Medi-Cal Claims Specialist: Precise Adjudication
Qualfon
Qualfon is a global provider of omnichannel customer experience and business support solutions. As a Medi-Cal Claims Examiner, you will review, process and adjudicate suspended healthcare claims to ensure accurate and timely payment in line with Medi-Cal policies and reimbursement guidelines. You will evaluate eligibility, provider information, required authorizations and benefits, document actions in our systems, and collaborate with internal teams while protecting PHI and maintaining HIPAA #J-18808-Ljbffr Qualfon
- Qualfon is seeking detail-oriented Medi-Cal Claims Processing Specialists to review and resolve suspended claims accurately and efficiently in a home... ...records, correcting errors, and applying Medi-Cal guidelines to adjudicate claims within deadlines. #J-18808-Ljbffr QualfonSuggestedRemote jobWork from home
$24 per hour
...Responsibilities What you'll do: Qualfon is seeking detail-oriented Medi-Cal Claims Processing Specialists to review and resolve suspended claims accurately and... ...and correct claim errors and make appropriate adjudication decisions. Resolve claim issues accurately within...SuggestedWork at officeLocal areaRemote workWork from home$20 - $23 per hour
Ultimate Staffing Services is seeking an experienced Claims Examiner to support a healthcare organization in Sacramento. This temporary... ...a Monday-Friday schedule. Responsibilities include reviewing, adjudicating, and processing medical claims, applying ICD, CPT, and revenue...SuggestedHourly payContract workTemporary workMonday to Friday$19.31 per hour
Dental Claims Specialist (Auditor) Location: Rancho Cordova, CA (Onsite)... ...procedures directly assists Medi-Cal beneficiaries and dental... ...beneficiaries with empathy and precision. Process Documentation... ..., dental codes, and claims adjudication processes. Ready to...SuggestedHourly payPermanent employmentTemporary workWork experience placementWork at officeLocal areaMonday to FridayShift work- Blue Shield of California is seeking a Claims Processor, Intermediate to review and adjudicate claims and adjustments for services in and outside California. The role reports to the Operations Supervisor and focuses on meeting operational, financial, and service requirements...SuggestedRemote jobWork at office
- ...Claims Processor, Intermediate The Blue Shield of California Claims teams process claims... ...will be responsible for reviewing and adjudicating claims and/or adjustments in accordance... ...within the Commercial, IFP, Medicare, Medi-Cal, FEP, ITS Home, ITS Host, or CalPERS lines...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- ...experience! Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Claims Specialist I - Provider Claims is responsible for evaluating... ...and HMO or Managed Care setting Medicare and/or Medi-Cal experience preferred Experience in a managed care...Contract workTemporary workWork at officeFlexible hours
$24 per hour
...and be part of a supportive, purpose-driven team. Responsibilities What You’ll Do: As a Medi-Cal Claims Examiner, you will be responsible for reviewing, processing, and adjudicating suspended healthcare claims to ensure accurate and timely payment. You will apply Medi-...Work at officeLocal area$84.6k - $120.8k
...Gainwell Technologies is seeking an experienced Claims Suspense Manager to lead claims operations supporting California’s Medi-Cal program. In this role, you will provide... ...claims, claims operations, claims adjudication, insurance operations, Medicaid/Medi-Cal, or...Full timeWork at officeRemote workFlexible hours$54.2k - $77.4k
...Gainwell Technologies is seeking an experienced Claims Suspense Supervisor to support claims operations for California’s Medi-Cal program. In this role, you will lead a... ...to support accurate and timely claims adjudication. You will oversee daily operations, manage...Full timeWork at officeRemote workMonday to FridayFlexible hours$59.4k - $84.9k
...Claims Appeals Supervisor - Onsite - West Sacramento, CA Join the group that solves... ...to support operations for California's Medi-Cal program at our West Sacramento office. In... ...of a team responsible for reviewing and adjudicating provider appeals, helping ensure accurate...Full timeWork at officeRemote workFlexible hours- ...Additional employee paid coverage options available. Job purpose The Claims Recovery Examiner position will be reviewing, requesting, and... .... Qualifications Five years’ experience processing Commercial, Medi-Cal and/or Medicare or other government agency claims Service/...Work at officeRemote workFlexible hours
$80k - $100k
...Subscriber Perk Credit building made easy Build credit while adjusting claims. Lock in 80% off credit building tools. Pie's mission is to... .... • Demonstrated knowledge and experience in claim adjudication, medical management and litigation management. • Developing ability...Remote jobFull timeWork experience placement$80k - $105k
...Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner Are you looking for an opportunity to join a global... ...involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices...Remote workFlexible hours- ...Workers Compensation Claims Team Leader At Gallagher Bassett, we're there when it matters most because helping people through challenging... ...make a real difference in people's lives. It takes empathy, precision, and a strong sense of partnershipand that's exactly what you'...Remote work
$70k - $75k
...flexibility, learning, and career development. Summary The Medical Claims Research Analyst supports providers, clients, and internal... ...customer service, business process outsourcing, or a related field; Medi-Cal or Medicaid experience preferred. Experience researching and...Remote jobFull timeFlexible hours$20 - $21 per hour
...Claims Examiner I Location: Sacramento, CA (Hybrid Eligible) About the Opportunity Seeking two detail-oriented and motivated... .... Apply benefit and eligibility information when adjudicating claims. Maintain productivity and quality standards while...Hourly payTemporary workLocal area$59.9k - $98.2k
...Zurich is seeking an experienced Litigation Claims Specialist to join its Commercial General Liability team. At Zurich North America Claims, we recognize that flexibility and work-life balance are key considerations when choosing your next career move. Our hybrid work...Full timeTemporary workApprenticeshipWork at officeLocal areaRemote workVisa sponsorship- ...Gallagher Bassett Claims Adjuster At Gallagher Bassett, we're there when it matters most because helping people through challenging... ...make a real difference in people's lives. It takes empathy, precision, and a strong sense of partnershipand that's exactly what you'll...Local areaRemote work
$43 - $75 per hour
...About the Positions Were seeking Contracts and Claims Specialists of various skill levels to support large complex heavy civil infrastructure programs including highways roads bridges transit (bus and rail) aviation (international airports) and water/wastewater projects...Contract workTemporary workFor contractorsWork at officeLocal areaHome officeFlexible hours- ...Workers Compensation Claims SpecialistAre you looking for an opportunity to join a fast-growing company that consistently outpaces the... ...offers an exciting opening for a Workers Compensation Claims Specialist within the West Region!As a Workers Compensation Claims Specialist...Work experience placementRemote work
- ...that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’... ...the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital...Local areaRemote work
$54.2k - $77.4k
...career development. Summary Gainwell Technologies is seeking an experienced Claims Data Entry Supervisor to support claims intake and data entry operations for California’s Medi-Cal program at our West Sacramento office. In this role, you will supervise a team...Full timeWork at officeRemote workMonday to FridayFlexible hours$84.6k - $120.8k
...career development. Summary Gainwell Technologies is seeking an experienced Claims Data Entry Manager to lead claims intake and data entry operations supporting California’s Medi-Cal program at our West Sacramento office. In this role, you will oversee high-...Full timeWork at officeRemote workFlexible hours$25.71 - $36 per hour
Your Role The Claims operational teams are responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Operations Manager. In this role you will be responsible for interfacing with other departments and vendors...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week$25.48 - $41.09 per hour
The Workers’ Compensation Claims Specialist floater manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims...Hourly payMinimum wageFull timeWork at officeLocal areaRemote workFlexible hours$80k - $105k
Job Title Workers Compensation Claims Examiner Primary Purpose of the Role To analyze complex or technically difficult California... ...claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices...Flexible hours- Inland Empire Health Plans is seeking a Claims Specialist II - Provider Claims to support appeals, complex claim adjustments, and provider disputes. The role emphasizes accurate processing of provider claims and handling escalated inquiries for the call center. You will...
$70k - $90k
Sompo has a unique opportunity for a WFRP Claims Specialist in our West Region team. As a Whole Farm Revenue Protection (WFRP) Claims Specialist will provide exceptional customer service to agents and producers by accurately and efficiently auditing and verifying WFRP Claims...Full timeWork at officeRemote workWorldwideFlexible hours$78.68k - $132.69k
...vibrant company we are today. We strive to make both our internal and external communities better everyday! PURPOSE OF THE JOB The Claims Specialist position is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to...Full timeWork at officeLocal area
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