Claims Adjuster III, CA Job Locations US CA Irvine Requisition ID 2024 16316 Category Claims Workers Compensation Position Type Regular Full Time Overview The Workers' Compensation Adjuster III is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with ins

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Your Role The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians . The Behavioral Health Registered Nurse Case Manager will report to th

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Providence caregivers are not simply valued they're invaluable. Join our team and thrive in our culture of patient focused, whole person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence is calling a Senior Claims Insurance Manager Medical Profe

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

REQUIRED EXPERIENCE Take on a significant role within a world class health organization. Elevate the operational and financial effectiveness of a complex health system. Take your professional expertise to the next level. You will leverage your extensive theoretical revenue cycle knowledge as you take on a vast range of critical revenue issues. This will involve applying d

Incumbent is responsible for obtaining all necessary authorizations in accordance with established guidelines. Verifies eligibility, obtains benefit information, and generates letters for authorizations. Responds to Member Services and Call Center inquiries and resolves any identified authorization issues which arise. Total Compensation In addition to the salary range lis

Serve as single point of contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum's internal processes and priorities, and other Optum initiatives, as applicable Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to dev

Apply if looking for Flexibility and Financial Freedom

Apply if looking for Flexibility and Financial Freedom

Working under the direction of the Director, Business Applications & Analytics, this position is responsible for performing alpha and numerical data entry and data verification functions according to established procedures using Teleform, member research in IDX, and mailing of correspondence. The Claims Verifier will perform duties in accordance with guidelines set forth

Coding Compliance Auditor (HIM Inpatient) HIM Financial Full Time 8 Hour Days (Non Exempt) (Non Union) Apply Keck Medicine of USC Hospital Alhambra, California In accordance with current federal & state coding compliance regulations and guidelines, the 'IP Coding Compliance Auditor" performs 2nd level reviews of previously coded inpatient accounts for MS DRG validation pu

Take on an important role within an award winning health organization. Help ensure the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. You will receive urgent, routine, pre service, and retro authorization requests, as well as process prior authorization requests with accuracy and timeliness.