Workers' Compensation Specialist Community OptionsWorkers' Compensation SpecialistPrinceton, New JerseyThe Worker’s Compensation Specialist will serve a critical role in the Benefits department, as a part of the Human Resources team, managing workers' compensation claims, organization wide. Take lead on workers’ compensation management initiatives pertaining to treatment and care of our employees.
Senior Staff Dentist LIBERTY Dental PlanSenior Staff DentistStaten Island, NJ$175,000–$185,000 / yearThis role allows you to leverage your clinical expertise beyond traditional practice-impacting care delivery at scale while working alongside a passionate and supportive team. You'll regularly partner with teams across Analytics, Utilization Management, Claims, and Provider Outreach, while also connecting directly with network dentists through peer-to-peer consultations.
Staff Data Engineer- RWE H1Staff Data Engineer- RWENew York, New YorkWe've built one of the largest healthcare datasets in the world: profiles of more than 10 million physicians, assembled from billions of insurance claims, 25 million publications, and nearly 500K clinical trials, with hundreds of sources feeding each doctor's profile. - Experience using AI-assisted coding tools (e.g., GitHub Copilot, Claude Code) to accelerate development while maintaining quality is encouraged COMPENSATION This role pays $190,000 to $230,000 per year, based on experience, in addition to stock options.
Senior Learning And Development Insurance Trainer Starr CompaniesSenior Learning And Development Insurance TrainerNew York, NY$115,000–$147,800 / yearThe wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets: experience and training: licensure and certifications: and other business and organizational needs. Reporting to the Director, Global Learning and Development, you will oversee the creation, design, and delivery of high-impact, insurance-specific training programs that support both new and experienced employees.
Administrator, Commercial General Liability New Jersey ManufacturersAdministrator, Commercial General LiabilityTrenton, New JerseyThe Administrator will have the unique ability to help shape the direction of the department working closely with strategic business partners cross the enterprise and senior leadership to create a best-in-class operation that supports NJM's growing commercial business throughout the Mid-Atlantic Region. Develop and engage supervisor and claims staff through coaching, monitoring performance and maximizing the effectiveness of operations creating an environment of accountability, continual improvement, superior customer service and professional development.
Director Configuration, Benefit Administration HealthfirstDirector Configuration, Benefit AdministrationNew York, NY$154,600–$236,555 / yearThis role implements the configuration structure within Healthfirst's technology platforms to administer benefits taking in coordination with Provider Contracting, Claims Operations, Provider Data Management, Clinical Operations, Payment Integrity, and Information Technology. The objective of this role is to ensure that the benefit structure implementation delivers the intended experience through claim adjudication, including benefits, authorizations, reference data, claims editing, regulatory requirements, payment policies, and overall claim system functionality.
Dir Configuration, Benefit Administration HealthfirstDir Configuration, Benefit AdministrationNew York, NY$154,600–$236,555 / yearThis role implements the configuration structure within Healthfirsts technology platforms to administer benefits taking in coordination with Provider Contracting, Claims Operations, Provider Data Management, Clinical Operations, Payment Integrity, and Information Technology. The objective of this role is to ensure that the benefit structure implementation delivers the intended experience through claim adjudication, including benefits, authorizations, reference data, claims editing, regulatory requirements, payment policies, and overall claim system functionality.
Director, Healthcare - Payment Integrity West Monroe Partners, LLCDirector, Healthcare - Payment IntegrityNew York, NY$200,000–$250,000 / yearWorking alongside leaders across our National Healthcare Practice, this role will be responsible for developing and growing client relationships, identifying and pursuing new business opportunities, leading complex consulting engagements, and delivering exceptional value to clients. This role will focus on delivering business and technology consulting solutions for payer organizations, with a specialization in Payment Integrity, claims operations, reimbursement methodologies, and healthcare finance transformation.
Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, Private & NFP D&OWarren, NJ$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Complex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - Private & NFP D&ONew York, NY$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex Financial Lines claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Configuration and Quality Audit Analyst | Hybrid NY HealthfirstConfiguration and Quality Audit Analyst | Hybrid NYNew York, NY$68,900–$99,620 / yearAt least three years of experience in a managed care organization, commercial health plan, government program, third-party administrator, or other healthcare operations environment performing claims analysis, configuration audit, provider reimbursement, payment integrity, or healthcare data analysis. Candidate must display effective communication skills and have detailed skillset to configure Office365, effectively communicate product updates, interface with the vendor on potential issues, and ensure platform governance rules are followed.
