274 claims jobs found in Aliso Viejo, CA

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Under moderate management, supervises a team of claims adjusters. Actively drives adjuster hiring and leads adjuster training. Actively manages assigned adjuster workloads and performance. Participates in compliance and best practice reporting. Demonstrates a thorough understanding of corporate policies and procedures. Essential Duties & Responsibilities: Uses various metric driven tools such as FOCUS, the Claim Operation Tool Kit to evaluate performance and identify problem areas in advance of them becoming service issues. Reviews findings with manager to jointly develop a plan for...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Under moderate management, supervises a team of claims adjusters. Actively drives adjuster hiring and leads adjuster training. Actively manages assigned adjuster workloads and performance. Participates in compliance and best practice reporting. Demonstrates a thorough understanding of corporate policies and procedures. Essential Duties & Responsibilities: Uses various metric driven tools such as FOCUS, the Claim Operation Tool Kit to evaluate performance and identify problem areas in advance of them becoming service issues. Reviews findings with manager to jointly develop a plan for...

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Facilitate end to end management of external and internal client audits of pharmacy benefits and pricing Gather PBM plan documentation from internal teams to provide to external audit firm  Read and interpret plan design documents and PBM service agreements  Research...

Job Summary: This role is responsible for designing, developing, and implementing projects and initiatives within a subset of a field discipline that aligns with claims strategic direction and supports strategic goals. The TCL manages a subset of the operations of a team within a market claim office (MCO), typically with an excess of 125 employees, including leading, training, inspiring, engaging and motivating leaders and employees in one or more business segments with a focus on collaboration, innovation, and customer centricity. Key Responsibilities: Analyzes results and contributes to the development of strategies and action plans to support the achievement of operational goals related to customer service, loss cost management, and expense controls Responsible for complex claim decisions, identification of hiring, training, and succession planning opportunities, and the development and implementation of short- and long-term strategies and process improvements to...

Job Summary: This role is responsible for designing, developing, and implementing projects and initiatives within a subset of a field discipline that aligns with claims strategic direction and supports strategic goals. The TCL manages a subset of the operations of a team within a market claim office (MCO), typically with an excess of 125 employees, including leading, training, inspiring, engaging and motivating leaders and employees in one or more business segments with a focus on collaboration, innovation, and customer centricity. Key Responsibilities: Analyzes results and contributes to the development of strategies and action plans to support the achievement of operational goals related to customer service, loss cost management, and expense controls Responsible for complex claim decisions, identification of hiring, training, and succession planning opportunities, and the development and implementation of short- and long-term strategies and process improvements to...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. CA based candidates only. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. CA based candidates only. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way. Position Summary: Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $10,000 liability and/or $25,000 workers compensation or greater. Essential Duties & Responsibilities: Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve  your life’s best work.(sm) This position is responsible for processing pending medical claim. MCR Coordinators are responsible for handling claim projects as needed. MCR Coordinators are responsible for making sure claims information is accurate. MCR Coordinators will be expected to maintain production and quality standards. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization Prepares cases for Medical Directors, UM Nurses and Case Managers to conduct clinical review Provide expertise or general claims support by reviewing, researching, investigating, negotiating,...

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.SM It’s that time, isn’t it? You’re ready for the next step forward and an opportunity to build on your skills. And it just so happens that there’s never been a better time to get on the team at UnitedHealth Group. We’ve built one of the world’s most effective and respected claims processing teams. And that’s where you come in. We’ll look to you to maintain our reputation for service, accuracy and providing a positive...

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm) Let’s talk about meaningful work, an important role and a career move that can transform your future.  WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. At WellMed, now part of Optum and the UnitedHealth Group family of businesses, we focus on prevention and the complete coordination of care for our patients. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth. Join us and you’ll be part of a team dedicated to patient-centered, safe and effective health care. Your skills and talents will make an important impact on our patients while you open doors for yourself that simply do not exist in any other organization. Times...