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8 results for Insurance Verification Specialist in Irvine, CA

Medical Insurance Collections Specialist

Los Angeles, CA
onsite
Temporary to Hire
25.01 - 31.9 USD / Hourly
A Hospital in Los Angeles is seeking an experienced Medical Insurance Collections Specialist to join its revenue cycle team. The Medical Insurance Collections Specialist role will focus on insurance follow-up and collections for HMO and PPO payers, with an emphasis on resolving outstanding balances, researching claim issues, and securing timely reimbursement. The ideal candidate for the Medical Insurance Collections Specialist role will also have experience working with UB04 claims in a hospital setting. Key Responsibilities:<ul><li>Perform insurance collections follow-up on outstanding hospital claims with a focus on HMO and PPO payers. </li><li>Contact insurance companies and payers to obtain claim status, secure payment, and resolve unpaid or underpaid accounts. </li><li>Review and work hospital UB04 claims to ensure accurate billing and proper reimbursement..</li><li>Investigate and resolve claim denials, rejections, underpayments, and payment delays. </li><li>Submit corrected claims, supporting documentation, and appeals as needed to facilitate payment resolution. </li><li>Follow up on aged accounts receivable and maintain productivity in line with departmental goals. </li><li>Document all collection activity, account updates, and payer communications in the billing system.</li><li>Collaborate with billing, coding, and patient financial services teams to resolve claim discrepancies and improve reimbursement outcomes. </li><li>Monitor payer trends and escalate recurring issues impacting collections. </li></ul> Qualifications:<ul><li>3+ years of experience in medical insurance collections, insurance follow-up, or healthcare accounts receivable..</li><li>Hospital billing or collections experience required. </li><li>Strong knowledge of HMO and PPO insurance plans, payer guidelines, and reimbursement processes. </li><li>Experience working with UB04 claims required. </li><li>Familiarity with denial management, appeals, and claim resolution processes</li><li>Strong attention to detail, organizational skills, and ability to manage a high-volume workload..</li><li>Excellent communication and problem-solving skills..</li><li>Proficiency with hospital billing systems and electronic medical records preferred.</li></ul>
2026-09-17T00:00:00Z

Credentialing Specialist

Long Beach, CA
onsite
Temporary / Contract
26 - 28 USD / Hourly
A healthcare company is looking for an experienced Credentialing Specialist to lead credentialing and provider data activities for a healthcare organization in Long Beach, California. The Credentialing Specialist is responsible for managing provider onboarding, recredentialing, payer enrollment support, and provider record maintenance while ensuring compliance with regulatory, accreditation, and health plan requirements. The Credentialing Specialist will also collaborate with internal teams to improve workflows, maintain audit readiness, and promote accurate, consistent credentialing practices. Key Responsibilities:<ul><li>Manage day-to-day credentialing activities for providers, including initial appointments, reappointments, and related follow-up tasks.</li><li>Coordinate provider onboarding, recredentialing cycles, payer enrollment support, and privileging documentation to ensure timely processing.</li><li>Maintain compliance with accreditation standards, delegated credentialing requirements, and applicable state and federal regulations.</li><li>Review credentialing files, provider rosters, and supporting documentation for completeness, accuracy, and timely updates.</li><li>Monitor credentialing volume, track turnaround times, and help resolve issues that may delay provider processing.</li><li>Conduct routine audits of credentialing records and assist with preparation for internal and external audits or delegated reviews.</li><li>Partner with leadership and cross-functional teams to support process improvements, policy updates, and reporting needs.</li><li>Maintain provider data integrity across systems to support accurate reporting, downstream operations, and compliance requirements.</li></ul>Benefits: Health, Dental, Vision, 401k, and Sick Time Off.
2026-09-17T00:00:00Z

