Printify Zip Code San Francisco Jobs in Usa

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As a dedicated Sr. Injury Adjuster, you will work within defined guidelines and framework, responsible to adjust attorney involved moderately complex bodily injury claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations. Accountable for delivering a concierge level of best in class member service through setting appropriate expectations, proactive communications, advice, and compassion.

This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX; Chesapeake, VA; Tampa, FL; Colorado Springs, CO and Phoenix, AZ. Relocation assistance is not available for this position.

What you'll do:

• Identifies and manages existing and emerging risks that stem from business activities and the job role.

• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.

• Follows written risk and compliance policies, standards, and procedures for business activities.

• Adjusts attorney-involved moderately complex bodily injury claims with demonstrable injuries (e.g. torn meniscus, broken bones, disc herniations), as well as all auto physical damage associated with those claims.

• Identifies, confirms, and makes coverage decisions on moderately complex bodily injury claims.

• Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines.

• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.

• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation.

• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.

• Supports workload surges and/or Catastrophe Operations as needed.

• May act as an informal resource for team members with less experience.

What you have:

• High School or General Equivalency Diploma.

• 1 year of injury adjusting experience.

• 2 years of auto liability claims adjusting experience.

• Deep knowledge and understanding of the auto claims contract as well as application of case law and state laws and regulations.

• Proficient negotiation, investigation, communication, and conflict resolution skills.

• Demonstrated time-management and decision-making skills.

• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.

• Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.

• Ability to exercise sound financial judgment and discretion in handling insurance claims.

• Proficient knowledge of coverage evaluation, loss assessment, and loss reserving.

• Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts.

What sets you apart:

• 4 or more years auto liability/casualty adjusting experience.

• 1yr Medical experience to include coding and billing or EMT.

• Ongoing Professional Development with a focus on Insurance. 

• Bachelors degree or higher.

• US military experience through military service or a military spouse/domestic partner.

Compensation Range: The salary range for this position is: $63,590 - $121,530.

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As a dedicated Sr. Injury Adjuster, you will work within defined guidelines and framework, responsible to adjust attorney involved moderately complex bodily injury claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations. Accountable for delivering a concierge level of best in class member service through setting appropriate expectations, proactive communications, advice, and compassion.

This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX; Chesapeake, VA; Tampa, FL; Colorado Springs, CO and Phoenix, AZ. Relocation assistance is not available for this position.

What you'll do:

• Identifies and manages existing and emerging risks that stem from business activities and the job role.

• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.

• Follows written risk and compliance policies, standards, and procedures for business activities.

• Adjusts attorney-involved moderately complex bodily injury claims with demonstrable injuries (e.g. torn meniscus, broken bones, disc herniations), as well as all auto physical damage associated with those claims.

• Identifies, confirms, and makes coverage decisions on moderately complex bodily injury claims.

• Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines.

• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.

• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation.

• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.

• Supports workload surges and/or Catastrophe Operations as needed.

• May act as an informal resource for team members with less experience.

What you have:

• High School or General Equivalency Diploma.

• 1 year of injury adjusting experience.

• 2 years of auto liability claims adjusting experience.

• Deep knowledge and understanding of the auto claims contract as well as application of case law and state laws and regulations.

• Proficient negotiation, investigation, communication, and conflict resolution skills.

• Demonstrated time-management and decision-making skills.

• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.

• Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.

• Ability to exercise sound financial judgment and discretion in handling insurance claims.

• Proficient knowledge of coverage evaluation, loss assessment, and loss reserving.

• Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts.

What sets you apart:

• 4 or more years auto liability/casualty adjusting experience.

• 1yr Medical experience to include coding and billing or EMT.

• Ongoing Professional Development with a focus on Insurance. 

• Bachelors degree or higher.

• US military experience through military service or a military spouse/domestic partner.

Compensation Range: The salary range for this position is: $63,590 - $121,530.

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As a dedicated Sr. Injury Adjuster, you will work within defined guidelines and framework, responsible to adjust attorney involved moderately complex bodily injury claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations. Accountable for delivering a concierge level of best in class member service through setting appropriate expectations, proactive communications, advice, and compassion.

This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX; Chesapeake, VA; Tampa, FL; Colorado Springs, CO and Phoenix, AZ. Relocation assistance is not available for this position.

What you'll do:

• Identifies and manages existing and emerging risks that stem from business activities and the job role.

• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.

• Follows written risk and compliance policies, standards, and procedures for business activities.

• Adjusts attorney-involved moderately complex bodily injury claims with demonstrable injuries (e.g. torn meniscus, broken bones, disc herniations), as well as all auto physical damage associated with those claims.

• Identifies, confirms, and makes coverage decisions on moderately complex bodily injury claims.

• Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines.

• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.

• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation.

• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.

• Supports workload surges and/or Catastrophe Operations as needed.

