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Pay will be determined by several factors, including, but not limited to: applicant's education, relevant work experience, knowledge, applicable and relevant skills and abilities, market demand, Company budget, as well as internal equity and alignment with geographic market data. Will walk doors to validate inventory to match drivers returns manifest, validate returns accuracy, service and Quality Support and ensure all items are dispositioned and tagged.

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Living Spaces Furniture LLC

AM-Warehouse Returns Processor

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We're looking for a Director, Product (Pharmacy Claims Platform) who brings deep experience developing pharmacy claims adjudication technology, understands how it works in a real-world PBM environment, and wants to help advance sophisticated pharmacy transaction capabilities. At least 8 years in product management or related platform roles, including at least 3 years directly accountable for the product requirements, priorities, and production delivery of a pharmacy claims adjudication engine or substantial core adjudication platform capabilities.

YEAR

Prescryptive Health Inc

Director Product Pharmacy Claims Platform

Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.

<p>CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all. </p>

CVS Health Corp

Senior Claims Benefit Specialist

The ideal candidate can independently identify systemic gaps, translate complex operational issues into actionable technical requirements, and partner with Product and Engineering to drive sustainable solutions. End-to-End Adjudication Knowledge: Demonstrated expertise in claims adjudication workflows, benefit hierarchy, health plan configuration, pend rules, and identifying systemic processing gaps.

CollectiveHealth Inc

Senior Manager, Claims Systems

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Analyze claim details and apply applicable benefits criteria to determine appropriate payment or denial outcomes.

Pyramid Consulting, Inc

Medical Claims Specialist

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Research and determine Reinsurance/Stoploss plan year, identify claim payments made by client versus the Stoploss carriers, and interpret complex plan language to ensure accurate handling of complex adjustments. Review, research, and adjust complex Reinsurance/Stoploss medical claims, splitting claims into multiple claim statuses; adjudicates high-dollar complex, sensitive, and/or specialized medical claims in accordance with claim processing guidelines.

Reinsurance/Stoploss Medical Claims Adjustor

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Perform data reconciliation between files, databases, data extracts, and source systems.

Healthcare Data Analyst (SQL, Claims & Reconciliation)

Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, Blue Card, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe. Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation.

Western Growers

Claims Examiner I (51691)

Claims Examiner I (50480)

ADAPTED_NOW

This exciting role offers the opportunity to deliver exceptional customer service and support to key clients, ensuring their benefit, eligibility, and reimbursement needs are managed efficiently and accurately. Join a collaborative team where your language skills and healthcare knowledge can make a real difference in people's lives, all while working remotely within a supportive company culture.

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<h4><strong>At JSG, We Understand People</strong></h4>
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<p>It is our mission to empower people, help our clients reach their goals, and hire motivated individuals.</p>
<p>Since our start in 1984, we’ve worked hard to establish our present position as the most effective cross-industry staffing and consulting solution available.</p>
<p>Headquartered in Chicago, IL with local offices throughout the United States and Canada, JSG proudly serves a diverse range of industries with the right solutions to help clients reach their company goals. Our client-centric approach enables us to create personalized solutions for businesses in need of top-tier talent.  Our dedication doesn’t stop at our clients. We strive to connect candidates with opportunities that match their skills and goals. More than just a go-between, we are a dependable bridge, uniting top talent with suitable opportunities, facilitating shared opportunities and growth.</p>
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Johnson Service Group

Customer Service - Claims Processing-Bilingual Spanish

Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Working under the direction of the Manager, Claims, this position has direct responsible for the supervision of staff and for overseeing the day-to-day operations of the Claims Processing and UM Denial Letter Units.

Providence St. Joseph Health

Supervisor Claims

This opportunity is ideal for candidates with experience in healthcare administration, medical billing, insurance, benefits, or claims who are comfortable working with detailed information and managing a steady volume of transactions. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Lee Hecht Harrison

Claims Specialist

We are hoping you will join us as a Business Analyst Sr, Claims, Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will support staff on issues related to California Department of Managed Health Care (DMHC), Department of Healthcare Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) claims regulations, reference guides, All Plan Letters (APLs) and other applicable regulatory guidance affecting all lines of business.

CalOptima

Business Analyst Sr, Claims, Covered California

You will also provide clerical, administrative, and technical assistance to the assigned claims staff; maintain specific, timely, accurate coding and file updates to support data warehouse searches for claims processing and TDC research projects. Benefits: The Doctors Company offers competitive compensation, an incentive bonus plan, outstanding career opportunities, an exceptional work environment, and an impressive benefits package, which starts with medical, family and bereavement leave; same-sex domestic partner benefits; short- and long-term disability programs; and an employee assistance program.

The Doctors Company

Claims Administrative Specialist

This role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

North East Medical Service

MSO Claims Manager

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Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. This role collaborates with internal departments, leadership, providers, clients, and external stakeholders to ensure timely, accurate, and compliant research outcomes while promoting operational excellence and continuous process improvement.

Gainwell Technologies LLC

Medical Claims Research Analyst Lead - Remote California

Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. The pay range for this position is $54,200 - 77,400 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Claims Suspense Supervisor - Hybrid - West Sacramento, CA

Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Claims Examiner I

Primarily seated work; extensive computer and telephone use; occasional standing, walking, reaching, bending, and lifting up to 10 lbs. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received.

ModivCare Inc.

Claims Analyst III

Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.

Claims Processor Jobs in California

AM-Warehouse Returns Processor Living Spaces Furniture LLC

Director Product Pharmacy Claims Platform Prescryptive Health Inc

Senior Claims Benefit Specialist CVS Health Corp

Senior Manager, Claims Systems CollectiveHealth Inc

Medical Claims Specialist Pyramid Consulting, Inc

Reinsurance/Stoploss Medical Claims Adjustor CVS Health Corp

Healthcare Data Analyst (SQL, Claims & Reconciliation) Pyramid Consulting, Inc

Claims Examiner I (51691) Western Growers

Claims Examiner I (50480) Western Growers

Customer Service - Claims Processing-Bilingual Spanish Johnson Service Group

Supervisor Claims Providence St. Joseph Health

Claims Specialist Lee Hecht Harrison

Business Analyst Sr, Claims, Covered California CalOptima

Claims Administrative Specialist The Doctors Company

MSO Claims Manager North East Medical Service

Medical Claims Research Analyst Lead - Remote California Gainwell Technologies LLC

Claims Suspense Supervisor - Hybrid - West Sacramento, CA Gainwell Technologies LLC

Claims Examiner I Lee Hecht Harrison

Claims Analyst III ModivCare Inc.

Claims Examiner I GuideWell Mutual Holding Corp

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