Top 376 Medical claims adjuster Jobs

Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)
UCLA Health —Los Angeles, CA
- $95,400 - $208,300 a year
- Management
- Customer service
- 5 years
Claims Manager I, Miscellaneous Medical Facilities Professional Liability
Liberty Mutual —Boston, MA
- $120,000 - $225,000 a year
- Urgently hiring
- Remote
- Office
- Bachelor's degree
- Organizational skills
Supervisor, Claims Medical Only
AmTrust Financial Services, Inc. —Princeton, NJ
- $66,900 - $92,000 a year
- Urgently hiring
- 5 years
- Office
- Bachelor's degree
- Health insurance
- Dental insurance
Workers' Compensation Medical-Only Claims Technician
Liberty Mutual —Los Angeles, CA
- $45,000 - $70,000 a year
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Work from home
11d
Workers' Compensation Medical-Only Claims Technician
Liberty Mutual —Orange, CA
- $45,000 - $70,000 a year
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Work from home
6d
Medical Claims Denial & Appeals Specialist
University of Colorado Medicine —Remote
- $29 - $35 an hour
- Full-time
- Remote
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
Medical Stop Loss Claims Auditor
Evolution Risk Partners, LLC —Remote
- $75,000 - $85,000 a year
- Remote
- Customer service
- Writing skills
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
Medical Claims Investigator
Claritev —Remote
- $50,000 - $55,000 a year
- Full-time
- HIPAA
- Mid-level
- Office
- Paid parental leave
- Employee stock purchase plan
Claims Specialist / Remote
PharMerica —Louisville, KY
- Full-time
- Remote
- Customer service
- Basic math
- Research
- Disability insurance
- Health insurance
Stop Loss Claims Specialist II-Specific
Allied Benefit Systems —Chicago, IL
- $24 - $26 an hour
- Full-time
- Remote
- Mid-level
- Finance
- High school diploma or GED
- Disability insurance
- Health insurance
VA Claims Specialist
Revecore —Remote
- $15 an hour
- Remote
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid training
- Paid holidays
Medical Billing Claims Specialist
Summit Spine and Joint Centers —Remote
- Full-time
- Remote
- Word processing
- Computer literacy
- Mid-level
- Health insurance
- Paid time off
Quick Apply
Pharmacy Claims Representative 2 - Remote
Dragonfly Health —Arlington, TX
- From $22 an hour
- 12 hour shift
- Remote
- HIPAA
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
Insurance Claims Specialist HB
SYSTEM West Virginia University Health System —Remote
- Full-time
- Remote
- Computer literacy
- Medical office experience
- Basic math
Health Claims Specialist
Revecore —Remote
- $17.50 an hour
- Remote
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid training
- Paid holidays
Appeals Specialist (Medical Claims)
Northwest Administrators, Inc. —Federal Way, WA
- $30.70 - $41.54 an hour
- Hybrid work
- Mid-level
- Office
- Analysis skills
- Disability insurance
- Health insurance
Quick Apply
6d
Claims - Care Manager, RN, Claims
Wellcove —Remote
- Full-time
- Remote
- RN License
- Mid-level
- Geriatrics
Quick Apply
RCM - Claims Specialist
Keplr Vision —Remote
- $21 - $25 an hour
- Full-time
- Remote
- Writing skills
- Mid-level
- Communication skills
- Vision insurance
Quick Apply
8d
Claims Manager
CFG HEALTH SYSTEM LLC —Mount Laurel, NJ
- $75,000 - $90,000 a year
- Full-time
- 5 years
- HIPAA
- Finance
Quick Apply
Medical Claims Specialist
Berkshire Hathaway Homestate Companies —Omaha, NE
- Hybrid work
- Office
- Administrative experience
- High school diploma or GED
- Free parking
- AD&D insurance
Quick Apply

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Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

UCLA Health -
Los Angeles, CA

Apply Now

Job Details

$95,400 - $208,300 a year

Qualifications

Data visualization software proficiency
HIPAA compliance
Management
Medicare
Managed care
Medical coding software
Managed care organization experience
CMS
Regulatory compliance in claims processing
HIPAA
Medical claims processing software
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Leading team collaboration initiatives
Centers for Medicare & Medicaid Services (CMS) billing regulations
Managing insurance claims teams
Operational excellence initiatives
Productivity software
Business operations
Cross-functional team management
Cross-functional communication

Full Job Description

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:

Implement and maintain efficient and streamlined claims adjudication processes that effectively utilize technology to automate business processes and maximize the accuracy of claims payments.
Foster a positive, high-performing team culture focused on quality and exceptional customer service
Identify opportunities to enhance workflows, resolve complex claim issues, and develop practical standard operating procedures
Empower the team to navigate challenging scenarios with confidence and consistency

Salary Range: $95,400 - $208,300/annually

Note: This position is flexible-hybrid.

Qualifications

We’re seeking a self-motivated, service-driven leader with:

Required:

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

Preferred:

Certified Professional Biller (CPB)
Certified Revenue Cycle Representative (CRCR)

Apply Now

Refine Your Search

medical claims adjuster jobs

Claims Manager, Medicare Advantage Plan (Flexible-Hybrid)

Claims Manager I, Miscellaneous Medical Facilities Professional Liability

Supervisor, Claims Medical Only

Workers' Compensation Medical-Only Claims Technician

Workers' Compensation Medical-Only Claims Technician

Medical Claims Denial & Appeals Specialist

Medical Stop Loss Claims Auditor

Medical Claims Investigator

Claims Specialist / Remote

Stop Loss Claims Specialist II-Specific

VA Claims Specialist

Medical Billing Claims Specialist

Pharmacy Claims Representative 2 - Remote

Insurance Claims Specialist HB

Health Claims Specialist

Appeals Specialist (Medical Claims)

Claims - Care Manager, RN, Claims

RCM - Claims Specialist

Claims Manager

Medical Claims Specialist

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