NewClaims Examiner I Beyond Risk Management IncClaims Examiner IBeverly, MAAssist with case reserve management: Help set and monitor case reserves for assigned claimants, research medical conditions and treatment plans, and document reserve rationale with support from management. Pitch in where needed: Assist with logging new claim submissions, notifications, claims reporting, cross-training opportunities, high-volume periods, and special projects assigned by management.
NewClaims Auditor - Workers Compensation (Temporary/Project Based) Alan Gray LLCClaims Auditor - Workers Compensation (Temporary/Project Based)Boston, MAThe auditor will apply his or her experience and training, along with specific account instructions and pertinent regulations, to evaluate all aspects of claim handling, including coverage determinations, negotiations, internal and external communications, and the notation and documentation contained in the files under review. Depending on experience and ability, the position may require project management responsibilities where the individual will direct and oversee audits and manage assigned auditors.
NewClaims Monitoring Counsel MG+M The Law FirmClaims Monitoring CounselBoston, MARemoteThe Consulting Group is at the forefront of emerging issues facing design professionals, including the use of AI, alternative construction delivery models such as Progressive Design Build, and project specific risk and insurance frameworks. Experience in one or more of the following practice areas: complex civil litigation preferably in the construction arena, claims management, interaction with insurers, involvement in the design or construction industry.
NewPatient Billing Specialist ActalentPatient Billing SpecialistWestwood, MA$25–$27 / hourUnderstand hospital and professional billing practices, including reading and interpreting Explanation of Benefits (EOBs), billing commercial and government payers, resolving claim denials, and assisting with coordination of benefits (COB). 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.
Claims Processor Global Channel ManagementClaims ProcessorWestford, MassachusettsReview incoming membership documents (Microsoft Excel and Word) to confirm accuracy in formatting and validity of data; includes communicating when updates are needed for successful membership enrollment and/or submission for processing. Monitor team shared Outlook mailbox for incoming membership documents sent from clients, brokers or Third Party Administrators.
NewBilling Specialist Kelly ServicesBilling SpecialistStoughton, MA$21–$27 / hourKelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account.
NewBilling Supervisor Kelly ServicesBilling SupervisorStoughton, MA$29–$49 / hourKelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account.
NewDental Office Receptionist HADAR DENTAL LLCDental Office ReceptionistLexington, MA$18–$22 / hourPrimary responsibilities will include answering phones, greeting patients, maintaining appearance and order of the dental office, patient scheduling, patient and records management, insurance and billing procedures, data entry, researching and preparing insurance estimates. You must have working knowledge of computers for word processing, scheduling, insurance claims processing and records management.
NewAssociate, Claims Receipt Processor Ametros FinancialAssociate, Claims Receipt ProcessorMassachusettsAmetros, a subsidiary of Santander Bank N.A., is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients.
MMIS Business Analyst The Computer Merchant, LtdMMIS Business AnalystQuincy, MA$60–$65 / hourContractorThe Business Analyst (BA) will work on our established Provider Reimbursement and Claims processing functional areas to support the development, testing and implementation of projects and enhancements to meet the business objectives of the MassHealth (Massachusetts Medicaid) program specifically projects to support the member community. * While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations.
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.
Claims Quality Control Auditor (44912) Neighborhood Health Plan of Rhode IslandClaims Quality Control Auditor (44912)Smithfield, RIResponsibilities include, but are not limited to the following: Review Neighborhood's claim process functions, including auto adjudicated and manually processed claims and issues, based on provider and health plan contractual agreements and claims processing guidelines. This Master IA will be created from results of the weekly Claims Adjustment Committee meeting and be used by adjusters from each delegate to reprocess claims according to the respective configuration changes in each system.
Senior Program Manager / Project Manager - Medicaid Claims CVS HealthSenior Program Manager / Project Manager - Medicaid ClaimsMassachusettsResponsible for implementing best practices, facilitating workstreams through change, and ensuring effective delivery of projects and initiatives that enhance provider experience. Lead enterprise delivery of multiple, highly complex business process and technology initiatives aligned to the Medicaid program, supporting all lines of business.
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.
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.
Senior Manager, Stop Loss & Health Claims Sun Life FinancialSenior Manager, Stop Loss & Health ClaimsWellesley Hills, MA$68,200–$102,300 / 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. At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
Complex Claims Director, Management Liability American International GroupComplex Claims Director, Management LiabilityBoston, MA$122,000–$150,000 / yearYou will be responsible for handling all aspects of complex directors & officers claims, including securities class actions, high exposure employment practices liability and fiduciary liability matters, from inception through conclusion brought against publicly traded, privately held and not-for-profit insureds. Our 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.
Remote Claims Representative 630810 Metro Public AdjustmentRemote Claims Representative 630810Woonsocket, RIRemoteAccepting applications form Rhode Island, Connecticut, New Hampshire, Vermont, Maine, New York and New Jersey in the United States only. If you think you would be a great fit for our team, click Apply to seize this opportunity and shape your own future You will receive a link to schedule an informative interview session.
NewClaims Consultant, Life Sciences CNAClaims Consultant, Life SciencesBoston, Massachusetts$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex commercial claims with large exposures that require a high degree of 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 complex manage litigation and authorizing payments within scope of authority.
Claims Casualty Adjuster AAAClaims Casualty AdjusterLincoln, Rhode Island$33.43–$44.53 / hourClaims Casualty Adjuster Job Summary The Claims Casualty Adjuster handles low to moderate-complexity claims involving material damage, property, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.