Claims examiner serp_jobs.h1.location_city
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Claims examiner • costa mesa ca
serp_jobs.last_updated.last_updated_variable_days
Orange, CA is a premier healthcare provider specializing in Medicare and HMO services.With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize acc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
By joining Sedgwick, you'll be part of something truly meaningful.It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Property Damage Claims Specialist.Elite Sourcing is seeking an experienced Property Damage Claim Specialist to join a well-known Law Firm in Costa Mesa, CA.
You will be responsible for investigating...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE / COE, Auto, and Homeowners.
SIU experience is highly desired, but not require...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Remote Commercial Title Examiner At First American.Join a team that puts its People First! First American's National Production Services division provides global title and escrow production support...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Remote Residential Title Examiner.Insight Global is looking for a Remote Residential Title Examiner to work at an industry-leading title company.
This employee will be responsible for searching publ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected.
We invite you to grow your c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
At Stewart we know that success begins with great people.As a Stewart employee youll be joining a company that was named a 2024-2025 Best Company to Work For by U.
News & World Report and a 2025...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
At Capital Insurance Group we offer our employees more than just a job.We foster career growth, provide opportunities to give back to our communities, and help you take the next step in your career...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Remote Commercial Title Examiner At First American.Join a team that puts its People First! First American's National Production Services division provides global title and escrow production support...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
A company is looking for a Claims Examiner to evaluate insurance claims and determine compensation.Key Responsibilities Review insurance claims for validity and compliance with policy terms Coll...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
If youve led estimating teams and obsess over accuracy, come scale something bigger.At Allied Public Adjusters, we dont just write scopeswe uncover the full truth behind every loss.Since 1997, weve...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Join a team that puts its People First! Since 1889, First American has held an unwavering belief in its people.They are passionate about what they do, and we are equally passionate about fostering ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
Claims Examiner - Workers Compensation.Our client, a business solutions company, is looking for a Claims Examiner - Workers Compensation for their Orange, CA / Hybrid location.Responsibilities : Anal...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Workers’ Compensation California.Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor.
Explore the Athens Administrators difference : We have been dynamic, innovati...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Only qualified Workers' Compensation candidates located in California are eligible to be considered for this role • • •.Candidates must be located in the state of California.High School Diploma or equ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Amtrust Financial Services, a fast growing commercial insurance company, has an immediate need for a .This role will be located in our Irvine, CA office.
The adjuster is responsible for the prompt a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
Manage med-mal claims end-to-end; larger / complex caseload; guide defense counsel; CRC / CSC reports; discovery / mediation / trial monitoring.
mentor CS I / II.BA / BS; 5 years med-mal claims (or WC / Bodily I...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
CAP seeks a Senior Claims Specialist for its Orange County office.This role involves handling technical and administrative duties to manage assigned claim files.
assumes increased workload of highl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
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Claims Examiner I
Astiva Health, IncOrange County, CA, United Statesserp_jobs.job_card.full_time
Liability Claims Examiner - Auto & GL
SedgwickOrange, CAserp_jobs.job_card.full_time
Claims Specialist
Elite SourcingCosta Mesa, CA, USserp_jobs.job_card.full_time
Claims Investigator - Experienced
Command InvestigationsOrange County, CA, USserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Ohio Commercial Title Examiner (Remote)
California StaffingSanta Ana, CA, USserp_jobs.filters.remote
serp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Remote Residential Title Examiner (FL)
Insight GlobalSanta Ana, CA, USserp_jobs.filters.remote
serp_jobs.job_card.full_time
Workers Compensation | Claims Examiner | California Residents
Sedgwick Claims Management Services, Inc.Orange, CA, United Statesserp_jobs.job_card.full_time
Commercial Title Examiner
StewartIrvine, California, USAserp_jobs.job_card.full_time
Claims Counsel
Capital Insurance GroupOrange, CA, United Statesserp_jobs.job_card.full_time
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Ohio Commercial Title Examiner (Remote)
Remote StaffingSanta Ana, CA, USserp_jobs.filters.remote
serp_jobs.job_card.full_time
Claims Examiner
VirtualVocationsCosta Mesa, California, United Statesserp_jobs.job_card.full_time
Claims Estimating Manager
ALLIED PUBLIC ADJUSTERS INCNewport Beach, CA, USserp_jobs.job_card.full_time
Associate Claims Counsel
First AmericanSanta Ana, CA, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Claims Examiner - Workers Compensation
StaffingOrange, CA, USserp_jobs.job_card.full_time
Senior Claims Examiner
ATHENS ADMINISTRATORSOrange, CAserp_jobs.job_card.full_time
Claims Examiner - Workers Compensation
Rose InternationalOrange, CA, USAserp_jobs.job_card.full_time
Lead Claims Examiner I, CA
AmTrust FinancialIrvine, CA, USserp_jobs.job_card.full_time
Claims Specialist
MY HROrange, California, USAserp_jobs.job_card.full_time +1
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Sr. Claims Specialist
Cooperative of American Physicians, Inc.Orange County, CA, USserp_jobs.job_card.full_time
Claims Examiner I
Astiva Health, IncOrange County, CA, United Statesjob_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
job_description.job_card.job_descriptionGood knowledge of CPT / HCPCS / ICD-10, and Revenue Codes, including modifiers. Assist customer service as needed to assist in claims resolution on calls from providers. Research authorizations and properly selects appropriate authorization for services billed. Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be financial responsibility of another organization. Coordinate Benefits on claims for which member has another primary coverage Run monthly reports. Review pre and post check run. Regular and consistent attendance Other duties as assigned High School Diploma or GED required. 1 to 3 years of previous experience in a health plan, IPA or medical group. Strong understanding of the benefit process including member services or customer service. Demonstrated proficiency in MS Office (Excel, Word, Outlook, and PowerPoint). Able to navigate difficult situations with empathy, discretion, and professionalism. Strong understanding of Senior Medicare Advantage Health plans. Able to explain member benefits, answer questions and concerns using a “Customer Service First” attitude. Able to live our mission, vision, and values, Bilingual in another language (written and oral) preferred.
About Us : Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY : Under the direction of the Vice President of Claims, this position is responsible for manual input and adjudication of claims submitted to the health plan. The ideal candidate will need to interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts; as well as resolving customer service inquiries, status calls, andclaim tracers.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following :
- Data enter paper claims into EZCAP.
- Review and interpret provider contracts to properly adjudicate claims.
- Review and interpret Division of Financial Responsibility (DOFR) for claims processing.
- Perform delegated duties in a timely and efficient manner.
- Verify eligibility and benefits as necessary to properly apply co-pays.
- Understands eligibility, enrollment, and authorization process.
- Knowledge of prompt payment guidelines for clean and unclean claims
- Process claims efficiently and maintains acceptable quality of at least 95% on reviewed claims.
- Meets daily production standards set for the department.
- Prepares claims for medical review and signature review per processing guidelines.
- Identify the correctly received date on claims, with knowledge of all time frames for meeting compliance for all lines of business.
Maintains good working knowledge of system / internet and online tools used to process claims
QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and / or EXPERIENCE :