Current jobs related to Claims Management Specialist - Whittier, California - Pacer Staffing

  • Claims Service Representative

    1 month ago

    Whittier, California, United States Innovative Management Systems Incorporated Full time

    Job Title: Claims Service SupportWe are seeking a highly motivated and detail-oriented Claims Service Support to join our team at Innovative Management Systems Incorporated. As a Claims Service Support, you will play a critical role in ensuring the satisfaction of our clients and members by delivering exceptional customer service and resolving any inquiries...

  • Medical Claims Specialist

    2 weeks ago

    Whittier, California, United States PIH Health Full time

    Job Title: Medical Biller/CollectorAt PIH Health, we are seeking a highly skilled and detail-oriented Medical Biller/Collector to join our team. As a Medical Biller/Collector, you will play a critical role in ensuring the accurate and timely processing of medical claims, while maintaining excellent relationships with patients, healthcare providers, and...

  • UM Case Manager

    3 weeks ago

    Whittier, California, United States Innovative Management Systems Incorporated Full time

    Job SummaryWe are seeking a highly skilled and experienced UM Case Manager to join our team at Innovative Management Systems Incorporated. As a UM Case Manager, you will be responsible for implementing effective and best practices of Utilization Management, providing high-quality medical care review and service, and making informed decisions regarding...

  • UM Case Manager

    2 weeks ago

    Whittier, California, United States Innovative Management Systems Incorporated Full time

    Job SummaryWe are seeking a highly skilled and experienced UM Case Manager to join our team at Innovative Management Systems Incorporated. As a key member of our Utilization Management team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.Key ResponsibilitiesComply with UM policies and procedures, annual...

  • Health Information Management Specialist

    4 days ago

    Whittier, California, United States CodeForce Full time

    Job Title: Health Information Management SpecialistAt CodeForce, we are seeking a skilled Health Information Management Specialist to join our team. As a key member of our healthcare team, you will be responsible for processing information into patient health records, preparing, scanning, indexing, and quality checking medical records and documents.Key...

  • Food Services Accounting Specialist

    3 weeks ago

    Whittier, California, United States East Whittier City School District Full time

    Job Title: Food Services Accounting SpecialistWe are seeking a highly skilled Food Services Accounting Specialist to join our team at East Whittier City School District.Key Responsibilities:Manage food service accounting and financial operationsEnsure accurate and timely financial reportingDevelop and implement financial policies and proceduresCollaborate...

  • Financial Operations Specialist

    5 days ago

    Whittier, California, United States Decision Point Ministries Full time

    Financial Operations SpecialistDecision Point Ministries is seeking a highly skilled Financial Operations Specialist to join our team. As a key member of our finance department, you will play a critical role in ensuring the financial health and stability of our organization.Key Responsibilities:Financial Coordination: Communicate with staff and bookkeeping...

  • Financial Operations Specialist

    1 week ago

    Whittier, California, United States Decision Point Ministries Full time

    Financial Operations SpecialistDecision Point Ministries is seeking a skilled Financial Operations Specialist to join our team. As a key member of our finance department, you will be responsible for ensuring cohesive financial communication within the organization and implementing our budget plan.Key Responsibilities:Financial coordination: Communicate with...

  • Health Information Specialist

    1 week ago

    Whittier, California, United States vTech Solution Full time

    Job Title: Health Information SpecialistAt vTech Solution, we are seeking a highly skilled Health Information Specialist to join our team. As a key member of our healthcare team, you will be responsible for processing information into patient health records, preparing, scanning, indexing, and quality checking medical records and documents.Key...

  • Business Operations Specialist

    4 weeks ago

    Whittier, California, United States House of Spices India Full time

    Job Title: Business Operations SpecialistHouse of Spices India is seeking a highly skilled Business Operations Specialist to join our team. As a key member of our operations team, you will be responsible for managing and deploying operational strategy, business processes, and systems for overall distribution operations.Key Responsibilities:Manage all supply...

  • Business Operations Specialist

    1 month ago

    Whittier, California, United States House of Spices India Full time

    Business Operations SpecialistHouse of Spices India is a leading wholesale/manufacturer in the specialty food and ingredient category. We are seeking a highly skilled Business Operations Specialist to join our team at the Texas distribution center.Key Responsibilities:Manage all supply chain activities, including product life cycle management, maintenance of...

  • Instructor - Family Support Specialist

    2 weeks ago

    Whittier, California, United States MERCEDES DIAZ HOMES INC Full time

    Job Title: Instructor - Family Support SpecialistJoin our team as a Family Support Specialist, where you will play a vital role in supporting individuals with intellectual and developmental disabilities in their daily lives. As a Family Support Specialist, you will work closely with our team to provide comprehensive support services, including daily living...

