Claims Examiner Jobs in California

Job Title: to $20hr/Medical Claims Examiner III Company: AppleOne Location: Anaheim, CA Description: Claims Examiner IIIWhat you will be doing:- Review and process all contracted capitated claims and fee-for-service PCP administration fee for-service claims paid and or denied while achieving and maintaining a 95% accuracy rate. - Review and process claims acknowledgment, payment and denial as set forth by CMS, Healthplans and departmental policy and procedures while achieving and maintaining a 95% timeliness standards.- Achieve and maintain 95% production requirements per claim type utilizing departmental policy and procedures as established per Healthplan and Network. - Recognize inappropriate CPT, ICD-9, HCPCS, and Revenue codes and accurately research member eligibility, duplicate claims submissions, out of network services, out of area services and COB and adjudicateaccording to departmental procedures. - Monitor and update inventory reports in order to track claims in inventory and follow-up on all claims suspended for review purposes or additional information requests until claims are in a final status.What you need to apply:- 4 years of experience prior experience as a Claims Examiner in an IPA, Medical Group or Health Plan.- Familiarity with computerized claims processing/transaction system- Should be familiar with the Microsoft windows operating environment.If you are an experienced Claims Examiner and looking for a position with growth, please apply today!df-lj

Job Title: Workers' Compensation Claims Examiner Company: York Insurance Services Group, Inc. Location: Oxnard, CA Description: Workers¡¦ Compensation Claims Examiner Ventura County, CaliforniaYork ISG Inc. ¡V CA has an immediate opening in the Ventura County Office located in Oxnard, California for a Workers¡¦ Compensation Claims Examiner. This position will be under the supervision of a Claims Supervisor in the Oxnard Office. The role of a Workers¡¦ Compensation Claims Examiner is to manage the day-to-day activities of a workers¡¦ compensation caseload from inception to the final settlement. This includes, but is not limited to working directly with injured workers, client representatives, medical vendors, legal and investigative vendors as well as internal claims managers, assistants and clerical staff via e-mail, telephone, standard mail and face-to-face interaction.Anyone interested in responding to this posting should possess the following:Education:„« High School Diploma„« IEA and/or Self Insurance Certification is preferred„« College or Associates degree is a plusExperience:„« Five (5) or more years of claims experience„« Public Entity and Ed Code experience is a plusSpecial Skills:„« Strong written and verbal communication skills defined by effectiveness and accuracy. „« Strong claims technical and desk management skills„« Knowledge of claims investigation and settlement procedures in the California Workers¡¦ Compensation system„« Strong organizational skills which support timely and well documented actions„« A working knowledge of Microsoft Office, Excel and Windows based products„« Good human relations sills, including the ability to work in conjunction with other administrative, management, and supervisory employees.A more detailed Job Summary is available upon request.If you are interested in applying for this position, please respond by e-mail to Register to View

Job Title: Medical Claims Examiner - Needed in LA ASAP!!!!! Company: ACT-1 Location: Los Angeles, CA Description: Large Company has an immediate need for a CLAIMS EXAMINER. Must have a demonstrated track record and the ability to work in a fast paced/deadline driven environment. Ideal candidate should be able to work independently or in a team oriented environment. Responsibilities: Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits, co-payments, deductibles, etc. Process claims based upon contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups' and company policies and procedures. Respond to and resolve provider and health plan claims inquiries and apply resolution in a timely manner. Maintain quality and productivity standards, teamwork, and comply with company/administrative guidelines. SEND all resumes to Tiffany Addison as a word attachment.df-lj

Job Title: Home Insurance Claims Examiner - Stable Company! Company: Company Confidential Location: Menlo Park, CA Description: Immediate need for home owners insurance examiner seeking stable company, great benefits and room for advancement. Dependability, key eye for detail, and strong time management will be keys to success in this stable organization. Will be responsible to review claims after they are submitted in order to ensure that proper guidelines have been followed. This person should have at least 5 + years of home owners insurance examiners experience. Direct Hire opportunity with great benefits! Apply for this great position as a home owners insurance examiner today, please call and speak with Norma.

Job Title: Medical Claims Examiner - Needed in LA ASAP!!!! Company: ACT-1 Location: Los Angeles, CA Description: Large Company has an immediate need for a CLAIMS EXAMINER. Must have a demonstrated track record and the ability to work in a fast paced/deadline driven environment. Ideal candidate should be able to work independently or in a team oriented environment. Responsibilities: Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits, co-payments, deductibles, etc. Process claims based upon contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups' and company policies and procedures. Respond to and resolve provider and health plan claims inquiries and apply resolution in a timely manner. Maintain quality and productivity standards, teamwork, and comply with company/administrative guidelines. SEND all resumes to Tiffany Addison as a word attachment. df-lj

