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claims manager medicare advantage plan

UCLA Health

<div><div>Description
Play a vital role on our Claims leadership team, you will manage a team of claim examiners, auditors, and support staff toward operational excellence. The Claims Manager of the Medicare Advantage Plan will:<ul><li>
Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
</li><li>Foster a positive, high-performing team culture focused on quality and exceptional customer service</li><li>
Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures</li><li>
Empower the team to navigate challenging scenarios with confidence and consistency</li></ul>

Salary Range: $95,400 - $208,300/annually
</div><div>
Qualifications
We&rsquo;re seeking a self-motivated, service-driven leader with:
Required:
<ul><li>Bachelor&rsquo;s degree in business, health care or a related field and/or equivalent work experience
</li><li>Five or more years of claims operations experience in a Medicare Advantage or related environment
</li><li>Three or more years of managing personnel in a claims processing environment
</li><li>In-depth knowledge of physician and facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding</li>
<li>Understanding of provider network/IPA arrangements and reimbursement methodologies, etc.</li>
<li>Knowledge of standard electronic and paper claim formats</li>
<li>Familiarity with AMA and Centers for Medicare and Medicaid Services coding guidelines</li>
<li>Computer proficiency with Microsoft Office Suite and data visualization tools</li>
<li>Knowledge of HIPAA, DMHC, AB1455, and CMS reporting requirements</li>
<li>Background with claims editing software (e.g., Optum CES, Web Strat, McKesson, etc.)</li>
<li>Experience in implementing and managing Prospective Payment System vendor application (Optum PPS, MicroDyn, 3M, etc.). (preferred)</li>
<li>Expertise with one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT</li>
<li>Excellent problem identification, resolution, and analytical abilities</li>
<li>Strong communication, interpersonal, and analytical skills</li>
<li>Ability to develop, implement, and evaluate methods/systems to improve efficiency</li>
<li>Ability to lead and facilitate cross-functional workgroups</li>
<li>Proficiency in achieving compliance with regulatory requirements</li>
<li>Ability to travel/attend off-site meetings and conferences</li>
</ul><div>Preferred:</div><div><ul><li>
Certified Professional Biller (CPB)</li><li>
Certified Revenue Cycle Representative (CRCR)</li></ul></div></div></div><div></div>

Claims Manager, Medicare Advantage Plan

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary
CVS Health/minute clinic is dedicated to helping people on their path to better health as part of the largest integrated pharmacy company in the United States. Through the company's more than 7,600 CVS/pharmacy stores; its leading pharmacy benefit manager serving more than 60 million plan members; and its retail health clinic system, the largest in the nation with more than 970 MinuteClinic locations, it is a market leader in mail order, retail and specialty pharmacy, retail clinics, and Medicare Part D Prescription Drug Plans. As a pharmacy innovation company with an unmatched breadth of capabilities, CVS Health continually strives to improve health and lower costs by developing new approaches. 
 
The Minute Clinic Accounts Receivable Associate, Senior Coordinator, will be responsible for:<ul><li>
Managing a high volume of medical claims that have denied by refuting the denials within payer guidelines through accurate review, correction, and resubmission</li><li>
Provide representation when needed of the Accounts Receivable area to internal dept.&rsquo;s as well as external dept.&rsquo;s, clients, vendors and processors to clearly relay situational occurrences and provide support when needed</li><li>
The account receivable associate will be responsible for identifying and quantifying trends/issues, developing potential solutions and then effectively communicate them to the appropriate members of the management team along with what the potential impact could be.</li><li>
Effectively prioritize and manage outstanding refund requests and overpayments to support contract and legal adherence with all payers including Medicare and Medicaid.</li><li>
Identify and implement process efficiencies across the dept. including automation opportunities or workflow enhancement opportunities to reduce manual efforts and improve productivity and overall compliance</li><li>
Recognize and Identify coding deficiencies and exercise the appropriate action based upon compliance and CMS regulations</li><li>
Identify key stake holders or primary contacts within payer communities to drive more effective processes</li></ul> 
Required Qualifications<ul><li>
The coordinator must have a clear understanding of the intricacies of medical billing encountered in such areas like ambulatory care, physician/provider offices, or professional billing settings.
</li><li>In addition, a clear understanding of CPT, ICD-9/10, CMS 1500 claim formatting, as well as, familiarity with Electronic Data Interchange (EDI) transmission, Electronic Health Record or encounter charge creation is key to success in this position.
</li><li>Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data is important.</li><li>
Minimum of 2 years of Medical Billing Experience or health plan claims adjudication experience</li></ul> 
Preferred Qualifications<ul><li>
3-5 Years of Medical Billing experience or health plan claims adjudication experience</li><li>
Technical Certificate in Medical Billing</li><li>
Microsoft Office with a focus on Excel, Outlook, and Word</li><li>
Time management skills</li><li>
The ability to multi-task</li><li>
Athena Practice Management experience
</li></ul>Education<ul><li>
Verifiable High School Diploma or GED required</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $42.35
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/31/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Minute Clinic Accounts Receivable Associate, Senior Coordinator, Revenue Cycle