Billing Specialist Community OptionsBilling SpecialistPrinceton, New JerseyThis person will collect Medicaid reimbursements by resolving discrepancies, adjusting claims, preparing reports, monitoring collections, and providing excellent customer service to internal staff and designated payers. Community Options, Inc. is a national non-profit agency providing services to individuals with disabilities in 12 states.
Paralegal New Jersey ManufacturersParalegalTrenton, New JerseyServe as the General Claims Legal liaison to General Claims Staff regarding issues associated with medical liens and releases, including: reviewing ERISA plan documents to determine whether the plan is a self-funded plan that legally may enforce a lien for medical benefits, and provide a recommended conclusion to GC Legal Staff; responding to requests for multi-state child support judgment searches and reviewing releases for inconsistencies that may not protect insureds or NJM interests. Provide paralegal support to nine attorneys including conducting legal research and circulating newly released court opinions on relevant issues; monitoring case and publication alerts through Westlaw on important cases, regulations or statutes; monitoring Google search reports on topics as requested; providing General Claims with current statutes regarding good-faith claims handling; and obtaining documents from state and federal dockets.
Audit Coordinator II (Repricing), Healthcare ExlService Holdings IncAudit Coordinator II (Repricing), HealthcareNYRemote$21.63–$26.44 / hourJoin our growing team as an Audit Coordinator II - Repricing, where you'll play a critical role in ensuring accurate claim payments, maximizing savings, and supporting top-tier healthcare clients. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others.
A&H Claims Specialist Sirius International Insurance Group Ltd (Inactive)A&H Claims SpecialistNew York, NY$110,000–$125,000 / yearThe Claims Specialist will interact frequently with brokers and clients, evaluate claim notices, and approve authorizations and financial transactions on behalf of SiriusPoint. In this capacity, you will handle claims emanating from the A&H Direct and Reinsurance books, including core MGA's and developing claim strategies to drive the best possible results.
Data Governance Lead ExlService Holdings IncData Governance LeadNY$120,000–$150,000 / yearExperience with data governance and data quality platforms such as Collibra, Ataccama, Informatica Axon/EDC, Alation, or similar tools for business glossary management, stewardship workflows, policy compliance, data quality monitoring, and governance KPI reporting. Define and implement data quality frameworks covering profiling, validation rules, completeness, accuracy, consistency, timeliness, uniqueness, exception management, issue tracking, root-cause analysis, and remediation workflows.
Senior Director, Data Engineering Starr CompaniesSenior Director, Data EngineeringNew York, NY$170,000–$225,000 / yearThe Senior Director, Data Engineering is a senior leadership role, responsible for driving the transformation and execution of Starr's enterprise data ecosystem in direct support of core insurance business functions-including underwriting, claims, risk, finance, and regulatory reporting. The Senior Director will optimize and enable critical finance and actuarial workflows-such as month-end close cycles and daily general ledger/reinsurance data processing-while safeguarding reliability and compliance for business operations.
Associate General Counsel - Risk Transfer Solutions Markel Group IncAssociate General Counsel - Risk Transfer SolutionsRed Bank, NJ$116,080–$159,610 / yearThis includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. The ideal candidate must be an excellent writer and communicator, a strategic thinker, have strong analytical skills, significant experience with the review of commercial contracts (specifically Insurance and Indemnity provisions), comfort communicating with other insurers and drafting lawsuits, and a demonstrated ability to manage multiple tasks and priorities.
Staff Dentist LIBERTY Dental PlanStaff DentistStaten Island, NJ$150,000–$165,000 / yearYour work directly influences patient outcomes, supports providers, and strengthens the integrity of dental benefits across Commercial, Marketplace, Medicare Advantage, and Medicaid programs. In this role, your day is highly focused and structured around clinical review and collaboration: ~90% of your time reviewing prior authorizations and dental claims using internal systems (including AI-supported platforms).
CLX Senior Manager, Pet Lemonade IncCLX Senior Manager, PetNY$110,000–$135,000 / yearDevelop a strategic technical vision for Pet Claims handling growth and scale, focusing on accurate payments, delightful customer experiences, and optimized handling times. We're looking for a senior-level, customer centric leader and technical expert to manage our Pet Claims Experience (CLX) teams and vendor relationships.