Credentialing Specialist

Long Beach, CA
onsite
Temporary / Contract
24 - 28 USD / Hourly
A healthcare organization in Long Beach, California is seeking an experienced Credentialing Specialist to support core credentialing and provider data operations. This role is responsible for managing provider onboarding, recredentialing, payer enrollment support, and provider record maintenance while ensuring compliance with regulatory, accreditation, and health plan requirements. The Credentialing Specialist will also collaborate with internal teams to improve workflows, maintain audit readiness, and promote accurate, consistent credentialing practices. Key Responsibilities:<ul><li>Manage day-to-day credentialing activities for providers, including initial appointments, reappointments, and related follow-up tasks.</li><li>Coordinate provider onboarding, recredentialing cycles, payer enrollment support, and privileging documentation to ensure timely processing.</li><li>Maintain compliance with accreditation standards, delegated credentialing requirements, and applicable state and federal regulations.</li><li>Review credentialing files, provider rosters, and supporting documentation for completeness, accuracy, and timely updates.</li><li>Monitor credentialing volume, track turnaround times, and help resolve issues that may delay provider processing.</li><li>Conduct routine audits of credentialing records and assist with preparation for internal and external audits or delegated reviews.</li><li>Partner with leadership and cross-functional teams to support process improvements, policy updates, and reporting needs.</li><li>Maintain provider data integrity across systems to support accurate reporting, downstream operations, and compliance requirements.</li></ul>Benefits: Health, Dental, Vision, 401k, and Sick Time Off.
2026-09-14T00:00:00Z

Credit Specialist

Brea, CA
onsite
Temporary to Hire
26 - 27 USD / Hourly
We are looking for a Credit Specialist to join an electronic components manufacturing organization in Brea, California. This contract opportunity with permanent potential is ideal for someone who thrives in a fast-paced finance environment and can confidently manage account reconciliations, payment issues, and deduction research. The person in this role will help maintain accurate customer account balances, support healthy cash flow, and collaborate with internal partners to resolve billing-related concerns. Responsibilities:• Reconcile assigned customer accounts by reviewing chargebacks, short payments, and other account discrepancies to ensure records remain accurate.• Investigate overdue invoices and follow up with customers to secure payment or determine the cause of delayed remittance.• Analyze customer deductions, validate supporting documentation, and work toward timely resolution of disputed items.• Review account standing and release orders for shipment when credit conditions and payment status support approval.• Prepare recurring updates for leadership that highlight collection activity, aging trends, cash expectations, and past-due balances.• Partner with teams across sales, sales support, and accounting to address billing questions and resolve account-related issues efficiently.• Provide guidance to colleagues within the credit function when training support is needed or assigned by management.• Offer backup assistance for select supervisory tasks when department leadership is unavailable.• Contribute to additional credit and collections activities as needed to support departmental priorities and service levels.
2026-09-10T00:00:00Z

Benefits Specialist

Irvine, CA
onsite
Temporary to Hire
34.257 - 39.666 USD / Hourly
We are looking for a Benefits Specialist to join a team in Irvine, California in a Contract to Permanent role. This position supports the delivery of employee benefits programs by helping with enrollments, employee inquiries, records management, and benefits system activity. The ideal candidate brings strong attention to detail, a service-oriented approach, and the ability to manage several priorities while contributing to a positive employee experience. Responsibilities: • Provide day-to-day support for health, retirement, life, disability, and voluntary benefit programs while ensuring employees receive accurate and timely assistance. • Investigate and resolve issues related to enrollments, eligibility, carrier connections, billing questions, and claims concerns. • Guide employees through benefits processes and help them use benefits administration tools effectively. • Process benefits-related events such as employee enrollments, life status changes, and open enrollment activities while monitoring deadlines and documentation requirements. • Partner with HR teams and internal stakeholders to verify data accuracy, reconcile records, and address discrepancies with carriers or system files. • Assist with audits, testing, troubleshooting, and ongoing maintenance for HRIS and benefits administration platforms, including support for system updates or implementations when needed. • Coordinate assigned benefits projects by tracking milestones, organizing communications, maintaining documentation, and following through on action items. • Contribute to process improvements, employee communications, wellness initiatives, and compliance reporting to strengthen consistency and engagement across the organization.
2026-09-17T00:00:00Z