Law Office of raymond Sarraf

Responsibilities:<ul><li>Schedule doctor appointments for clients</li><li>Open insurance claims</li><li>Maintain Liability</li><li>Open Medi-Cal/Medicare/Private Insurance Liens</li><li>Collect all possible information, evidence and documentation that pertains to the case</li><li>Collect and organize medical records</li><li>Prepare files to submit to demand writers</li><li>Manage medical treatment while providing treatment recommendations</li><li>Client communication</li></ul><ul><li>Qualifications:</li><li>Bilingual English/Spanish</li><li>Client service-oriented</li><li>Ability to multi-task</li><li>Attention to detail and deadline oriented</li></ul>Job Type: Full-timePay: $25.00 - $35.00 per hourBenefits:<ul><li>Dental insurance</li><li>Free parking</li><li>Health insurance</li><li>Paid sick time</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: In person

Personal Injury Case Manager

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;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 career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Examiner - Liability (MUST RESIDE IN Louisiana)
<div>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&rsquo;s best brands?
<ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>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.
PRIMARY PURPOSE : To analyze complex or technically difficult general liability 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
<ul><li>Analyzes and processes complex or technically difficult general liability 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.
</li><li>Assesses liability and resolves claims within evaluation.
</li><li>Negotiates settlement of claims within designated authority.
</li><li>Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
</li><li>Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li><li>Travels as required.
</li></ul>QUALIFICATIONS
Education &amp; Licensing
Bachelor's degree from an accredited college or university preferred.
Experience :
Five (5) years of Liability claims management experience or equivalent combination of education and experience required.
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul>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
</div>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">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.</h2></div>

Claims Examiner - Liability (MUST RESIDE IN Louisiana)

Capital Insurance Group

<div>Why CIG?
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!
CIG was founded in 1898 by a group of earnest farmers in need of protection and today, we are the leading West Coast Property &amp; Casualty insurer. CIG is certified as a Great Place to Work and provides a collaborative, inclusive, and fun work culture for all employees.
Why choose CIG&rsquo;s Claim&rsquo;s Team?
CIG claims department is here to support our insureds throughout their claims process. We work directly with our agency partners and policyholders to accomplish successful claim resolutions. Join the claims operation and you can be part of a team who provides excellent service, build relationships, and achieves successful outcomes for our clients.
Learn what it means to be a Claim Representative III - Property at CIG HERE!
Benefits
<ul><li>Accrue twenty-one days of Paid Time Off during your first year
</li><li>Up to eighty-seven percent of benefits covered by CIG for you and your family members
<ul><li>Medical, dental, vision plans
</li></ul></li><li>One hundred percent covered plans
<ul><li>Basic Life &amp; AD&amp;D
</li><li>Employee Assistance
</li><li>Leave Management
</li><li>Long Term Disability
</li><li>Short Term Disability (Outside of CA)
</li><li>Family Caregiver Support (Homethrive)
</li><li>Child Care Resources (Tootris)
</li><li>Business Travel Accident Protection
</li></ul></li><li>Voluntary benefit offerings
<ul><li>Short-term (CA only)
</li><li>Voluntary Life AD&amp;D self, spouse and child plans
</li><li>Flexible Spending
</li><li>Health Savings (HSA)
</li><li>Hospital Indemnity
</li><li>Accidental Injury
</li><li>Critical Illness
</li><li>ARAG Legal Services
</li><li>Norton LifeLock
</li></ul></li><li>Nine paid holidays, plus two floating holidays
</li><li>Above and Beyond Reward Recognition Program
<ul><li>Kudos &amp; Shout Out Points Program
</li><li>Quarterly Above and Beyond Bonus Program
</li><li>Annual Above and Beyond Bonus Program
</li></ul></li><li>Competitive compensation
<ul><li>Base compensation
</li><li>Salary Management Spot Bonuses
</li><li>Annual Incentive/Profit sharing program, potential payout annually based on company results.
</li></ul></li><li>Discount partnerships
<ul><li>Gym memberships, credit union, travel, shopping, restaurants, theme parks, and more
</li></ul></li><li>Insurance Educational reimbursement and bonus programs
</li><li>Employee Referral Bonus Program
</li><li>Home and Auto Insurance Discount Program.
</li><li>Paid Volunteer Time &ndash; Through company planned community events and choose your own adventure PVT in giving back in ways that are meaningful to you!
</li><li>Retirement savings benefit (401k and Roth + match)
</li><li>Health &amp; Financial Wellness
<ul><li>Wellness platform, tools and events
</li><li>Health Savings Account &ndash; match
</li><li>Financial Wellness Resources
</li></ul></li></ul>WORK ENVIRONMENT
This is a remote, field-based role with regional responsibility. Candidates must be located in California to effectively serve the assigned territory in the San Fernando Valley.
Job Overview
Provides the highest company-wide level of technical claim-handling, including investigation, evaluation, and negotiations pertaining to Property, Collapse, Earth Movement and Total loss of building. Supports the team as technical supervisor in manager&rsquo;s absence. Assists with Regional audits, mentors less experienced Claim Reps and performs other duties as required or assigned by the Claim Manager or Director.
Requirements
<ul><li>College degree or equivalent experience and seven (7) years of claim experience, including three years&rsquo; experience in handling complex claim files.</li>
<li>Knowledge of Current claims laws, specifically civil and tort law and current trends in Property insurance case law and issues</li>
<li>Good working knowledge of mathematics and common accounting practices which relate to gross and net income or living-expense calculations.</li>
<li>Demonstrate strong negotiation skills and communicate complex legal concepts and policy-contract interpretation in writing and orally</li>
<li>Plan, organize, and prioritize work under the pressure of critical deadlines</li>
<li>Perform inspections of sites and properties, including roofs, basements, and attics, which may require the use of ladders or stairs to access or the ability to kneel, crawl, and bend</li>
<li>Demonstrate strong negotiation skills and communicate complex legal concepts and policy-contract interpretation in writing and orally</li>
<li>Maintain a valid California Driver License and operate a vehicle</li>
</ul>
Career Path potential:
<ul><li>Claims Manager - Property
</li></ul>Salary Range: $77,406.00 - $129,010.00
The salary range listed here has been provided to comply with local regulations and represents a potential base salary range for this role. Please note that actual salaries may vary within the range above or below, depending on experience and location. We look at compensation for each individual and base our offer on your unique qualifications, experience, and expected contributions. This position may also be eligible for other types of compensation in addition to base salary, such as benefits and bonus programs.</div>