• May act as an informal resource for team members with less experience.

What you have:

• High School or General Equivalency Diploma.

• 1 year of injury adjusting experience.

• 2 years of auto liability claims adjusting experience.

• Deep knowledge and understanding of the auto claims contract as well as application of case law and state laws and regulations.

• Proficient negotiation, investigation, communication, and conflict resolution skills.

• Demonstrated time-management and decision-making skills.

• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.

• Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.

• Ability to exercise sound financial judgment and discretion in handling insurance claims.

• Proficient knowledge of coverage evaluation, loss assessment, and loss reserving.

• Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts.

What sets you apart:

• 4 or more years auto liability/casualty adjusting experience.

• 1yr Medical experience to include coding and billing or EMT.

• Ongoing Professional Development with a focus on Insurance. 

• Bachelors degree or higher.

• US military experience through military service or a military spouse/domestic partner.

Compensation Range: The salary range for this position is: $63,590 - $121,530.

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As a dedicated Sr. Injury Adjuster, you will work within defined guidelines and framework, responsible to adjust attorney involved moderately complex bodily injury claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations. Accountable for delivering a concierge level of best in class member service through setting appropriate expectations, proactive communications, advice, and compassion.

This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX; Chesapeake, VA; Tampa, FL; Colorado Springs, CO and Phoenix, AZ. Relocation assistance is not available for this position.

What you'll do:

• Identifies and manages existing and emerging risks that stem from business activities and the job role.

• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.

• Follows written risk and compliance policies, standards, and procedures for business activities.

• Adjusts attorney-involved moderately complex bodily injury claims with demonstrable injuries (e.g. torn meniscus, broken bones, disc herniations), as well as all auto physical damage associated with those claims.

• Identifies, confirms, and makes coverage decisions on moderately complex bodily injury claims.

• Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines.

• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.

• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation.

• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.

• Supports workload surges and/or Catastrophe Operations as needed.

• May act as an informal resource for team members with less experience.

What you have:

• High School or General Equivalency Diploma.

• 1 year of injury adjusting experience.

• 2 years of auto liability claims adjusting experience.

• Deep knowledge and understanding of the auto claims contract as well as application of case law and state laws and regulations.

• Proficient negotiation, investigation, communication, and conflict resolution skills.

• Demonstrated time-management and decision-making skills.

• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.

• Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.

• Ability to exercise sound financial judgment and discretion in handling insurance claims.

• Proficient knowledge of coverage evaluation, loss assessment, and loss reserving.

• Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts.

What sets you apart:

• 4 or more years auto liability/casualty adjusting experience.

• 1yr Medical experience to include coding and billing or EMT.

• Ongoing Professional Development with a focus on Insurance. 

• Bachelors degree or higher.

• US military experience through military service or a military spouse/domestic partner.

Compensation Range: The salary range for this position is: $63,590 - $121,530.

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Why USAA?

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

The Opportunity

As an Audit Lead, you'll support audit engagements of varying complexity, often participating in cross-functional, risk-based assurance and advisory projects, contributing to the quality of audit work. A key aspect of this role involves testing models and model-related tools as part of audit engagements. You will support Auditor-In-Charge (AIC) responsibilities and maintain knowledge of financial services regulations, effectively responding to and interacting with regulators.

This role provides support and oversight to multiple audit engagements and participates in the review of engagement planning, fieldwork, and reporting. You will also manage strategic initiatives and assist with the development and implementation of a risk-based audit plan. You will serve as, and/or partner with, subject matter expert(s) within audit or the business to analyze issues, establish collaborative client relationships, and proactively work with client management to assess risk and improve internal controls. You will also adhere to the Institute of Internal Auditors' International Standards for the Professional Practice of Internal Auditing (Standards) and Code of Ethics.

We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position can be based in one of the following locations: San Antonio, TX, Plano, TX, or Charlotte, NC.

Relocation assistance is available for this position.

What you'll do:

• Contribute to continuous monitoring, advisory activities, special reviews, and investigations.
• Ensure assigned audit engagements are completed objectively, professionally, and timely, adhering to audit standards.
• Identify control weaknesses and recommend improvements, drafting audit issues and reports for client leadership and conducting follow-up.
• Support quality of audit reviews and propose updates to the universe risk assessment based on audit results.
• Build client relationships to drive strategic objectives.
• Communicate effectively with business/clients, delivering risk-based and difficult messages, and potentially with regulators and executive leaders.
• Provide coaching and guidance to other auditors, ensuring timely and quality deliverables, and may provide engagement evaluations.
• Provide input into the internal audit universe and risk profiles, updating risk assessment information.
• Participate in the development and execution of the annual audit plan, assessing and covering risks.

