Responsible for auditing and training claims staff on all Managed Care claims received from outside providers to ensure the Claims Examiners processed and adjudicated them accurately and consistently in accordance with outside Provider Contracts, State, Federal, CMS, DMHC and Health Plan contracts, internal departmental policies and procedures. Must maintain a productivit

Senior Claim Examiner Workers Compensation (CA) Requisition ID 2024 25271 Job Locations US CA Brea Position Type Regular Part Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on mod

IMA's Private Equity and M&A Practice provides buyers and targets with a range of insurance, benefits and retirement products and services designed to assist them throughout the life cycle of the M&A transaction. For M&A activity, IMA's in house Transactional Liability Practice, Project Managers and Due Diligence Specialists bring depth and experience to address financial

Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting . The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination

Senior Claim Examiner Workers Compensation (CA) Requisition ID 2024 24366 Job Locations US CA Brea Position Type Regular Full Time Category Claims Business Unit BUS_TPA US Excellence In Everything We Touch Position Summary We are seeking candidates with experience handling WC claims in CA! Bilingual is a plus. Must have a CA adjuster certification and be current on hours.

Claims Analyst II Job Location Remote Position Type Full Time/Regular Qlarant is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality rev

Director of Workers' Compensation Claims Job Locations US CA Irvine Requisition ID 2024 16202 Category Claims Workers Compensation Position Type Regular Full Time Overview AmTrust Financial Services, a fast growing commercial insurance company, is currently seeking an experienced and driven Workers' Compensation Claims Director in our Irvine, CA office. In this role, the

Manager, Claims Job Locations US CA Irvine Requisition ID 2024 16419 Category Claims Workers Compensation Position Type Regular Full Time Overview AmTrust Financial Services, a fast growing commercial insurance company, has an immediate need for a Workers' Compensation Claims Manager in Irvine, CA. The Workers Compensation Claims Manager is responsible to supervise activi

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions

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 Registered Nurse Case Manager will report to the FEP Department M

Conduct on site inspections and assessments of property damages for both residential and commercial claims Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions

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

At American Family Insurance Claims Services (AFICS, Inc.), we're embarking on a transformation of our claims capabilities that will put customers at the center of what we do best protecting and restoring their dreams when they need us most. We're leveraging our expertise, technology and new ways of working to actively reinvent one of America's largest industries creating

Your Role The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi Cal members under 21 years old and collaborates within Promise Clinical Team. The Case Management, Senior will report to the CHP Manager. In this role you will be Perform clinical review, assessment, evaluation of medical services for the organization us

Who We Are Join a team that puts its People First! Since 1889, First American (NYSE FAF) has held an unwavering belief in its people. They are passionate about what they do, and we are equally passionate about fostering an environment where all feel welcome, supported, and empowered to be innovative and reach their full potential. Our inclusive, people first culture has e