Top 1430 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
Dental front Office coordinator/ Biller
MVD —Montclair, CA
- $24 - $28 an hour
- Part-time
- Dental office
- Administrative experience
- In-person
Quick Apply
1d
Ecommerce Specialist & Customer Service (Cross-Border)
Winheart Living INC —Ontario, CA
- $50,000 - $55,000 a year
- Email
- Word processing
- English
- Mid-level
- Health insurance
- Paid time off
Quick Apply
Case Manager - Class Action Settlement Administrator
ILYM Group, Inc. —Tustin, CA
- From $80,000 a year
- Full-time
- Microsoft Excel
- Mid-level
- Bachelor's degree
- Health insurance
- 401(k)
Quick Apply
Medical Claims Biller and Bookkeeper
Mi Sueño Speech Therapy —Covina, CA
- $25.17 - $30.31 an hour
- Overtime
- Spanish
- Mid-level
- Office
- Paid training
- Health insurance
Quick Apply
Claims Adjuster Trainee - National General
National General —Ontario, CA
- $22.84 - $29.57 an hour
- Online Application
- Office
- US work authorization
- Fair chance
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
Claims Assistant (On-Site Ontario, CA)
Sedgwick —Ontario, CA
- Full-time
- Computer literacy
- Writing skills
- Office
- Health savings account
- Disability insurance
7d
Claims Assistant
Trean Corporation —Ontario, CA
- $20 - $23 an hour
- Monday to Friday
- Office
- High school diploma or GED
- Analysis skills
Quick Apply
23h
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
PERSONAL INJURY CASE MANAGER (Remote)
Adamson Ahdoot, LLP. —California
- $70,000 - $100,000 a year
- Urgently hiring
- Remote
- Spanish
- Writing skills
- Medical office experience
- Free parking
- Health savings account
Quick Apply
Workers Compensation Claims Specialist, West
CNA Insurance —Brea, CA
- $54,000 - $103,000 a year
- Full-time
- Hybrid work
- Mid-level
- 3 years
- Analysis skills
Provider Service Representative
Optum —Ontario, CA
- $18 - $32 an hour
- Full-time
- Spanish
- Pass drug screening
- English
- AD&D insurance
- Employee stock purchase plan
Claims Assistant Workers Compensation - (In-Office Ontario, California)
Sedgwick —Ontario, CA
- Full-time
- Computer literacy
- Writing skills
- Mid-level
- Health savings account
- Disability insurance
Claims Letter Correspondence Coordinator
Choice Physicians Network Inc —San Bernardino, CA
- $20 - $31 an hour
- Full-time
- Hybrid work
- Mid-level
- Neurology
Quick Apply
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
12d
Risk Management Coordinator
City of Upland —Upland, CA
- $78,526.56 - $100,222.00 a year
- Full-time
- Word processing
- Basic math
- English
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
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
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

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claims jobs near ontario ca

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

Dental front Office coordinator/ Biller

Ecommerce Specialist & Customer Service (Cross-Border)

Case Manager - Class Action Settlement Administrator

Medical Claims Biller and Bookkeeper

Claims Adjuster Trainee - National General

Transportation Network Representative

Claims Assistant (On-Site Ontario, CA)

Claims Assistant

Claims Operations Coordintor

PERSONAL INJURY CASE MANAGER (Remote)

Workers Compensation Claims Specialist, West

Provider Service Representative

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

Claims Letter Correspondence Coordinator

Field Claims Adjuster - Auto Damage

Risk Management Coordinator

Claim Operations Specialist

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

Lead Claims Compliance Coordinator

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