What you have:

• Bachelor's degree in Business or relevant field such as Finance, Accounting, Business, or Information Technology. Four additional years of related experience beyond minimum required may be substituted in lieu of a degree.
• 8 years of audit, financial, insurance, banking, information technology or related business and/or leadership experience.
• Experience performing internal audits, external audits, or applying audit, risk, or compliance acumen in a complex operational and regulatory environment.
• Broad and comprehensive experience in Audit theory, internal audit principles with demonstrated experience in audit examining, analyzing, assessing, and drawing conclusions from audit work.
• Demonstrated experience effectively communicating and challenging Controls with business partners and influencing business outcomes.
• Understanding of risks and internal controls and the ability to evaluate and determine adequacy and efficiency of controls.
• Experience in a support role, mentoring, and providing feedback to audit team members throughout the audit.
• Experience in overseeing work with both internal and external partners in a highly collaborative environment
• Demonstrated critical thinking and knowledge of data analysis tools and techniques and decision-making abilities.
• Demonstrated experience in highly dynamic environment undergoing change; ability to deal with competing priorities.

What sets you apart:

• AI/ML Knowledge: Comprehensive understanding of AI/ML concepts, lifecycle stages, data sourcing, model types, tools, applications, and model risk management principles.
• AI Risk Management Expertise: Proficient in identifying, assessing, and mitigating risks associated with AI systems (e.g., safety, data integrity, privacy, security, biases).
• Model Risk & Control: Deep knowledge of model risk frameworks and control testing methodologies.
• Regulatory & Governance Expertise: Familiarity with AI-related regulatory guidance (e.g., SR 11-7, OCC 2011-12) and emerging governance principles (e.g., NIST AI RMF, ISO/IEC 42001, EU AI Act).
• AI Explainability & Transparency: Ability to evaluate interpretability techniques for regulatory and business transparency.
• Emerging Technology Awareness: Awareness of generative AI, LLMs, and automated decisioning frameworks to assess evolving risks and adapt audit techniques.

Compensation range: The salary range for this position is: $143,320 - $273,930

USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).

Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on .

Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.

USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

AI Research Scientist | Machine Learning | Deep Learning | Natural Language Processing | LLM | Hybrid | San Jose, CA

Title: AI Research Scientist

Location: San Jose, CA

Responsibilities:

• Design, execute, and analyze machine learning experiments, establishing strong baselines and selecting appropriate evaluation metrics.
• Stay up to date with the latest AI research; identify, adapt, and validate novel techniques for company-specific use cases.
• Define rigorous evaluation protocols, including offline metrics, user studies, and adversarial (red team) testing to ensure statistical soundness.
• Specify data and annotation requirements; develop annotation guidelines and oversee quality control processes.
• Collaborate closely with domain experts, product managers, and engineering teams to refine problem statements and operational constraints.
• Develop reusable research assets such as datasets, modular code components, evaluation suites, and comprehensive documentation.
• Work alongside ML Engineers to optimize training and inference pipelines, ensuring seamless integration into production systems.
• Contribute to academic publications and represent the company in research communities, as needed.

Educational Qualifications:

• Ph.D. in Computer Science, Artificial Intelligence, Machine Learning, or a related field is strongly preferred.
• Candidates with a master’s degree and exceptional research or industry experience will also be considered.

Industry Experience:

• 3–5 years of experience in AI/ML research roles, ideally in applied or product-focused environments.
• Demonstrated success in delivering research-driven solutions that have been deployed in production.
• Experience collaborating in cross-functional teams across research, engineering, and product.
• Publications in top-tier AI/ML conferences (e.g., NeurIPS, ICML, ACL, CVPR) are a plus.

Technical Skills:

• Strong foundational knowledge in machine learning and deep learning algorithms.
• Hands-on experience with PEFT/LoRA, adapters, fine-tuning techniques, and RLHF/RLAIF (e.g., PPO, DPO, GRPO).
• Ability to read, implement, and adapt state-of-the-art research papers to real-world use cases.
• Proficiency in hypothesis-driven experimentation, ablation studies, and statistically sound evaluations.
• Advanced programming skills in Python (preferred), C++, or Java.
• Experience with deep learning frameworks such as PyTorch, Hugging Face, NumPy, etc.
• Strong mathematical foundations in probability, linear algebra, and calculus.
• Domain expertise in one or more areas: natural language processing (NLP), symbolic reasoning, speech processing, etc.
• Ability to translate research insights into roadmaps, technical specifications, and product improvements.

AI Research Scientist | Machine Learning | Deep Learning | Natural Language Processing | LLM | Hybrid | San Jose, CA

Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.

Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.

Provides support for claim appeals in relation to medical necessity.

Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.

Facilitates member second level appeal process.

Graduate from an accredited school of professional nursing is required.

BSN preferred.

Minimum 2 years acute care experience or managed care experience is required.

Basic knowledge of Medicaid, Medicare preferred.

Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.

Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.

Active Certification in Case Management (CCM) is preferred.