- Sedgwick (Roseville, CA)
- …Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Future Medical Medical Only Claims Representative Workers Compensation Are you ... + May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims . + Maintains… more
- Ford Motor Company (Sacramento, CA)
- …the freedom to define and realize your dreams. With our incredible plans for the future of mobility, we have a wide variety of opportunities for you to accelerate ... you'll do ** The APD Auto Physical Damage Catastrophe Claims Adjuster/Field Service Manager is a field-based position representing...benefit of choice. You can choose what your Ford future will look like: will your story span the… more
- Kemper (Sacramento, CA)
- …negotiation skills? Kemper is looking for experienced Represented Bodily Injury Claims Adjusters for our growing teams! This specialized position focuses solely ... on the analysis & negotiation of bodily injury claims that are ordinarily assigned after the initial coverage...time limit demands + Obtain and thoroughly analyze complex medical records and data + Research and apply applicable… more
- AECOM (Sacramento, CA)
- …with clients to solve the world's most complex challenges and build legacies for future generations. There has never been a better time to be at AECOM. With ... world. Join us. **Job Description** **AECOM** is seeking a **Senior Forensic Claims Analyst** to be based in **Sacramento, CA.** **JOB RESPONSIBILITIES:** + Perform… more
- Health Advocates Network (Folsom, CA)
- …a Library of Payer reference material regarding requirements for pre-authorization, medical necessity, and documentation requirements. Works with the Revenue Cycle ... etc.) to provide information related to denials and opportunities for future denials. **Denials Analyst** ** Qualification and Requirements:** + High school… more
- Travelers Insurance Company (Sacramento, CA)
- …and complex Life Science medical products, clinical trial and pharmaceutical bodily injury claims , as well as General Liability Coverage B claims and E&O ... medical products, clinical trial and pharmaceutical bodily injury claims , as well as General Liability Coverage B ...with respect to accuracy and adequacy of, and potential future changes to, loss reserves on assigned claims… more
- Sedgwick (Sacramento, CA)
- …medical records. + Utilizes claims , legal, and/or nursing knowledge to analyze medical records and identify future medical treatment as documented in ... coding guidelines and utilization and practice guidelines. + Reviews medical claims and completes complex file review...complex file review for Medicare Set- Asides (MSA) and future medical cost projections. + Serves as… more
- Kemper (Sacramento, CA)
- …III is responsible for the investigation of complex, large loss, and multi-injury claims that may contain elements of fraud or claims otherwise deemed ... multi-feature and attorney represented losses. Basic functions include: Investigation of claims , analysis and development of facts and evidence, and conducting… more
- ICW Group (Sacramento, CA)
- …The purpose of this job is to detect, prevent, and investigate suspected fraudulent claims for all lines of insurance, with heavy emphasis on Workers' Compensation ... claims . This position exists in order to protect company...Marketing, Underwriting, Claimants, Policyholders, Agents, Brokers, SIU, Legal and Medical Professionals, Government/Regulatory Agencies, Law Enforcement and Vendors. +… more
- Sedgwick (Sacramento, CA)
- …and to share your insights. **PRIMARY PURPOSE** **:** To handle losses or claims nationally regardless of size, including having the ability to address any complex ... a plus!). **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies, claims , and other records to determine insurance coverage. + Administers and… more
- Zurich NA (Sacramento, CA)
- …candidate will demonstrate experience with general liability. At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority ... your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct… more
- Lincoln Financial Group (Sacramento, CA)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... this role you will provide coaching and guidance to claims regarding medical management **What you'll be...each of us to take charge of our own future . **What's in it for you:** + Clearly defined… more
- Sedgwick (Rancho Cordova, CA)
- …+ This role will be primarily responsible for **_Large Complex Property_** claims . **PRIMARY PURPOSE** **:** To investigate losses or claims internationally ... be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probably costs. + Prepares loss experience reports to help… more
- Cardinal Health (Sacramento, CA)
- …and adjustments as necessary. + Financial Acumen: + Analyze benefits utilization and claims data to identify opportunities for cost savings or plan enhancements that ... Oversee the end-to-end benefits administration process, including enrollment, eligibility, and claims resolution, to deliver a positive employee experience. + Stay… more
- UIC Government Services and the Bowhead Family of Companies (Sacramento, CA)
- …other protected characteristics EOE/AA/M/F/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual ... their Descendants, based on the provisions contained within The Alaska Native Claims Settlement Act. All candidates must apply online at www.uicalaska.com, and… more
- Sedgwick (Sacramento, CA)
- …role will be responsible for investigating and adjusting property and casualty claims , both residential and commercial, with little to no supervision. **ESSENTIAL ... be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Assists in preparing loss experience report… more
- Sumitomo Pharma (Sacramento, CA)
- …and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into the ... Commercial Validata system to prevent revenue leakage by scrubbing for duplicate claims across channels. The position will also provide operational and cooperative… more
- Humana (Sacramento, CA)
- …informaticists to define various clinical concepts and extract clinical information from medical , pharmacy, and lab claims for analytics and modeling purposes ... to work closely with strategy partners and clinicians to shape Humana's future enterprise clinical strategies and initiatives. The Lead Research Scientist will lead… more
- Evolent (Sacramento, CA)
- …science, or engineering) - Preferred + Professional experience in healthcare analytics (eg medical and pharmacy claims data, membership data, or other healthcare ... **Your Future Evolves Here** Evolent partners with health plans...Payment Models) - Preferred + Working knowledge of Medicare claims , episode and condition groupers, case/episode and risk adjustment,… more
- CDM Smith (Sacramento, CA)
- …expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs ... in regular FEMA meetings by providing updates on work status and may evaluate claims and make recommendations to FEMA as to whether the claim is eligible. Assists… more