ul>Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and. Minimum 1 year of experience in claims examining or customer service within healthcare, insurance, finance, or managed care environment; or equivalent combination of relevant experience and education. PRIMARY PURPOSE: To supervise a team of liability claims examiners and adjusters; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the teams including frequent diaries on complex or high exposure claims. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Walnut Creek, CA30+ days ago p>JOB DESCRIPTION:Essential Duties & Responsibilities: • Performs a combination of duties in accordance with departmental guidelines: • Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. • Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. Walnut Creek, CA28 days ago p>Performs a combination of duties in accordance with departmental guidelines: - Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages.
- Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements.
Walnut Creek, CA7 days ago p>JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
Proficiency in Typescript, JavaScript, ES6, HTML, CSS, and Angular framework, Strong understanding of component-based development, familiarity with Angular, Vue.js, ReactJS, or any other equivalent library, framework2-3 years of experience building applications with Angular, Typescript, HTML, CSS, Proficiency with software engineering best practices, including writing production quality code, agile development, version control, Degree in Computer Science or related, or equivalent experience, Experience with NodeJS is a plus. Build and maintain multiple tools in Angular, Typescript, JavaScript, Learn complex systems pertaining to claims, be responsible for deployment stability and usability of applications, Work with agile requirements, Collaborate with backend developers, testers, end users, Demonstrate ability to communicate and collaborate effectively at all levels in the organization and across multiple disciplines, Alignment with Teslas mission of accelerating the worlds transition to sustainable energy. Walnut Creek, CA27 days ago In these roles, you will be responsible for the analysis and management of moderate to complex workers' compensation claims, including reviewing, investigating, and making determinations around coverage, compensability, and claim appropriateness. Success in this role requires strong judgment, consistent performance, and a high level of competency in negotiating settlements, managing subrogation, and delivering sound, compliant outcomes. This role is responsible for analyzing claims data, identifying trends, and delivering actionable insights using advanced tools such as Microsoft Excel, Power BI, and Tableau, while also supporting key administrative and operational workflows. Fueled and driven by capable, committed people who share common beliefs and values and bring it every day, EPIC is always looking for people who have the right stuff people who know what they want and arent afraid to make it happen. p>Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Adjusting various levels of workers' compensation claims under close supervision, which includes: Processing and responding to incoming mail, emails and other claim related documents according to status of the claim. The position is co-responsible for the operational functions for the organization's capitated hospital and medical group business, processing all claims, oversees customer service issues, researching/resolving payment issues and addressing corrections in the system with the Claims Specialist. Requires a high comfort level with taking initiative and responsibility, high energy and productivity, plus an orientation and ability to manage details in an organized work style. p>The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children's Hospital Oakland (BCH Oakland), By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production supports all electronic claim production to various payers and clearinghouses, including Medicare, Medi-Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally. San Francisco, CA30+ days ago Team Collaboration: Work closely with cross-functional teams, including developers, and product managers, to gather requirements and ensure solutions meet business needs. Lead full-stack development and support of services across backend (Java/Spring Cloud), integration platforms (Kafka, Mulesoft), and frontend (React/Angular/GraphQL etc.). San Francisco, CA4 days ago This is your opportunity to make a meaningful impact by resolving claims efficiently, mitigating risks, and delivering exceptional service. : In this role, you’ll manage Workers' Compensation indemnity claims, ensuring they’re handled with care and precision. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. This is your opportunity to make a meaningful impact by resolving claims efficiently, mitigating risks, and delivering exceptional service. : In this role, you’ll manage Workers' Compensation indemnity claims, ensuring they’re handled with care and precision. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. The Senior Claims Examiner will adjust workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) . The Senior Claims Examiner will adjust workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) . The Senior Claims Examiner will adjust police and fire 4850 workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. Responsibilities: When we hire supervisors at CCMSI, we look for people-leaders who recognize that every claim impacts a real person’s livelihood, hold themselves and their teams accountable for results, and approach challenges as opportunities to develop others and drive excellence.. At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. Fairfield, California30+ days ago ul>Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and. Follows established Partnership policies and procedures, Partnership Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims. San Francisco, CA30+ days ago Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. p>LHH is working with a leading organization is seeking a Senior-level Workers' Compensation Claims Specialist to manage a high-volume California desk with a strong focus on litigated claims. To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.lhh.com/us/en/candidate-privacy. p>Knowledge and Skills: As a Property Claims Field Adjuster 1, you will: Concord, California14 days ago p style="margin:0px">Learn more about us here: https://www.mercuryinsurance.com/about/careers. As a Property Claims Field Adjuster 1, you will: • Possess the ability to work independently with limited or no supervision over daily activities required to successfully investigate, evaluate, write damage estimates, negotiate, and resolve property claims . |