Claims Auditor Lead Elevance Health IncClaims Auditor LeadLouisville, KYMinimum Requirements: Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
WFRP Claims Specialist Sompo International Holdings LimitedWFRP Claims SpecialistKY$70,000–$90,000 / yearThe employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading; visual inspection involving small defects, small parts, and/or operation of machines (including inspection); using measurement devices; and/or assembly or fabrication parts at distances close to the eyes. As one of the leading writers of Federal Crop Insurance, AgriSompo North America combines industry experience, resources, capital and talent to deliver both traditional and innovative crop insurance and productivity tools to farmers, ranchers, insurers and agribusinesses in the United States.
Medical Director - PI, Claims Humana IncMedical Director - PI, ClaimsKYRemote$223,800–$313,100 / yearWork at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
Claims Auditor Lead Elevance HealthClaims Auditor LeadLouisville, KYMinimum Requirements: Requires a HS diploma or GED and a minimum of 6 years related experience in a quality audit capacity (preferably in healthcare or insurance sector); or any combination of education and experience which would provide an equivalent background. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Field Claims Representative Auto-Owners Insurance CompanyField Claims RepresentativeLouisville, KentuckyAbility to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents). This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability.
Lost Time Claims Specialist - Workers'''' Compensation Encova Mutual Insurance GroupLost Time Claims Specialist - Workers'''' CompensationKYOur current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate.
Complex Claims Consultant - Private & NFP D&O CNA Financial CorpComplex Claims Consultant - Private & NFP D&OLouisville, KY$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 - Epl, Private & NFP D&O CNA Financial Corp.Complex Claims Consultant - Epl, Private & NFP D&OLouisville, KY$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.
Pharmacy Claims Auditor CPhT Conduent IncPharmacy Claims Auditor CPhTKYIn this role, you can expect the following working conditions: Hybrid work: Will be working from home 25% of the month and will be working in the field doing audits at different pharmacy locations 75% of the month. Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them.
Senior Claims Benefit Specialist CVS Health CorpSenior Claims Benefit SpecialistKY$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
EPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full Time SolutionHealthEPIC Applications Analyst (1-4): Hospital Billing Admin and Hospital Billing Claims - IT Services - Full TimeKYEpic Application Analysts 2-4 require current Epic training status (certification, accreditation, and/or proficiency) in primary application required, with a combination of current Epic training statuses in additional area(s) in application maintenance and development required in upper levels. Ideal candidates will possess strong experience as analyst with expert knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required.
NewMedical Claims Reviewer, 6 Month Contract (Remote) Broadway VenturesMedical Claims Reviewer, 6 Month Contract (Remote)Louisville, KYRemoteWe are seeking a dedicated RN to conduct medical reviews to perform comparisons between End Stage Renal Disease patient medical records documentation and data submitted to the Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Quality Reporting System (EQRS) and the Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN) based on the approved data validation methodology. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.
Pharmacy Claims Adjudication- Supervisor Onco360Pharmacy Claims Adjudication- SupervisorLouisville, KentuckySkills/Knowledge Required: NDC medication billing, PBM and medical contracts, healthcare audit experience, knowledge of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, excellent interpersonal skills, able to work with all levels of management and staff, vast knowledge of pharmacy terminology and process including sig codes, and roman numerals, brand/generic names of medication, advanced typing, math and analytical skills. Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.
Pharmacy Claims Analyst 2 SS&C Technologies Holdings IncPharmacy Claims Analyst 2KYRemoteWhat You Will Get To Do: As a Pharmacy Claims Analyst 2, you will support critical processes to ensure accuracy and compliance for pharmacy point-of-sale processing as it relates to Prescriber requirements and error override logic when a disaster has been declared by a state or federal government agency. Unless explicitly requested or approached by SS&C Technologies, Inc. or any of its affiliated companies, the company will not accept unsolicited resumes from headhunters, recruitment agencies, or fee-based recruitment services.
NewSr. Claim Recovery Specialist The Phia GroupSr. Claim Recovery SpecialistLouisville, KY$50,000–$65,000 / yearMeanwhile, from a regional perspective, The Boston Globe, Courier Journal, and Louisville Business First annually recognize our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees by listing The Phia Group in their respective lists for the Top Places to Work. At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their families, you can look forward to not only exceptional benefits for yourself but also being immersed in a company that was named one of USA Today’s Top Workplaces for 2026.
Pharmacy Claims Business Lead SS&C Technologies Holdings IncPharmacy Claims Business LeadKYRemoteThis role owns the integrity and performance of pharmacy claims functionality across Commercial, Medicare, and Medicaid lines of business, with direct accountability to operational metrics, quality measures, and contractual performance guarantees. SS&C is a leading provider of mission-critical, AI-powered technology and services empowering financial services and healthcare organizations to work smarter, faster, and securely.
Claim Specialist - Workers'''' Compensation Mitsui Sumitomo Insurance Company Of AmericaClaim Specialist - Workers'''' CompensationKYRemoteSummary/Job Purpose: This position is responsible to adjust assigned claims within delegated limits of authority, conduct timely and thorough investigations, handle subrogation claims, and complete fair and equitable claim settlements in accordance with MSMM Claim Handling Guidelines and/or requirements of principals regarding TPA business to ensure services are provided in a fair, equitable and timely manner. 5+ years of claims experience, including ability to successfully negotiate settlements, verify coverage, appropriately set reserves, successfully complete investigations and understand rules associated with state regulations.
Workers'''' Compensation Senior Claim Representative - Eastern Alliance ProAssurance CorpWorkers'''' Compensation Senior Claim Representative - Eastern AllianceKentucky, KY$66,229–$109,289 / yearResponsibilities of this position include managing all aspects of assigned claims, including verifying coverage, investigating, managing, and resolving complex workers' compensation claims for the Company's large customers under moderate supervision, following established Company requirements and procedures, and promptly establishing and maintaining accurate reserves with an authority limit of up to $75,000 all in support of the Company's revenue and profitability objectives and overall business plan. What we're looking for: A bachelor's degree and a minimum of five years' experience in workers' compensation claims management or a minimum of ten years working in a professional claims capacity in worker's compensation without a degree is required; advanced certification or training is preferred.
NewSenior Claim Benefit Specialist - Remote CVS Health CorpSenior Claim Benefit Specialist - RemoteKYRemote$18.50–$42.35 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication.
Claim Specialist FCCI Insurance GroupClaim SpecialistLouisville, KY$91,389–$140,737 / yearResponsibilities include maintaining an inventory of claims handled within departmental guidelines, following best practices policies and procedures and budgetary guidelines, field investigations, negotiating limited settlements, setting reserves, attending mediations, and documenting all file activity. At FCCI, it is the personal touch of our local presence and expertise, combined with the knowledge and relationships of our agency partners, that creates a winning combination which sets us apart.