Claims Professional

Cheviot Hills, CA
onsite
Temporary to Hire
25.65 - 29.7 USD / Hourly
We are looking for a Claims Specialist to support workplace injury case coordination for a service organization in Los Angeles, California. This contract-to-permanent opportunity is ideal for someone with experience handling workers’ compensation documentation, medical status tracking, and communication with supervisors and adjusters. The person in this role will help maintain accurate claim records, promote timely follow-up, and assist with return-to-work efforts for employees recovering from job-related injuries. Responsibilities: • Manage an assigned group of modified duty and lost time workers’ compensation claims from intake through closure support. • Review work-related medical documentation, record key details in the system, and route records to the appropriate insurance adjuster. • Notify supervisors of initial medical findings, work status updates, and any changes that affect employee availability. • Coordinate follow-up activity by scheduling reminders for medical appointments and obtaining documented status updates within 24 hours of each visit. • Share appointment outcomes promptly with both the insurance adjuster and internal leadership to keep claim activity current. • Support early return-to-work efforts by working with management and affected employees to align contract work options with medical restrictions. • Track lost work time and modified duty assignments to ensure claim records remain complete and accurate. • Maintain ongoing communication with insurance adjusters at regular intervals until each claim is resolved, and perform routine audits of claim data for accuracy and completeness.
2026-09-16T00:00:00Z

Medical Claims Examiner

San Bernardino, CA
onsite
Temporary to Hire
25.01 - 33.67 USD / Hourly
A Medical Claims Organizations is in the immediate need of Medical Claims Examiner with experience in grievances and appeals to join the team. The Medical Claims Examiner is responsible for reviewing, investigating, and resolving member and provider grievances and appeals in compliance with regulatory requirements and internal policies. The Medical Claims Examine candidate will have hands-on experience working within EZ-CAP and a solid understanding of health plan operations. Key Responsibilities: <ul><li>Review, research, and process member and provider grievances and appeals accurately and within required turnaround times</li><li>Use EZ-CAP to document, track, and manage case activity</li><li>Analyze case details, benefits, claims, authorizations, and supporting documentation to determine appropriate resolutions</li><li>Ensure all grievances and appeals are handled in accordance with health plan policies, CMS, DMHC, and other applicable regulatory guidelines</li><li>Communicate with internal departments, providers, and members regarding case status and resolution</li><li>Prepare written correspondence for grievance and appeal determinations</li><li>Maintain complete, accurate, and audit-ready documentation</li><li>Identify trends or recurring issues and escalate as needed</li></ul>
2026-09-14T00:00:00Z

Medical Claims Examiner

San Bernardino, CA
onsite
Temporary / Contract
26 - 33 USD / Hourly
We are seeking a detail-oriented Medical Claims Examiner to join our team. In this role, you will review, analyze, and process medical claims accurately and efficiently while ensuring compliance with company policies, client requirements, and regulatory guidelines. The ideal candidate will have strong knowledge of claims adjudication, medical terminology, and healthcare insurance processes. Experience with EZ-CAP is a plus, and grievances experience is highly preferred.Key Responsibilities:<ul><li>Review and process medical claims for accuracy, completeness, and eligibility</li><li>Analyze claims to determine coverage, payment, and denial outcomes</li><li>Research and resolve claim discrepancies, adjustments, and pended claims</li><li>Interpret provider contracts, benefit plans, and reimbursement guidelines</li><li>Ensure timely adjudication of claims in accordance with turnaround standards</li><li>Investigate and respond to inquiries related to claims status, denials, and escalations</li><li>Maintain accurate documentation of claim actions and decisions</li><li>Collaborate with internal departments, providers, and health plan representatives to resolve complex claims issues</li><li>Assist with appeals and grievance-related cases as needed</li><li>Stay current on policies, procedures, and regulatory requirements affecting claims processing</li></ul>
2026-09-14T00:00:00Z