Claims Resolution Specialist

We are seeking a highly skilled Senior Claims Examiner to join our team at TheBest Claims Solutions in Long Beach, California. This is an exciting opportunity for a seasoned professional with extensive experience in handling complex workers' compensation claims.About the Job:The ideal candidate will have 3+ years of experience in managing workers'...

Job OverviewWe are seeking a highly motivated and detail-oriented Tax Resolution Specialist to join our team at Tax Resolution Group LLC. As a key member of our accounting firm, you will be responsible for preparing individual and business tax returns, ensuring accuracy and compliance with federal, state, and local tax laws.This is an in-office position, and...

About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our purpose is to take care of people, and we strive to make a positive impact on the world through the people and organizations we serve.Job DescriptionWe are seeking a skilled Compensation Claims Adjudicator to join our team. As a...

Job OverviewThe Medical Claims Review Specialist will be responsible for reviewing facility claims to ensure compliance with medical necessity and billing standards. This role involves conducting retrospective utilization reviews, preparing cases for medical director oversight, and ensuring adherence to regulatory and accreditation requirements.Key...

At Sedgwick, we believe in the value of caring for our colleagues and clients alike. Our mission is to provide exceptional service and support to those who need it most.What We Offer:We offer a comprehensive benefits package that includes medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or...

Job OverviewThe American Automobile Association is seeking a skilled Insurance Liability Specialist to join our team. This role will involve handling low to moderate-complexity claims, ensuring compliance with regulatory and statutory requirements.ResponsibilitiesLiability Investigation: Conduct thorough investigations to determine liability and damages in...

About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to help our clients protect their brand, minimize business interruptions, and provide exceptional customer experiences. Job Description: Claims Team Lead - Workers CompensationPrimary Responsibilities:Supervise multiple...

Job OverviewAt Advanced Medical Manage, we are seeking an EDI Process Specialist to join our team. This is a unique opportunity to work in a fast-paced environment and make a significant impact on the organization's operations.Salary: $80,000 - $110,000 per yearAbout the RoleThe EDI Process Specialist will be responsible for managing and overseeing...

Job OverviewWe are seeking a highly skilled Medical Biller to work closely with our team at JOSEPH VARDAYO MD INC. This role requires strong attention to detail, excellent customer service skills, and the ability to work in an office environment.Key Responsibilities:Process insurance claims through private insurance and Medicaid/Medicare.Collect and verify...

Job OverviewWe are seeking an experienced General Liability Claims Specialist to join our team at Insure National, LLC in Huntington Beach, CA.About the Role:This is a Contract-to-hire position with a hybrid work environment, requiring in-office presence on Mondays, Tuesdays, and Thursdays.A minimum of 5+ years of experience handling General Liability claims...

Job SummaryWe are seeking a highly skilled and detail-oriented Medical Billing & Back Office Specialist to join our team at Vensure Employer Services. This individual will be responsible for processing medical claims, collecting patient or provider payments, resolving questions and problems with customer accounts, and performing various administrative...

At Blue Shield of California, we're seeking a highly skilled Healthcare Compliance Specialist to join our Facility Compliance Review team. As a key member of this team, you will play a vital role in reviewing post-service prepayment facility claims for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never...

Senior Healthcare Compliance Specialist Job DescriptionIn this challenging role, you will be responsible for conducting retrospective utilization reviews to ensure compliance with medical necessity and billing standards.The ideal candidate will possess strong analytical skills and effective communication to manage claims and improve quality of care. You will...

Job SummaryThe Clinical Review Specialist, Senior at Blue Shield of California will lead retrospective utilization reviews and first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare and FEP.Key...

At the Department of Energy, Environment and Climate Action, we are seeking a highly skilled Strategic Assets Procurement Specialist to join our Roads and Fixed Assets unit.This fixed-term position is available until 31 October 2025. The successful candidate will have the flexibility to work from various locations within Victoria with hybrid work...

**Overview of Blue Shield of CaliforniaWe are a not-for-profit health plan that provides high-quality healthcare services to millions of Californians. Our mission is to make a meaningful difference in the lives of our members by delivering innovative, patient-centered care.About the RoleWe are seeking an experienced Clinical Review Specialist - Utilization...

General Liability Claims Adjuster Role OverviewWe are seeking an experienced General Liability Claims Adjuster to join Insure National, LLC in Huntington Beach, CA.Key Responsibilities:Evaluate and process claims from initiation to resolution.Develop and maintain strong relationships with clients and stakeholders.Requirements:5+ years of experience in...

Job OverviewSalary: $80,000 - $120,000 per yearTGG Accounting seeks a skilled Production Leadership Specialist to oversee daily production targets, promote a positive and safe work environment, and drive high performance across crews in our fast-paced production department.Key ResponsibilitiesDaily Operations: Ensure the production site is opened and closed...

Blue Shield of California seeks a Pharmacy Support Specialist to join our team.Estimated Salary: $60,000 - $80,000 per yearAbout the RoleIn this role, you will be part of our Pharmacy Prior Authorization team, providing efficient and accurate responses to external customers and internal team members for all outpatient pharmacy benefit inquiries.You will...

Job OverviewThe Children's Clinic is seeking a skilled IT Technical Support Specialist II to join our dynamic team. This role will be responsible for providing second-line technical support to staff, managing IT projects, and facilitating issue resolution.Key Responsibilities:Project Assistance: Collaborate with the IT department to manage IT projects and...