Senior Claims Examiner

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 OverviewWe are seeking an experienced Claims Senior Casualty Adjuster to handle complex insurance claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements.Salary RangeThe starting pay range for this position is $36.70 - $48.93 per...

About the RoleThe Facility Compliance Review team reviews post-service prepayment facility claims for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never events. As a Utilization Management Nurse, Senior, you will report to the Senior Manager, Facility Compliance Review.

About OnPoint Search ConsultantsWe are a California-based general liability defense firm with a team of 35+ attorneys statewide.Job SummaryWe are seeking a skilled Senior Litigation Attorney to join our team. As a Senior Litigation Attorney, you will be responsible for defending workers' compensation cases and representing third-party administrators,...

About UsSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to make a positive impact on the world through the people and organizations we serve.

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...

At Blue Shield of California, we're seeking an experienced Senior Clinical Utilization Review Nurse to join our Facility Compliance Review team. This role is ideal for a highly skilled professional who can ensure medical necessity and billing standards are met.Key Responsibilities:Conduct retrospective utilization reviews and first-level determination...

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...

Role Overview:The Clinical Coding Analyst RN Senior will be responsible for performing in-depth quality audits of hospital claims to support ICD-10-CM and ICD-10 PCS codes, as well as MS-DRG and APR-DRG reviews based on clinical determination. This role requires a strong understanding of medical necessity and reimbursement requirements, as well as the...

About the RoleAre you a detail-oriented healthcare professional with a passion for delivering high-quality care? Blue Shield of California is seeking a skilled Clinical Coding Analyst RN, Senior to join our team. As a member of our Facility Compliance Review team, you will play a critical role in ensuring the accuracy and integrity of medical coding for our...

Job SummaryWe are seeking a highly skilled Senior Project Manager to join our team at GPAC. As a Senior Project Manager, you will be responsible for delivering superior customer service to our clients while successfully managing commercial construction projects.Key ResponsibilitiesReview and understand the Owner contract language to identify key risk areas...

Critical Role in Enhancing Healthcare QualityThe Senior Clinical Quality Analyst plays a vital part in elevating healthcare quality performance through intricate data analysis and reporting. This position demands the development of sophisticated data systems, the execution of high-level analyses for enhancing healthcare quality metrics, and collaboration...

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...

About the RoleAs a senior member of the Facility Compliance Review team at Blue Shield of California, you will play a critical role in ensuring that post-service prepayment facility claims are thoroughly reviewed for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never events. Reporting directly to the...

Career Consulting Partners is a leading provider of legal services, partnering with top law firms to represent clients across various industries. We are seeking a highly motivated litigation attorney to join our team in Long Beach, California.Job SummaryThis role offers the opportunity to work on complex cases, from case management and motion practice to...

Company Overview:Blue Shield of California is a leading healthcare organization that delivers best-in-class clinical quality analytics and informatics to enable high-quality and affordable member-centered care.About the Role:We are seeking an experienced Data Analyst - Clinical Quality Senior to join our team. This role will provide data, analytic, and...

Role OverviewThe Senior Clinical Quality Analyst plays a pivotal role in enhancing clinical quality performance through complex data analysis and reporting. This position involves the development of data systems, the execution of high-level analyses for improving healthcare quality metrics, and collaboration with various teams to support regulatory and...

Job OverviewBlue Shield of California is seeking a Clinical Quality Analytics Professional - Senior to join our team. This role plays a critical part in delivering best-in-class clinical quality analytics and informatics to enable high-quality, member-centered care.About the RoleThis position reports to the Clinical Quality Manager or Senior Manager and...

We are seeking a seasoned Healthcare Data Analyst Consultant to join our team at Blue Shield of California. In this role, you will leverage your expertise in data analytics and informatics to enhance member-centered care.Job Description:The Clinical Quality Analytics Consultant utilizes data analytics and informatics to drive performance improvement and...

About UsAt Blue Shield of California, we deliver best-in-class clinical quality analytics and informatics to enable high-quality, affordable member-centered care.We use data, intelligence, and actionable insights to drive quality strategy, performance improvement, and regulatory reporting.Your RoleThe Clinical Quality Analyst - Consultant will report to the...