Claims Processing Clerk jobs in San Diego, CA
Claims Processing Clerk receives and inputs new healthcare claims, processes payments, researches billing issues, and responds to email and telephone inquiries. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Being a Claims Processing Clerk produces routine and ad hoc reports. Requires a high school diploma. Additionally, Claims Processing Clerk typically reports to a supervisor. The Claims Processing Clerk works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)
Recently Added Claims Processing Clerk jobs
Workers Compensation Claims Examiner | Must Reside in California
- Sedgwick Claims Management Services Inc.
-
San Diego, CA
FULL_TIME
- Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace® Forbes Best-in-State Employer Workers Compensation Claims Examiner | Must Reside in California Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. Enjoy flexibility and autonomy in your daily work, your location, and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATIONS Remote within California San Diego, CA (Hybrid) PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. TAKING CARE OF YOU Flexible work schedule. Referral incentive program. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. SALARY TRANSPARENCY – CO, NY, WA, CA As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $77,602 - $99,774. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. #claimsexaminer #claims Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Taking care of people is at the heart of everything we do. Caring counts Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us.
- 15 Days Ago
Senior Workers Compensation Adjuster
- TheBest Claims Solutions
-
San Diego, CA
FULL_TIME
- Senior Workers Compensation Adjuster SAN DIEGO, CA 92101 $85,000 - $95,000, DEPENDING ON EXPERIENCE Job Description Our client, a National Insurance Carrier, is looking for a Senior Workers Compensati...
- 21 Days Ago
Sterile Processing Clerk, Part Time - Palomar Surgical Center Escondido
- SCA Health
-
San Diego, CA
PART_TIME
- Overview: Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teamma...
- 1 Month Ago
Sterile processing
- HealthEcareers - Client
-
San Marcos, CA
FULL_TIME
- Job Summary : Oversees department(s) applying best standards and practices in Supply Chain and Logistics and advocates and proactively monitors departmental compliance of relevant guidelines. Monitors...
- 14 Days Ago
Processing worker
- Goodwill Industries of San Diego County
-
Encinitas, CA
FULL_TIME
- POSITION SUMMARY : Sorts, cleans, prices and stocks donated goods in a Goodwill store. Accepts donations and provides assistance on sales floor as needed. Provides excellent customer service to donors...
- 14 Days Ago
Cycle Processing
- Polaris Pharmacy Services
-
San Diego, CA
OTHER
- Job Details Job Location: Polaris Pharmacy Services of San Diego - San Diego, CA Position Type: Full Time Salary Range: Undisclosed Job Category: Pharmaceutical DescriptionCYCLE PROCESSING WHO WE ARE ...
- 4 Days Ago
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0 Claims Processing Clerk jobs found in San Diego, CA area
Compliance Specialist
- Pure Financial Advisors, LLC
-
San Diego, CA
- Pure Financial Advisors, LLC is looking for a Compliance Specialist to join the Compliance department. This position wil...
- 4/19/2024 12:00:00 AM
Manager, Product Compliance - REMOTE
- Net Health
-
San Diego, CA
- About Net Health Belong. Thrive. Make a Difference. Are you looking for a meaningful and satisfying career where you hav...
- 4/19/2024 12:00:00 AM
Healthcare Partner - Telemetry 5E - Sharp Grossmont Hospital - Night Shift - Full-time
- Sharp Healthplan
-
La Mesa, CA
- Hours Shift Start Time: 7 PM Shift End Time: 7:30 AM Additional Shift Information: 12-hour shift Weekend Requirements: E...
- 4/18/2024 12:00:00 AM
Manager, Product Compliance - REMOTE
- Net Health
-
San Diego, CA
- About Net Health Belong. Thrive. Make a Difference. Are you looking for a meaningful and satisfying career where you hav...
- 4/18/2024 12:00:00 AM
Actuary (Hybrid / Remote #54965)
- Dw Simpson Global Actuarial & Analytics Recruitment
-
San Diego, CA
- Actuary Phoenix, AZ / Hybrid / Remote This is a real chance for you to progress in your career. As an Actuary you will p...
- 4/18/2024 12:00:00 AM
Permitting Compliance Manager- Remote- Full Time (100% FTE)
- Adv-soc Inc
-
San Diego, CA
- Company Description ADV-SOC, Inc is a full-service, employee-owned, science, operations, and consulting partnership serv...
- 4/17/2024 12:00:00 AM
Entry Level Insurance Sales Agent - Hybrid Remote
- Bankers Life
-
San Diego, CA
- Bankers Life seeks professionals for a dynamic hybrid remote work environment. Start your insurance agent career and ear...
- 4/16/2024 12:00:00 AM
Remote Life Insurance Agent
- AO Globe Life
-
San Diego, CA
- AO is a pioneering force in the life insurance industry. We are committed to providing a financial safety net for every ...
- 4/15/2024 12:00:00 AM
About San Diego, California
According to SDSU professor emeritus Monte Marshall, San Diego Bay is "the surface expression of a north-south-trending, nested graben". The Rose Canyon and Point Loma fault zones are part of the San Andreas Fault system. About 40 miles (64 km) east of the bay are the Laguna Mountains in the Peninsular Ranges, which are part of the backbone of the American continents.
The city lies on approximately 200 deep canyons and hills separating its mesas, creating small pockets of natural open space scattered throughout the city and giving it a hilly geography. Traditionally, San Diegans have built the...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Processing Clerk jobs
$40,540 to $49,023
San Diego, California area prices
were up 2.6% from a year ago
were up 2.6% from a year ago