documentation.Key ResponsibilitiesSet up new claims in our system and prepare paper files, verifying documentation...
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Claims Examiner
1 day ago
Long Beach, California, United States Mary Kraft HR Full timeJob Title: Claims Examiner - Workers CompensationMary Kraft HR is seeking an experienced Claims Examiner - Workers Compensation to analyze complex workers' compensation claims and determine benefits due. The ideal candidate will have expertise in workers' compensation principles, insurance laws, recoveries, claim durations, and cost containment practices.Key...
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Claims Resolution Specialist
3 weeks ago
Long Beach, California, United States VirtualVocations Full timeVirtualVocations is seeking a highly skilled Claims Representative Sr to provide exceptional customer service to customers and retailer partners. The ideal candidate will possess strong communication skills, attention to detail, and the ability to manage multiple claims simultaneously. Key Responsibilities: \tManage inbound customer and retailer inquiries...
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Workers Compensation Claims Adjuster
3 weeks ago
Long Beach, California, United States Sedgwick Full timeAbout the RoleSedgwick is seeking a skilled Workers Compensation Claims Adjuster to join our team. As a key member of our claims team, you will be responsible for analyzing and processing complex claims to ensure timely and accurate resolution.Key ResponsibilitiesAnalyze and process claims through well-developed action plans to achieve timely...