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Clinical Operations Jobs in Laguna Hills, CA

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Billing Advocate Associate Sun Life Financial

Wellesley Hills, MA

$47,600–$64,300 / year

Utilize Microsoft Office Suite (Excel for tracking, Word for appeals and summaries, Outlook for communications), PDF/document management tools for review and annotation, and insurance carrier portals/call systems for status checks and escalations. 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.

11 days ago

Complex Claims Consultant - Professional Liability (Architects & Engineers) CNA Financial Corp

Boston, MA

$72,000–$141,000 / year

Performs 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 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.

2 days ago

Claims Complex Property Adjuster AAA

Lincoln, Rhode Island

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. Demonstrate proficiency with assessment of personal property, property damage, coverage, loss of use, arbitration responses, damage evaluations, and claims technology and tool usage.

30+ days ago

SCA Claims Processor I Elevance Health

Hingham, MA

Preferred Skills, Capabilities, and Experiences: Good oral and written communication skills; previous experience using PC, database system, and related software (i.e., MSWord, Excel, etc.) strongly preferred. This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants to meet the residency requirement of living in the United States for at least three of the past five years.

4 days ago

Claims Consultant -Life Sciences or Cyber/Technology E&O (Hybrid) Onebeacon Professional Insurance Inc

Boston, MA

$143,000–$167,000 / year

Special 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.

30+ days ago

Claims Consultant -Life Sciences Intact Insurance

Canton, MA

$143,000–$167,000 / year

Special 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. Ability to independently interpret specialty insurance policies, identify coverage issues, formulate coverage positions, draft reservation of rights and declination letters, evaluate exposure, establish reserves, manage litigation, and clearly articulate coverage positions verbally and in writing.

30+ days ago

SIU Investigator Allied Universal

Framingham, MA

$28–$34 / hour

Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.

4 days ago

Claims Consultant - Advertising / Personal Injury CNA Financial Corp.

Boston, MA

$72,000–$141,000 / year

Individual contributor responsible for the overall strategic management and resolution of highly complex claims that involve personal and advertising injury exposures, including but not limited to intellectual property, class action, and commercial disparagement. Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost-effective manner and ensuring timely issuance of disbursements.

30+ days ago

Marine Claims Specialist- Household Goods The Hanover Insurance Group Inc

Worcester, MA

This includes determining coverage, conducting thorough investigations, evaluating damages, interpreting contractual liability provisions, and negotiating settlements in accordance with policy terms, customer agreements, best practices, and jurisdictional requirements. This position primarily supports claims within the Moving & Storage/Household Goods business and requires experience evaluating contractual liability, transportation-related exposures, commercial customer agreements, and litigated matters.

30+ days ago

Starr Associates Program - Claims Starr Companies

Boston, MA

$68,000–$78,000 / year

The Associates Program complements your department work by offering professional development opportunities, including direct exposure to senior leadership, technical training, and a comprehensive understanding of key functions throughout the organization. The 2027-2028 Starr Global Associates Program is a dynamic, accelerated training program designed to identify, cultivate, and retain high-potential college graduates.

30+ days ago

Senior Claims Representative Field -MA Plymouth Rock Management Company of New Jersey

Boston, MA

$79,000–$103,000 / year

The Senior Claims Representative is responsible for the end‑to‑end adjustment of complex homeowners property claims, including on‑site inspections, vendor oversight, reserve management, and resolution of coverage and liability matters. The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service.

30+ days ago

Claims Specialist II - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims Adjuster Liberty Mutual Holding Company Inc

Boston, MA

Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Westborough, MA; Hoffman Estates, IL; Weatogue, CT; Indianapolis, IN; Plano, TX; Suwanee, GA; or Lake Oswego, OR; Las Vegas, NV; Chandler, AZ.

2 days ago

Multi-Line Claims Adjuster - Massachusetts Provencher & Company, LLC

Boston, MA

We excel in providing professional, knowledgeable claims professionals to handle large losses, catastrophe claims, business interruption and daily property claims, as well as handle complete liability investigations, task assignments including scene investigations and property damage appraisals, construction defect claims as well as first party automobile claims for personal and commercial insurance policyholders. Experience in industry specific areas a plus, but not necessary: fire departments, agricultural, lumber mills, high value or historic buildings or Construction Defects, Automobile Liability, Subrogation Recovery investigations.

30+ days ago

Homeowner Claims Quality Assurance Senior Analyst - Remote CSAA Insurance Group

Remote

$99,855–$133,250 / year

Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Colorado - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers {+ 21 more}. Your Role: The Claims QA function applies quality assurance techniques and methods to examine the output and efficiency of business processes within the CSAA Insurance Group claims organizations and business partners.

11 days ago

Commercial Auto Claims Consultant CNA Financial Corp.

Boston, MA

$72,000–$141,000 / year

Performs a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements.

10 days ago

Managing Director Strategic Claims Oversight - Healthcare Severity CNA Financial Corp

Boston, MA

$97,000–$189,000 / year

Develops and maintains collaborative working relationships with internal and external business partners including Operations, Underwriting, Actuary and Risk Control and regularly shares claims outcomes, trends, legal developments and other relevant business updates. Responsible for the ongoing management of staff by attracting talent, setting clear direction, providing appropriate guidance, managing performance, recognizing contributions, and developing capabilities.

30+ days ago

Pharmacy Claims Adjudication Specialist Onco360

Waltham, Massachusetts

Skills/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.

16 days ago

Remote Claims Representative 630810 Metro Public Adjustment

Boston, MA

Remote

Accepting 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.

4 days ago

Remote Claims Representative Part and Full Time 630810 Metro Public Adjustment

Boston, MA

Remote

Accepting applications form Rhode Island, Connecticut, New Hampshire, Vermont, Maine, New York and New Jersey and all other states except Alaska, Alabama, Arkansas and Florida in the United States. 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.

1 day ago

Claims Specialist Liberty Mutual Holding Company Inc

Boston, MA

Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role.

16 days ago

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Clinical Operations Jobs in Laguna Hills, CA

Billing Advocate Associate Sun Life Financial

Complex Claims Consultant - Professional Liability (Architects & Engineers) CNA Financial Corp

Claims Complex Property Adjuster AAA

SCA Claims Processor I Elevance Health

Claims Consultant -Life Sciences or Cyber/Technology E&O (Hybrid) Onebeacon Professional Insurance Inc

Claims Consultant -Life Sciences Intact Insurance

SIU Investigator Allied Universal

Claims Consultant - Advertising / Personal Injury CNA Financial Corp.

Marine Claims Specialist- Household Goods The Hanover Insurance Group Inc

Starr Associates Program - Claims Starr Companies

Senior Claims Representative Field -MA Plymouth Rock Management Company of New Jersey

Claims Specialist II - Rideshare Commercial Auto - Attorney Represented Bodily Injury Claims Adjuster Liberty Mutual Holding Company Inc

Multi-Line Claims Adjuster - Massachusetts Provencher & Company, LLC

Homeowner Claims Quality Assurance Senior Analyst - Remote CSAA Insurance Group

Commercial Auto Claims Consultant CNA Financial Corp.

Managing Director Strategic Claims Oversight - Healthcare Severity CNA Financial Corp

Pharmacy Claims Adjudication Specialist Onco360

Remote Claims Representative 630810 Metro Public Adjustment

Remote Claims Representative Part and Full Time 630810 Metro Public Adjustment

Claims Specialist Liberty Mutual Holding Company Inc

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