Senior Medi-Cal Claims Examiner II
Partnership HealthPlan of California
Partnership HealthPlan of California is seeking a Claims Examiner II to review, research, and resolve Medi-Cal claims within established production and quality standards. This role handles manual processing, completes claims and worksheets, and generates provider communications as needed. In addition, the examiner routes claims for review, tracks statuses, and ensures timely updates. A high school diploma and at least one year in Medi-Cal billing or claims examining are required, with strong #J-18808-Ljbffr Partnership HealthPlan of California
- ...Overview To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including... ...staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level...Suggested
$110k - $130k
CAP seeks a Claims Specialist II or Senior Claims Specialist. This role involves handling technical and administrative duties to manage assigned claim files, as well as participates in the ongoing training and oversight of Claims Specialist I team members. Essential Duties...Senior$91.67k - $128.33k
...Operations by researching, analyzing, and resolving complex encounter, claims, reimbursement, and operational issues requiring advanced... ...reimbursement methodologies, healthcare transaction standards, Medi-Cal and Medicare regulations, provider contracts, and industry best...SeniorRemote work$24 - $30 per hour
Johnson Service Group (JSG) is seeking a Claims Examiner II for a remote opportunity with a health plan organization. Typical schedule is Monday through Friday, 8am-5pm, with a pay rate range of $24-$30 per hour depending on experience and qualifications. You will review...SuggestedRemote jobHourly payMonday to Friday- ...Job Description Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information...SeniorFull time
$68.48k - $115.49k
...both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Senior Claims Examiner position handles moderate to complex claims with a focus on providing the highest level of service for policyholders and...SeniorFull timeWork at officeLocal area- ...Career Ladder: Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor ATHENS POSITION DETAILS Position Title: Bilingual Senior Claims Examiner Department: Workers’ Compensation Reports To: Claims Supervisor FLSA Status: Non-Exempt Job...SeniorFull timeWork at officeLocal areaImmediate startRemote workMonday to FridayFlexible hours1 day per week
$14.9 - $29.06 per hour
Molina Healthcare in California seeks a Senior Claims Examiner to provide support for claims examination, focusing on evaluating claims for coding errors and fraud. You will manage a caseload and ensure compliance with state and federal regulations while maintaining meticulous...SeniorHourly payWork at office- A leading claims management firm is seeking a full-time Bilingual Senior Claims Examiner to handle workers' compensation claims in Southern California. This role allows for a hybrid work schedule, with specific in-office requirements. Applicants must be fluent in Spanish...SeniorRemote jobFull timeWork at office
- Athens Administrators has an immediate need for a full-time Bilingual Senior Claims Examiner to support our workers compensation offices and can be located anywhere in the state of California. The role requires fluent Spanish, deep claims experience, and a hybrid work...SeniorRemote jobFull timeWork at officeImmediate start
- Live Nation Entertainment is seeking a Senior Accountant II for the Concerts division. The role blends transactional and intermediate-to-advanced accounting tasks, requiring self-motivation, multi-tasking, and strong knowledge of accounting principles. You will perform...Senior
- Live Nation Entertainment is seeking a Sr. Accountant II for the Live Nation Concerts division. This role blends transactional and intermediate-to-advanced accounting tasks, requiring self-motivation, multitasking, and solid accounting knowledge. The position supports...Senior
- iHerb is seeking a Senior Product Designer II - Discovery to set the strategic design direction for our global e-commerce platform. This role combines senior design leadership with hands-on contribution, owning the most complex and high-impact design initiatives across...Senior
- Arch Insurance Group Inc. is seeking a skilled professional to join its Claims Division on the Professional Liability team, focusing on Lawyers Professional Liability across the United States. You will actively manage claims, develop strategies to resolve indemnity exposure...Senior
- Crawford & Company is seeking a Senior Claims Examiner - Liability in the United States. You will manage high‑exposure, complex claims from investigation through resolution, exercising independent judgment and coordinating with supervisors and defense attorneys. Responsibilities...Senior