Job Title: Temp to Hire Insurance Claims Examiner Company: Location: San Diego, CA Description: **This is a temp-to-hire position **Hours are M-F 7-4 or 8-5 **Pay is $11/hour Education/Training/Experience/Licenses ? High school diploma or equivalent. ? Minimum 2 years data entry experience with 10 key and word processing; minimum 8,000 key strokes per hour required. ? Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred. ? Proficient in MS Office. Skills/Abilities: ? Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships. ? Ability to display excellent customer service to meet the needs and expectations of both internal and external customers. ? Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment. ? Ability to effectively organize, prioritize, multi-task and manage time. ? Demonstrated accuracy and productivity in a changing environment with constant interruptions. ? Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions. ? Ability to exercise strict confidentiality in all matters. The primary purpose of this position is to enter data from specific Claim Forms into the Claims Processing System for all capitated and ASO accounts. This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, company standards and contractual obligations of the organization. 95% Processes claims accurately and efficiently. 5% Performs other duties and responsibilities as assigned.

Job Title: Medical Claims Examiner Company: Insurance Overload Staffing Location: Buena Park, CA Description: Medical Claims Examiner- Must have 2+ years recent experience adjudicating HMO Claims. Candidate must have strong knowledge of CPT, ICD-9 coding, and Medical Terminology. Job Requirements:2+ years experience as a Claims Examiner Recent HMO experience COPT, ICED-9 and Medical Terminology

Job Title: Sr. Liability Claims Examiner Company: Tower Group Companies Location: Irvine, CA Description: Job Type: Full-Time Location: Irvine, CA Job Description:GENERAL SUMMARY Handles the most complex claims including complex coverage issues, preferably those arising out of a specific program or within specific state jurisdictions. ESSENTIAL RESPONSIBILITIES & DUTIES * Review and analyze coverages that apply to the claim * Prepare draft coverage letters as necessary * Plan and execute investigations of liability and damages on both first and third party claims * Apply facts as determined by investigation to the particular law of the jurisdiction to properly evaluate claim exposures * Establish reserves based on evaluation and adjust reserves as necessary with all new information * Work with defense counsel to establish agreed upon complex litigation plans and budgets on all litigated files * Determine and execute proper disposition plans on all claims, negotiating claims to a conclusion to minimize litigation where appropriate * Control expenses such as independent adjuster and defense costs * Minimizes losses through identification and collection of subrogation and prompt disposal of salvage * Provide excellent customer service to both Partner Agents, insureds and claimants * Develops knowledge of program specific business * Work closely with Corporate Claims in the investigation, analysis and settlement of complex and high exposure claims * Achieve quality initiatives * Assists in the mentoring and training of less experienced staff * Other duties as assigned by Supervisor or Manager DESIRED QUALIFICATIONS Education * Bachelor’s degree preferred * Professional insurance designation desirable Experience * Minimum of 5 years complex casualty or auto claim handling experience is required * Experience handling litigated claims and coverage issues is required * Experience with Commercial and Personal lines policy forms preferred * Inland Marine and/or Property claims experience a plus * Alternative Dispute Resolutions and structured settlements Skills * Licensed as an adjuster or the ability to be licensed in multiple states * In-depth knowledge of the Commercial Auto, General Liability and Homeowners policy and coverage * Ability to analyze contracts and indemnity agreements * Able to analyze coverage issues, as well as prepare Reservation of Rights letters and * Disclaimers * Ability to work in a team environment * Excellent verbal and written skills are necessary * Strong attention to detail * Proficient in the use of Microsoft Office products (i.e. Word, Excel) * Ability to partner with policyholders and defense counsel in litigation Other * Minimal travel required (approximately 5-10%) Physical * Occasional bending, reaching, and light physical effort (under 10 pounds) required. We are an equal opportunity employer dedicated to the professional development and success of its employees. Tower offers a highly competitive compensation package, with comprehensive benefits package.

Job Title: Insurance Claims Examiner-Experienced Company: Company Confidential Location: Loma Mar, CA Description: Claims examiners within property and casualty insurance firms. Duties similar to those of an adjuster. Primary job is to review claims after submission. Ensure that proper guidelines have been followed. Looking for candidate with at least 5 + years of experience on the home owners side. Review reports submitted, determine coverage for home owners. Prefer candidate that has experience with multiple states, CA, AZ, TX, FL, and NV. However, CA is largest book of business.

Job Title: Home Insurance Claims Examiner Company: AppleOne Location: Menlo Park, CA Description: Immediate need for home owners insurance examiner seeking stable company, great benefits and room for advancement. Dependability, key eye for detail, and strong time management will be keys to success in this stable organization. Will be responsible to review claims after they are submitted in order to ensure that proper guidelines have been followed. This person should have at least 5 + years of home owners insurance examiners experience. Direct Hire opportunity with great benefits! Apply for this great position as a home owners insurance examiner today, please call and speak with Norma.df-lj