  • Store Security Specialist

    4 weeks ago

    Whittier, California, United States Ross Stores Full time

    Job Summary:Ross Stores is seeking a highly skilled and detail-oriented Store Protection Specialist to join our team. As a Store Protection Specialist, you will play a critical role in maintaining a safe and secure environment for our customers and employees.Key Responsibilities:Mitigate theft and fraud by identifying and addressing potential security...

  • Food Safety Compliance Specialist

    4 weeks ago

    Whittier, California, United States H Mart Full time

    Job Title: Food Safety and Health Compliance SpecialistAt H Mart, we are seeking a highly experienced Food Safety and Health Compliance Specialist to join our team. This role will play a pivotal part in ensuring compliance with health and safety regulations across our West Coast locations.Key Responsibilities:Develop, implement, and continuously improve...

  • Exercise Specialist 10 Hour Shift, FT Days

    1 month ago

    Whittier, California, United States PIH Health Full time

    Job Title: Exercise Specialist 10 Hour Shift, FT DaysPIH Health is a leading healthcare provider in the Los Angeles County, Orange County and San Gabriel Valley region. We are seeking an experienced Exercise Specialist to join our team in Cardiac Rehabilitation.Job Summary:The Exercise Specialist will develop, implement and supervise exercise training...

  • Exercise Specialist 10 Hour Shift, FT Days

    2 weeks ago

    Whittier, California, United States PIH Health Full time

    Job Title: Exercise Specialist 10 Hour Shift, FT DaysPIH Health is a leading healthcare provider in the Los Angeles County, Orange County and San Gabriel Valley region. We are seeking an experienced Exercise Specialist to join our team.Job Summary:The Exercise Specialist will develop, implement and supervise exercise training guidelines and sessions for...

  • Exercise Specialist 10 Hour Shift, FT Days

    3 weeks ago

    Whittier, California, United States PIH Health Full time

    Job Title: Exercise Specialist 10 Hour Shift, FT DaysAt PIH Health, we are seeking a highly skilled Exercise Specialist to join our team. As an Exercise Specialist, you will play a critical role in developing and implementing exercise training guidelines and sessions for cardiac rehabilitation patients.Key Responsibilities:Administer fitness assessments on...

  • Payroll Specialist

    2 weeks ago

    Whittier, California, United States Vaco Full time

    Job Title: Payroll SpecialistVaco is seeking a detail-oriented and highly organized Payroll Specialist to join our team. The successful candidate will be responsible for ensuring accurate and timely processing of payroll for our employees.Key Responsibilities:Process payroll for employees on a regular basis, including data entry, calculation of wages, and...

  • Quality Assurance Specialist

    4 weeks ago

    Whittier, California, United States Aerotek Full time

    Job SummaryWe are seeking a highly skilled Quality Assurance Specialist to join our team at Aerotek. As a Quality Assurance Specialist, you will be responsible for conducting online inspections and verifying control parameters according to procedures and instructions for production, filling, and packaging processes.Key ResponsibilitiesConduct online...

  • Food Safety Compliance Specialist

    3 weeks ago

    Whittier, California, United States H Mart Full time

    Job Title: Food Safety and Health Compliance SpecialistJob Summary:The Health and Inspection Specialist will play a pivotal role in overseeing and ensuring compliance with health and safety regulations across our West Coast locations. This role is ideal for a seasoned professional with extensive experience in the health inspection field, preferably someone...

Claims Management Specialist

2 months ago

Whittier, California, United States Pacer Staffing Full time

Shift: Monday - Friday (07:00 - 15:30)

Position Overview:

  • The Claims Management Specialist is accountable to the Claims Supervisor. This role focuses on the essential processing activities (operations, adjudication, and payment) of UB-92 and HCFA-1500 claims submitted by affiliated medical groups and healthcare facilities for HMO patients.

Essential Qualifications:

  • A high school diploma or equivalent is mandatory. Candidates must provide verification of educational background if required.
  • A minimum of 2 years of experience in claims adjudication within an ambulatory, acute care hospital, HMO, or IPA setting is essential.
  • Familiarity with payment structures for Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services is required.
  • Understanding of timeliness and accuracy standards for commercial, senior, and Medi-Cal claims is crucial.
  • Awareness of compliance matters related to claims processing is necessary.
  • Experience in interpreting provider contract reimbursement agreements is preferred.
  • Capability to identify non-contracted providers for Letter of Agreement discussions.
  • Proficiency in data entry is expected.
  • Training in basic office automation and managed care information systems is advantageous.