- Acrisure is seeking a Senior Workers' Compensation Claims Examiner to independently manage complex California claims from assignment through resolution. This role requires hands-on experience with CA workers' compensation laws, indemnity claims, and litigated matters....SeniorRemote job
- Crawford & Company is seeking an experienced claims professional to investigate and settle advanced, large loss cases promptly under minimal supervision. You will review coverages, determine liability, and set reserves to settle claims efficiently. The role involves assisting...Senior
- A leading risk management firm based in California seeks a Claims Manager to oversee and manage claim files effectively. The ideal candidate will have a Bachelor’s degree and 3-5 years of relevant experience, alongside skills in problem solving and customer service. Responsibilities...Senior
- County of Los Angeles, Department of Mental Health, seeks qualified candidates for emergency Fiscal Officer II vacancies related to the homelessness crisis. Under the emergency order, hires may be made for an initial period of up to 90 days, with an opportunity for permanent...SeniorPermanent employment
- ...Summary Arch Insurance Group Inc., AIGI, has an opening with our Claims Division on the Professional Liability Team with a focus on... ...recommending reserves Prepare and present written/oral reports to senior management setting forth all issues influencing evaluation and recommending...SeniorTemporary workWork experience placementWorldwide
- Volunteers of America Los Angeles is seeking a Senior Case Manager II to mentor the case management team and ensure services meet client needs. The role blends administrative duties with field outreach. You will assess client needs, develop service plans, coordinate referrals...Senior
$50 - $60 per hour
...Insurance Carrier, is seeking to add a Sr. Workers Compensation Claims Adjuster to their California team. This remote role will... ...permanent employee Flex schedule and ability to work remotely Seniority level Seniority level Mid-Senior level Employment type Employment...SeniorRemote jobPermanent employmentContract workTemporary workFlexible hours- A leading data streaming platform company in Missouri seeks a Senior Software Engineer II to design and deliver large-scale backend services. You will lead technical projects, mentor engineers, and collaborate across teams to build cloud-native solutions. Ideal candidates...Senior
- The California Department of Developmental Services is seeking a Speech Pathologist II to plan and supervise speech therapy clinics. The position involves assessing speech and language disabilities, providing therapy, and training staff. Applicants must have a valid Speech...Senior
$110k - $130k
Cooperative of American Physicians, Inc. seeks a Claims Specialist II or Senior Claims Specialist to manage medical malpractice claim files and provide oversight to junior staff. You will review complex cases, coordinate with defense counsel, and prepare case evaluations...Senior$70k - $80k
...Percentage: No Travel Job Category: Finance The primary focus of the Senior Merchant Underwriter is to review, analyze, and make confident... ...escalation point and subject-matter resource for Underwriter I/II staff on complex or high-risk applications. Review and provide QA...SeniorWork experience placement- ...effective compliance. Independently develops innovative approaches and engages regulators on technical matters. The Environmental Senior II (Natural Resources) is a key member of the Cultural and Natural Resources (CNR) Team, a collaborative group of scientists in the Environmental...SeniorFor contractors
$56.7k - $94.9k
SUMMARY Claim Representative I: This is the entry level professional claim handler. Handles medical only and indemnity benefits. Exercises... ...and settles claims within given authority. Claim Representative II: This is the intermediate level of the claim handler career path....Remote jobContract workTraineeshipWork at office- ...Zurich North America is seeking an experienced Litigation Claims Specialist to join its Commercial General Liability team. This role, which can be based out of Gold River, CA, offers a hybrid work schedule and requires managing multi‑party commercial claims involving...Senior
- ...Manage a casualty claims portfolio focused on Construction Defect, Job Site Bodily Injury, OCIP/CCIP, and New York Labor Law matters , including coverage analysis, exposure assessment, reserving, and claim resolution. Communicate loss assessments and recommendations to...SeniorWork at office
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