Top 1463 Claims Jobs in Ontario, Ca

Compliance Auditor II
Inland Empire Health Plan —Rancho Cucamonga, CA
- $80,059.20 - $106,059.20 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Disability insurance
- Health insurance
Workers' Compensation Claims Examiner
JT2 Integrated Resources —California
- From $90,000 a year
- Full-time
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Workers Compensation Claims Examiner | Bonus Eligible | Roseville or Long Beach, CA
Sedgwick —California
- Full-time
- Hybrid work
- Background check
- Customer service
- 5 years
- Health savings account
- Disability insurance
Quick Apply
Data Entry & Analyzing Specialist - Returns / RMA
Confidential —Rialto, CA
- $24 - $26 an hour
- Full-time
- Background check
- Spanish
- ERP systems
- Health insurance
- Dental insurance
Quick Apply
Associate Claims Adjuster, Workers Compensation
Liberty Mutual —Orange, CA
- $50,000 - $94,000 a year
- Full-time
- Mid-level
- Office
- Analysis skills
13d
Field Claims Adjuster - Auto Damage
Progressive —Riverside, CA
- $35.29 - $43.17 an hour
- Inventory management
- Mid-level
- Driver's License
- Health savings account
- Disability insurance
7d
Claims Letter Correspondence Coordinator
Choice Physicians Network Inc —San Bernardino, CA
- $20 - $31 an hour
- Full-time
- Hybrid work
- Mid-level
- Neurology
Quick Apply
Claims Assistant Workers Compensation - (In-Office Ontario, California)
Sedgwick —Ontario, CA
- Full-time
- Computer literacy
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
13d
Claims Assistant (On-Site Ontario, CA)
Sedgwick —Ontario, CA
- Full-time
- Computer literacy
- Writing skills
- Office
- Health savings account
- Disability insurance
2d
Transportation Network Representative
Inland Empire Health Plan —Rancho Cucamonga, CA
- $27.43 - $35.66 an hour
- Extended hours
- Hybrid work
- Microsoft Word
- Mid-level
- Office
- Disability insurance
- Health insurance
13d
Claims Operations Coordintor
Choice Physicians Network Inc —San Bernardino, CA
- $20 - $32 an hour
- Full-time
- Hybrid work
- Mid-level
- Analysis skills
- Neurology
Quick Apply
Claims Associate - Workers Compensation (On-Site - Rancho Cucamonga)
Sedgwick —Rancho Cucamonga, CA
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Health savings account
- Disability insurance
Claims Adjuster – Attorney Represented Injury
Progressive —Riverside, CA
- $30.29 - $43.17 an hour
- Hybrid work
- Mid-level
- Office
- Driver's License
- Health savings account
- Disability insurance
14d
Lead Claims Compliance Coordinator
Choice Physicians Network Inc —San Bernardino, CA
- $68,000 - $88,400 a year
- Full-time
- Hybrid work
- Analysis skills
- Neurology
- Senior level
Quick Apply
Claims Representative (IAP) - Workers Compensation Training Program - Ontario, CA
Sedgwick —Ontario, CA
- Full-time
- Customer service
- Office
- High school diploma or GED
- Health savings account
- Disability insurance
Workers Compensation Claim Representative Associate
The Travelers Companies, Inc. —Diamond Bar, CA
- $52,600 - $86,800 a year
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- High school diploma or GED
- Wellness program
- Paid holidays
Workers Compensation - Claims Adjuster | HYBRID | Riverside, CA
Sedgwick —Riverside, CA
- Full-time
- Mid-level
- Office
- 3 years
- Health savings account
- Disability insurance
Retail Claims Investigator
Rebel Convenience Stores —Upland, CA
- $25 - $30 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Claims Examiner (Project Hire)
Disneyland Resort —Anaheim, CA
- Full-time
- Spanish
- English
- Mid-level
6d
Claim Operations Specialist
The Travelers Companies, Inc. —Diamond Bar, CA
- $45,400 - $74,900 a year
- Hybrid work
- Computer literacy
- Office
- High school diploma or GED
- Wellness program
- Paid holidays

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Compliance Auditor II

Inland Empire Health Plan -
Rancho Cucamonga, CA

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Job Details

Full-time
$80,059.20 - $106,059.20 a year

Benefits

457(b)
Disability insurance
Health insurance
On-site gym
Dental insurance
Flexible spending account
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

Managed care
Managed care organization experience
Health insurance knowledge
Quality improvement
Healthcare quality audits

Full Job Description

Overview:

