Manages documents and prioritizes caseloads to ensure timely turnaround. * Ensures adherence to ... Experience working in group health insurance, particularly within claims processing or operations.
Manages documents and prioritizes caseloads to ensure timely turnaround. * Ensures adherence to ... Experience working in group health insurance, particularly within claims processing or operations.
Manages documents and prioritizes caseloads to ensure timely turnaround. * Ensures adherence to ... Experience working in group health insurance, particularly within claims processing or operations.
Manages documents and prioritizes caseloads to ensure timely turnaround. * Ensures adherence to ... Experience working in group health insurance, particularly within claims processing or operations.
Workers Compensation Claims Manager, West
Brea, CA · On-site
$72K - $141K/yr
... resources, underwriters, SIU, Recovery Services, brokers, and vendors. Communicate relevant ... Required Skills, Knowledge & Abilities Knowledge of the insurance industry, organization products ...
Workers Compensation Claims Manager, West
Brea, CA · On-site
$72K - $141K/yr
... resources, underwriters, SIU, Recovery Services, brokers, and vendors. Communicate relevant ... Required Skills, Knowledge & Abilities Knowledge of the insurance industry, organization products ...
Workers Compensation Claims Manager, West
Brea, CA · On-site
$72K - $141K/yr
... resources, underwriters, SIU, Recovery Services, brokers, and vendors. Communicate relevant ... Required Skills, Knowledge & Abilities Knowledge of the insurance industry, organization products ...
Workers Compensation Claims Manager, West
Brea, CA · On-site
$72K - $141K/yr
... resources, underwriters, SIU, Recovery Services, brokers, and vendors. Communicate relevant ... Required Skills, Knowledge & Abilities Knowledge of the insurance industry, organization products ...
Physician / Internal Medicine / California / Permanent / Internal Medicine Physician in San Francisc
Internal Medicine Physician San Francisco, California Karen Khoo, MD and Clair Siu, MD manage a ... The practice has loyal, well-insured patients and a high quality, high functioning staff; including ...
Physician / Internal Medicine / California / Permanent / Internal Medicine Physician in San Francisc
Internal Medicine Physician San Francisco, California Karen Khoo, MD and Clair Siu, MD manage a ... The practice has loyal, well-insured patients and a high quality, high functioning staff; including ...
CNA insures a wide variety of business professionals through its Real Estate Errors and Omissions ... Manages an inventory of moderate to high complexity and exposure commercial claims by following ...
CNA insures a wide variety of business professionals through its Real Estate Errors and Omissions ... Manages an inventory of moderate to high complexity and exposure commercial claims by following ...
CNA insures a wide variety of business professionals through its Real Estate Errors and Omissions ... Manages an inventory of moderate to high complexity and exposure commercial claims by following ...
CNA insures a wide variety of business professionals through its Real Estate Errors and Omissions ... Manages an inventory of moderate to high complexity and exposure commercial claims by following ...
Candidates must be able to work independently, demonstrate strong time management, and possess ... Insurance Experience, Worker's Compensation, Auto, Liability, or similar SIU / Surveillance ...
Candidates must be able to work independently, demonstrate strong time management, and possess ... Insurance Experience, Worker's Compensation, Auto, Liability, or similar SIU / Surveillance ...
... manager for self-insured organizations , uniting respected regional leaders in workers ... SIU, and all files with unresolved coverage issues. * Upon request or in accordance with the ...
... manager for self-insured organizations , uniting respected regional leaders in workers ... SIU, and all files with unresolved coverage issues. * Upon request or in accordance with the ...
... Insurance Company Pay Range: $55,000- $65,000 Per Year. The exact starting compensation to be ... Escalate SIU concerns when appropriate * Maintain accurate claim documentation and diary management
... Insurance Company Pay Range: $55,000- $65,000 Per Year. The exact starting compensation to be ... Escalate SIU concerns when appropriate * Maintain accurate claim documentation and diary management
SVP, Chief Claims Officer
Cerritos, CA · On-site
$250K - $350K/yr
... SIU (Special Investigations Unit), and vendor management, with a strong emphasis on managing ... At least 15 years claims leadership experience in auto insurance, with significant exposure to ...
SVP, Chief Claims Officer
Cerritos, CA · On-site
$250K - $350K/yr
... SIU (Special Investigations Unit), and vendor management, with a strong emphasis on managing ... At least 15 years claims leadership experience in auto insurance, with significant exposure to ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
Manages an inventory of moderate to high complexity and exposure commercial claims by following ... Solid working knowledge of the commercial insurance industry, products, policy language, coverage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
... SIU resources for further investigation. * Achieves quality standards by appropriately managing ... Experience interpreting complex commercial insurance policies and coverage. * Ability to manage ...
Manager Insurance Siu information
What is the difference between Manager Insurance Siu vs Insurance Claims Adjuster?
| Aspect | Manager Insurance Siu | Insurance Claims Adjuster |
|---|---|---|
| Certifications | Insurance licenses, management certifications | Insurance licenses, claims handling certifications |
| Work Environment | Supervisory role, team management, strategic planning | Field or office-based, claims assessment, customer interaction |
| Employer & Industry Usage | Insurance companies, risk management firms | Insurance companies, third-party claims agencies |
| Search & Comparison Intent | Management, oversight, leadership in insurance | Claims processing, damage assessment, customer service |
The Manager Insurance Siu primarily oversees claims and manages teams within insurance companies, focusing on strategic and supervisory tasks. In contrast, an Insurance Claims Adjuster handles the assessment and settlement of individual claims, often working directly with clients. Both roles require insurance licenses and relevant certifications but differ in responsibilities and work environment.
What are popular job titles related to Manager Insurance Siu jobs in California? For Manager Insurance Siu jobs in California, the most frequently searched job titles are:
What job categories do people searching Manager Insurance Siu jobs in California look for? The top searched job categories for Manager Insurance Siu jobs in California are:
What cities in California are hiring for Manager Insurance Siu jobs? Cities in California with the most Manager Insurance Siu job openings:
$20.73 - $42.55/hr
Full-time
Re-posted 3 days ago
Molina Healthcare rating
8.0
Based on 198 frontline employees who took The Breakroom Quiz
163rd of 303 rated insurance
Job description
JOB DESCRIPTION
Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims.
Essential Job Duties
- Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and applicable Federal and State regulatory requirements, and Molina policies.
- Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments.
- Manages documents and prioritizes caseloads to ensure timely turnaround.
- Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements.
- Devises clinical summary post-review.
- Communicates and participates in meetings related to cases.
- Completes medical review to facilitate referral to law enforcement or payment recovery.
- Supports investigation work as necessary and required by the regulatory agency.
Job Requirements
- At least 2 years CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience.
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified
- Critical-thinking, problem-solving and analytical skills.
- Ability to prioritize and manage multiple tasks.
- Ability to work in a team setting.
- Strong verbal/written communication skills, and presentation skills.
- Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
- In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
- Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
- Knowledge of Managed Care and the Medicaid, Medicare, and Marketplace programs.
- Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
- Ability to research and interpret regulatory requirements.
Preferred Qualifications
- Certified Professional Compliance Officer (CPCO).
- Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI).
- Experience working in group health insurance, particularly within claims processing or operations.
- Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.).
- Experience with claims processing systems.
- Ability to use Microsoft Excel/Access platforms working with large quantities of data.
- Ability to answer questions, identify trends and patterns, and present findings.
To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $20.73 - $42.55 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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About Molina Healthcare
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980