Claim Representative III - Property

Connie Health

<div>Description:

About Connie Health &amp; The Role
At Connie Health, we&rsquo;re revolutionizing the way older Americans navigate Medicare&mdash;but we&rsquo;re doing it together. As an independent agent, you&rsquo;ll have the freedom to grow your business with the full support of our team. We&rsquo;ve built a culture of collaboration, innovation, and fun, where success is shared, and no one feels alone. With cutting-edge technology, real-time support, and a community that celebrates wins, we make it easier for you to focus on what matters most: helping seniors find the right Medicare coverage and the best healthcare solutions.
We&rsquo;re looking for licensed, ambitious, and customer-focused Medicare Agents to join our growing team. Our unique approach provides agents with cutting-edge tools, personalized support, and a business model built on trust and long-term relationships. If you're passionate about helping others and want to maximize your earning potential, this is the opportunity for you!
Why Join Connie Health?<ul><li>
Uncapped Earning Potential</li><li>
Full commission and renewals on business you generate.</li><li>
Competitive flat fee + yearly renewal for company-scheduled appointments.</li><li>
Exclusive Access to Cutting-Edge Technology</li><li>
Proprietary Connie Health Agent Platform with powerful recommendation and quoting tools.</li><li>
Streamlined sales process so you can focus on building relationships and closing deals.</li><li>
Dedicated Support &amp; Training</li><li>
Backing from Western Asset Protection (25+ years of Medicare expertise).</li><li>
Internal operations team to assist with technical and sales support.</li><li>
Ongoing Member Support &ndash; Less Hassle, More Sales</li><li>
Our internal Medicare Advisor team handles post-sale customer support.</li><li>
We assist your clients with insurance issues and provider selection&mdash;allowing you to focus on selling!</li></ul>
What You&rsquo;ll Love About Connie Health<ul><li>
Lucrative commissions &amp; bonuses</li><li>
Pre-scheduled, qualified leads and appointments - at no cost to you!</li><li>
Proprietary technology for increased productivity</li><li>
Continuous training &amp; development</li><li>
Internal customer service team&mdash;less admin work for you!</li><li>
A mission-driven organization with a collaborative, supportive team</li></ul>
Requirements:

Who We&rsquo;re Looking For:<ul><li>
Licensed: Active Health &amp; Life license &amp; AHIP Certification</li><li>
Experienced: 1-3 years of Medicare sales experience.</li><li>
Locally Connected: In-depth knowledge of your local healthcare market.</li><li>
Entrepreneurial: Self-starter with a go-getter mindset.</li><li>
Tech-Savvy: Comfortable using sales platforms and digital tools.</li><li>
Flexible: Willing to work non-traditional hours, especially during AEP.</li><li>
Compliant: Strong understanding of CMS Guidelines.</li></ul></div>

Remote Independent Medicare Sales Agent

Independent Medicare Sales Agent – Remote/WFH

Explore 373+ Claims manager medicare advantage plan in Los Angeles this March. Find roles across top companies and apply now to boost your career.