Complex Claims Consultant - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, 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.
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.
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.
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.
NewTechnical PM Aviva PlcTechnical PMNew York, NY$125,000–$225,000 / yearSubstantial experience delivering complex technology implementation programs, including multi-vendor core system implementations and system integration workstreams, with personal accountability for the outcome. Physical Requirements: This position is primarily performed in an office or remote work environment and requires prolonged periods of computer use, analysis of complex business and program data, communication with internal and external stakeholders, and participation in virtual and in-person meetings.
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.
Senior Facets Product Consultant / Facets Solution Manager Iconma LLCSenior Facets Product Consultant / Facets Solution ManagerNJ$5–$10 / hourUnderstand business and technical requirements, consult customers to design and recommend solution architecture, manage mid and large-sized projects of the following nature( Product updates, Application Maintenance, etc., guide product specialists to ensure complete coverage of client's requirements and product quality within the client and project specifications. The role requires excellent general consulting and Facets application skills to work with the client technical team to understand: the technical and functional ecosystem; analyze customer requirements; challenges from an IT and business process perspective by interacting with the customer architects / SMEs, and reviewing documentation.
Commercial Development Specialist Henry Schein IncCommercial Development SpecialistNY$62,893–$86,479 / yearVendor Management: Oversee monthly data exchange and communication with approximately 14 vendors, including preparing and submitting sales files, consolidating incoming claims data, and supporting accurate vendor billing and reimbursement processes. Rate Sheet Development & SKU Management: Support the creation and maintenance of rate sheets and SKU lists, including generating and managing item codes to ensure accurate product identification and pricing across the extended warranty program.
ISO Regulatory Reporting Analyst ExlService Holdings IncISO Regulatory Reporting AnalystNew Jersey, NJThis position requires strong insurance domain expertise, advanced data analysis capabilities, excellent stakeholder management skills, and the ability to identify and resolve complex reporting and data quality issues. Prepare, validate, and submit complex regulatory reports and data calls to various State Insurance Departments, regulatory bodies, and industry bureaus within established deadlines.
Manager, Healthcare Data Management ExlService Holdings IncManager, Healthcare Data ManagementNY$75,100–$107,300 / yearStrong problem solving and analytical skills and the ability to "roll up your sleeves" and work to create timely solutions and resolutions, to validate, verify, communicate, and resolve application issues. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
NewMedical Biller (Fertility Specialty) Actalent IncMedical Biller (Fertility Specialty)New York, NYRemote$62,400–$83,200 / yearWe are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing winner for both client and talent service. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Outpatient Auditor III ExlService Holdings IncOutpatient Auditor IIINYRemote$70,000–$90,000 / yearAs a Remote Certified Outpatient Facility Auditor, you will apply your in‑depth knowledge of CPT/HCPCS coding, APC payment methodologies, and outpatient regulatory guidelines to audit UB‑04 facility claims only, ensuring accurate APC assignment, proper packaging, and compliant facility billing. Conduct audits across infusion therapy, outpatient surgeries, imaging, and interventional radiology, such as: Verifying correct APC assignment for chemotherapy and non-chemotherapy infusions, hydration services, and observation-related services.
Principal, Medical Economics Evergreen Nephrology LLCPrincipal, Medical EconomicsNY$135,000–$150,000 / yearThis role will help ensure the integrity of claims data flowing into enterprise datasets, enable more sophisticated economic and impact modeling, and connect cost insights with clinical and risk stratification efforts to support value-based care performance. Partner with data, actuarial, and analytics teams to validate healthcare claims data structures, ensure data is accurately represented in enterprise datasets, and resolve discrepancies affecting downstream reporting and analysis.
Senior Analyst, Audit and Compliance Analytics (Hybrid NY) HealthfirstSenior Analyst, Audit and Compliance Analytics (Hybrid NY)New York, NY$83,100–$120,360 / yearThis role partners with cross-functional teams to identify risks, evaluate controls, analyze claims and configuration data, and develop reporting that supports operational excellence, compliance, and payment accuracy. Demonstrated ability to develop innovative solutions to complex problems, leveraging advanced problem-solving skills and sound judgment to make critical, independent decisions within area of responsibility.
Ancillary Services Network Account Manager I HealthfirstAncillary Services Network Account Manager INew York, NY$68,900–$99,620 / yearUnder the direction of the Manager of Ancillary Services, the Ancillary Services Contractor develops and maintains an Ancillary provider network that ensures Healthfirst members have superior access to the highest quality by focusing efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Create contracts in HF contract software and review credentialing documents submitted by Provider/facility via Universal Credentialing Data Source, The Council for Affordable Quality Healthcare (CAQH) or PDF application to ensure that all the required credentials are included and that valid documents for behavioral Providers and facilities are provided.
Regulatory Specialist (Cosmetics) AtriumRegulatory Specialist (Cosmetics)North Brunswick, NJThe Regulatory Specialist will support regulatory compliance efforts for personal care and cosmetic products by performing raw material coding, managing ingredient documentation, product registrations, testing coordination, and labeling reviews. Coordinate product safety and stability testing, including working with Formulation teams, external labs, protocols, quotations, sample shipments, and final documentation.
Loss Control and Risk Management Specialist BerkleyLoss Control and Risk Management SpecialistParsippany, New Jersey$125,000–$195,000 / yearThe company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role includes: Base Salary Range: $125,000 - $195,000 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. This individual will be instrumental in leveraging emerging technologies, delivering enhanced value to our insureds and broker partners, and strengthening collaboration across underwriting, loss control, and claims to drive improved loss performance.