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Compliance Auditor II conducts comprehensive audits and reviews across the Plan, including assigned areas and Plan delegates, to ensure adherence to Federal, State, and contractual regulatory requirements. Identifies and assesses risks impacting overall compliance, drafts detailed audit findings and actionable recommendations, and evaluates operations, policies, and processes throughout the Plan. Conducts evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues. Issues corrective action plans and reviews for acceptance to ensure that all compliance issues are appropriately addressed. Performs validation audits to determine if actions have been taken to mitigate identified risks and conducts routine monitoring across the Plan to address compliance concerns and emerging risks. Participates in special reviews as necessary.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Key Responsibilities:

Conduct audits and testing procedures of assigned areas and Plan delegates, including detailed testing activities, documenting findings in audit work papers, developing detailed document requests lists, conducting walk-throughs, and proposing recommendations for improvement.
Develop and maintain audit tools based on regulatory compliance with DHCS, DMHC, and CMS requirements.
Document audit conclusions that are based on a complete understanding of the process, circumstances, and risk.
Perform validation audits to determine if actions have been taken to mitigate risks identified.
Support the development and acceptance of corrective action plans (CAPs) from internal departments and delegates to ensure accuracy and regulatory adherence.
Validate corrective action plans (CAPs) from internal departments and delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
Perform evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues.
Support the identification of and communicates issues raised, offering recommended solutions relevant to business and risk.
Conduct regulatory research and provides interpretation of regulations to ensure appropriate application.
Support the maintenance of risks for assigned areas in the Compliance Risk Universe to ensure risk mitigations plans are developed and risks assessed and refreshed as needed.
Support the development of risk assessments to identify compliance risks posed to the Plan.
Conduct routine monitoring activities to ensure compliance with regulatory and contractual requirements.
Assist with reports for presentation to the Executive Compliance Committee and the IEHP Governing Board.
Conduct compliance assessments as needed.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Qualifications:

Education & Requirements

Minimum or five (5) or more years in managed care operations requierd, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, Delegation Oversight, Quality Management, Care Management, and/or Grievances and Appeals
Demonstrated experience, at a professional level, in an audit role
Experience with interpretation and/or implementation of California managed care regulations
Two (2) years of audit or quality assurance/quality improvement experience required
Bachelor’s degree from an accredited institution required
- In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
- This experience is in addition to the minimum years listed in the Experience Requirements above
Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), Certified Healthcare Auditor (CHA), and/or CHIAP (Certified Healthcare Internal Audit Professional) preferred

Key Qualifications

Demonstrated understanding of audit standards and requirements, statistical data interpretation and applicability, risk assessment and control environments, audit theory and processes, and of the professional practice standards of internal auditing
Demonstrated current knowledge of business ethics and compliance risks and the knowledge to assist with management of those risks in a dynamic health care environment
Proficient knowledge of CMS Program Audit Protocols, DHCS Technical Assistance Guides, and DMHC Technical Assistance Guides
Knowledge of regulatory research and regulations that apply to California Managed Care Health Plans
Possess strong written and verbal communication skills, including a strong business writing aptitude
Possess strong problem solving and creative thinking skills and the ability to reprioritize workload as needed
Must be detail oriented, self-directed, and work with minimal supervision, both independently and in teams
Requires well-developed skills in problem identification, analysis, resolution, organization, prioritization, timeliness, and attention to detail
Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook, etc.). Advanced skills in MS Excel preferred
Effective in a consulting role with the ability to become a trusted advisor
Ability to maintain excellent interpersonal relationships within the department and at all levels of the organization
Ability to organize thoughts and data into well-organized communications and reports

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Pay Range: USD $80,059.20 - USD $106,059.20 /Yr.

Apply Now

Refine Your Search

claims jobs in ontario, ca

Compliance Auditor II

Workers' Compensation Claims Examiner

Workers Compensation Claims Examiner | Bonus Eligible | Roseville or Long Beach, CA

Data Entry & Analyzing Specialist - Returns / RMA

Associate Claims Adjuster, Workers Compensation

Field Claims Adjuster - Auto Damage

Claims Letter Correspondence Coordinator

Claims Assistant Workers Compensation - (In-Office Ontario, California)

Claims Assistant (On-Site Ontario, CA)

Transportation Network Representative

Claims Operations Coordintor

Claims Associate - Workers Compensation (On-Site - Rancho Cucamonga)

Claims Adjuster – Attorney Represented Injury

Lead Claims Compliance Coordinator

Claims Representative (IAP) - Workers Compensation Training Program - Ontario, CA

Workers Compensation Claim Representative Associate

Workers Compensation - Claims Adjuster | HYBRID | Riverside, CA

Retail Claims Investigator

Claims Examiner (Project Hire)

Claim Operations Specialist

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