Pharmacy Claims Adjudication Specialist Onco360Pharmacy Claims Adjudication SpecialistWaltham, MassachusettsSkills/Knowledge Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360.
Claims Consultant -Life Sciences Or Cyber/Technology E&O (Hybrid) Intact InsuranceClaims Consultant -Life Sciences Or Cyber/Technology E&O (Hybrid)Boston, MA$143,000–$167,000 / yearSpecial consideration will be given to candidates who have personally litigated life sciences matters as attorneys and possess firsthand experience developing litigation strategy, managing scientific and expert evidence, conducting depositions, participating in trial preparation, and evaluating product liability and professional liability exposures from both the litigation and insurance claims perspectives. The ideal candidate will possess substantial Technology Errors & Omissions claims experience and a deep understanding of E&O coverage, including the ability to analyze complex professional liability exposures, contractual liability issues, performance disputes, and technology-related loss scenarios.
Claims Service Specialist IV - Commercial Lines Bodily Injury ArbellaClaims Service Specialist IV - Commercial Lines Bodily InjuryQuincy, Massachusetts$85,000–$105,000 / yearOur current reasonable and good faith estimate of the annual salary range for this position is approximately $85,000 - 105,000 based on a variety of factors including, but not limited to, relevant skills and experience, educational background and certifications, performance and qualifications, market demand for the role and other organizational needs. Interprets and evaluates medical reports to determine if they are applicable to the claim; monitors legal and medical billings and investigates for proper charges and pays accordingly.
Claims Supervisor 1 Concord General Mutual Insurance CompanyClaims Supervisor 1Westborough, MassachusettsSupervisory responsibilities include but not limited to: training and developing associates and conducting performance appraisals; planning, assigning, and directing work to meet Company objectives; ensure that associates consistently meet Company service expectations; addressing complaints and resolving problems; e. For those assigned a fleet vehicle: drive an automobile, possess a valid driver’s license, and maintain a driving record consistent with the Company’s underwriting guidelines for coverage.
NewClaims Review Specialist, DSNP Mass General BrighamClaims Review Specialist, DSNPSomerville, MassachusettsRemoteWorking with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Property Claims Specialist Ursus, Inc.Property Claims SpecialistAndover, MA$30–$32.47 / hourExcellent written communication: capable of presenting work and writing work reports, scope of work, and contractual documentation; Excellent verbal communication: able to verbalize in clear, concisely, and tactful communication with senior executive management, clients, peers, and team members. The position is responsible for the day-to-day activity of property loss and business interruption claims, communication of loss incidents, interaction/coordination with Operations and Maintenance groups, claims submission, preparation and coordination with claims consultants, financial tracking and reporting for accounting, and status reporting on recovery.
NewProcess Consultant, Stop Loss Claims Sun Life FinancialProcess Consultant, Stop Loss ClaimsWellesley Hills, MA$60,400–$90,600 / yearThrough employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. Job Description: The opportunity: The Process Consultant, Stop Loss Claims is accountable for process governance, end-to-end documentation strategy, and continuous improvement that strengthens quality, compliance, scalability, and risk management within Stop Loss Claims Operations.
Claims Manager, Risk Management Starr CompaniesClaims Manager, Risk ManagementBoston, MAThe Claims Manager, Risk Management will be responsible for: Active oversight of claims currently managed by a Third Party Administrator as well as direct handling of an active inventory of primary and excess claims related to policies written out of the Risk Management Profit Center in various jurisdictions. At Starr, you'll work in an entrepreneurial culture alongside accessible leaders, leveraging our financial strength and vast industry experience to deliver solutions for our clients, no matter how complex.
General Liability Claims Consultant CNA Financial Corp.General Liability Claims ConsultantBoston, MA$72,000–$141,000 / yearThis individual contributor role operates under broad authority to manage commercial claims of high complexity and exposure within the Commercial Auto/General Liability/ Construction Auto and General Liability line(s) of business. Performs a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages.
Claims Manager CB Consulting GroupClaims ManagerBoston, MassachusettsIdeal candidates are attorneys with 2 years of experience in civil litigation, OR paralegals with 5+ years of experience with civil litigation (bonus if there is exposure to toxic tort litigation). This role begins in office, but generous flexibility comes after an initial ramp-up period.
Claims - Field Claims Representative Cincinnati Financial CorporationClaims - Field Claims RepresentativeBoston, MA$68,400–$91,200 / yearThis territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person.
Claims Supervisor GpacClaims SupervisorWoburn, MA90000–110000GPAC (Growing People and Companies) is an award-winning search firm specializing in placing quality professionals within multiple industries across the United States since 1990. This role offers the opportunity to lead a high-performing team, influence process improvements, and make a direct impact on operational excellence in a supportive, forward-thinking environment.
Director of Claims GpacDirector of ClaimsWoburn, MA110000–130000GPAC (Growing People and Companies) is an award-winning search firm specializing in placing quality professionals within multiple industries across the United States since 1990. This role offers the opportunity to lead a high-performing team, influence process improvements, and make a direct impact on operational excellence in a supportive, forward-thinking environment.
Claims Consultant BerkleyClaims ConsultantBoston, Massachusetts$50–$70 / hourThe company offers a competitive compensation plan which for this role include: oHourly: $50-$70/hr oThis is a temporary role (not permanent) – estimated 3-6 months oPart time 20 - 25 hours a week The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Review, evaluate and, if necessary, respond in a reasonable and timely fashion to demands seeking payment of an insured’s total applicable limits of liability, time-limited demands, offers of judgment, demands that Gemini settle a claim within its limits of liability and similar types of demands or offers.
Stop Loss Claims Resolution Consultant Sun Life FinancialStop Loss Claims Resolution ConsultantWellesley Hills, MA$54,100–$81,200 / yearThis role combines deep technical expertise as a Stop Loss Health Claims Analyst with responsibility for managing end-to-end inquiry resolution, including research, claim determination support, documentation review, and clear customer communication. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation.
Sr. Claims Analyst, Health And Risk Solutions Sun Life FinancialSr. Claims Analyst, Health And Risk SolutionsWellesley Hills, MA$68,200–$102,300 / yearYou will also play a key role in managing internal and external relationships, supporting new hire training, and coaching and mentoring Health and Risk Solutions Claim Analysts and Overpayment Specialists. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation.
Sr. Claims Analyst, Health and Risk Solutions Sun Life FinancialSr. Claims Analyst, Health and Risk SolutionsWellesley Hills, MA$68,200–$102,300 / yearYou will also play a key role in managing internal and external relationships, supporting new hire training, and coaching and mentoring Health and Risk Solutions Claim Analysts and Overpayment Specialists. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation.
Assistant Vice President, Excess Claims American International GroupAssistant Vice President, Excess ClaimsBoston, MA$175,000–$225,000 / yearOur Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.
Workers Compensation Claims Supervisor - New England GallagherWorkers Compensation Claims Supervisor - New EnglandQuincy, MassachusettsRemoteFull timeHow you'll make an impact : Supervise: Lead and encourage a Workers Compensation claims team handling a variety of caseload sizes and complexities to deliver high-quality and efficient service. Prioritize and Develop: Effectively manage multiple competing priorities, identify coaching opportunities, and position team members for successful development.
Workers Compensation Claims Associate WayfairWorkers Compensation Claims AssociateBoston, MAThe Workers Compensation Claims Associate will support management of Workers Compensation claims to resolution of each claim that is compatible with the goals of Wayfair and that returns the injured team member to work at the earliest possible time. We’re a community of innovators, risk-takers, and trailblazers who celebrate our differences, and know that our unique perspectives make us stronger, smarter, and well-positioned for success.