- 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
- Ford Motor Company (Sacramento, CA)
- …is a hybrid role.** **What you'll do ** Lead development efforts for claims /returns modernization, ensuring current and future business requirements are met with ... ** Claims Lead Analyst** We are the movers of the world and the makers of the future . We get up every day, roll up our sleeves and build a better world --… more
- Stantec (Roseville, CA)
- …Worker Compensation system is a plus!). + Guide injured employees through the claims process, including monitoring medical management. + Assist complex claim ... and records management. + Manage and work with external partners, including claims adjusters, case managers, and early medical intervention (telehealth). +… 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
- Evolent (Sacramento, CA)
- …via telephone and other communication channels, regarding health plan benefits and claims , eligibility, medical and other healthcare procedures, billing and ... **Your Future Evolves Here** Evolent partners with health plans...their representatives, as it relates to our **Pharmacy and Medical benefits.** Collaboration can enhance overall team performance, improve… 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
- Sedgwick (Sacramento, CA)
- …Forbes Best-in-State Employer GL Adjuster **PRIMARY PURPOSE** **:** To investigate claims against insurance or other companies for personal, casualty, or property ... be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probably costs. + Assists in preparing loss experience report… 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
- 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 (Roseville, 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
- 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
- CVS Health (Sacramento, CA)
- …+ Innovation and ideation around new areas of data driven impact around medical cost and patient experience + Work closely with other development teams to ... experience in developing and operating innovative healthcare analytic solutions utilizing member, claims , clinical and provider data + 10+ years working with… 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
- CVS Health (Sacramento, CA)
- … medical records and system documentation to evaluate post-service claims for payment based on clinical policies, legislation, regulatory requirements, and ... line with regulatory and accreditation requirements for member and/or provider claims . Independently coordinates the clinical resolution with clinician/MD support as… 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
- 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
- Evolent (Sacramento, CA)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... impact on the organization and patient health. This role supports both medical cost management activities and business development efforts. **What You Will Be… more
- Western Digital (Sacramento, CA)
- …biggest companies and public cloud, Western Digital is fueling a brighter, smarter future . Binge-watch any shows, use social media or shop online lately? You'll find ... owner to drive improvements and alignment across all aspects of rebates and claims settlements, as we harmonize rebate programs across all subsidiaries. + Actively… more