Claims Supervisor University HealthClaims SupervisorSan Antonio, TXPOSITION SUMMARY/RESPONSIBILITIES Supervises, assists, and directs the activities of the assigned claims processing unit and the assigned staff. Three (3) or more years experience project coordination in a managed care environment is preferred.
Liability Claims Specialist (Remote) Creative Risk SolutionsLiability Claims Specialist (Remote)IndianaRemoteWe do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Skills & Technical Competencies : Knowledge of both general and auto liability coverages, claims processing procedures, perform complex mathematical calculations, ability to learn multiple state insurance regulations and pass state licensing exams.
Director, Claims (Commercial-Self-Funded) The Health PlanDirector, Claims (Commercial-Self-Funded)Wheeling, WVMonitors all daily activities with the assistance direct reports regarding claims processing/review, productivity, timeliness of payments and quality indicators of services. Coordinates claim review activities with internal departments as well as participants on internal committees representing the claims department and formulates workflow between all departments.
Claims/Customer Service Rep The Health PlanClaims/Customer Service RepCharleston, WVThe Claims/Customer Service Rep runs monthly reporting to send out to stop loss carriers, reviews reports to see if claims have exceeded the specific deductible and files any claims over the deductible with the stop loss carrier for reimbursement to the Client. The Claims/Customer Service Rep also reviews Level Funding stop loss reporting submitted by finance to determine if a reimbursement request needs to be filed and will file as required.
Sr. Manager - Claims Astrana Health IncSr. Manager - ClaimsMonterey Park, CAYou'll partner closely with internal teams, resolve escalations, and coach a team of claims professionals to deliver compliant, efficient, and accurate outcomes in a fast‑paced environment. In this role, you'll oversee daily claims processing, drive quality and turnaround time performance, and support the onboarding of new IPAs and implementations.
Claims Architect Diverse Lynx, LLCClaims ArchitectMinneapolis, MNThe consultant will work closely with business, operations, technology, product, and client stakeholders to assess current claims processes, identify improvement opportunities, and define AI-enabled solutions that enhance claims accuracy, reduce manual effort, improve first-pass adjudication, and accelerate operational efficiency. The ideal candidate should have strong understanding of medical claims, prior authorization, claim edits, denials, rework, provider/member data, payment integrity, and regulatory compliance, along with the ability to leverage GenAI tools like Claude for requirements analysis, process documentation, knowledge summarization, workflow optimization, and solution ideation.
Claims Support Advocate (Temp) Included Health IncClaims Support Advocate (Temp)NYFor context, these markets include Zone A (e.g., Phoenix AZ, San Antonio TX, Columbus OH, Charlotte NC), Zone B (e.g., Chicago IL, Denver CO, San Diego CA, Houston TX), and Zone C (e.g., Los Angeles CA, Seattle WA, Washington, D.C., Boston MA). Job Summary: As a Claims Support Advocate (CSA), you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality member experience within our service level agreements.
NewClaims Learning Consultant EMC Insurance Group Inc.Claims Learning ConsultantCA$78,726–$108,771 / yearWorking closely with leaders and subject matter experts, you'll develop training solutions, support key business initiatives and system enhancements, and drive continuous improvement through learner feedback and data insights. As a Claims Learning Consultant, you'll make a direct impact on the success of Claims team members by designing and delivering engaging learning programs that build technical, system, and professional capabilities.
Medical- Dental Claims Specialist Mountain State Oral & Facial SurgeryMedical- Dental Claims SpecialistHurricane, WVOur company has been a prominent provider specializing in oral and maxillofacial surgery throughout the state of West Virginia for over 25 years with recent expansion into the Kentucky and Virginia regions. Our skilled surgeons utilize advanced oral and facial surgical techniques to deliver exceptional care.
Claims & Provider Relations Oversight Specialist Western Health AdvantageClaims & Provider Relations Oversight SpecialistSacramento, CASupport Annual Network Review (ANR), Geo Access, Provider Appointment Availability Surveys (PAAS), Provider Satisfaction Surveys (PSS), after-hours surveys, and related compliance activities. Western Health Advantage is seeking a detail-oriented Claims & Provider Relations Oversight Specialist to support compliance and regulatory operations within our Claims and Provider Relations department.
Stop Loss Claims Resolution Consultant Sun LifeStop Loss Claims Resolution ConsultantKansas City, Missouri$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.
LTC Claims Pending Specialist - Remote USA. Northwestern MutualLTC Claims Pending Specialist - Remote USA.WisconsinRemoteDetermines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy. Communicate effectively verbally and in writing with Insureds and their representatives, Field Force, medical practitioners, and related service providers, attorneys, other insurance companies, and divisional resources, is involves negotiation and conflict resolution.
Medical Billing and Claims Specialist PEDIATRIC CARDIOLOGY CONSULTANTS OF SOUTH TEXASMedical Billing and Claims SpecialistLIVE OAK, TXFull timeGeneral Administrative Duties: Answer incoming phone calls, manage emails, and respond to patient inquiries regarding appointments, billing, or general clinic information. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks.
NewWorkers 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.
Associate Bond Claims Attorney Tokio Marine HCCAssociate Bond Claims AttorneySanta Ana, CaliforniaAs an insurance company, however, we must comply with certain Federal and state laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which limits our ability to employ individuals with certain types of criminal convictions. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report.
Associate Bond Claims Attorney HCC Life InsuranceAssociate Bond Claims AttorneySanta Ana, CA$85,400–$117,500 / yearAs an insurance company, however, we must comply with certain Federal and state laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which limits our ability to employ individuals with certain types of criminal convictions. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report.
Medical Biller & Coder - Podiatry Max AIMedical Biller & Coder - PodiatryMichiganStrong knowledge of podiatry-related medical terminology, DRG (Diagnosis Related Group), and various coding systems (ICD-10, ICD-9, CPT, HCPCS). The ideal candidate will be responsible for managing the billing process, ensure accuracy in medical coding, and facilitating timely payments from insurance companies and patients.
Claims Analyst University HealthClaims AnalystSan Antonio, TXPOSITION SUMMARY/RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication.
Cyber Claims Advocate Marsh & McLennan Companies, Inc.Cyber Claims AdvocatePhiladelphia, PA$84,700–$180,300 / yearLiaises with clients, and third parties as necessary such as attorneys and technology forensic firms, for claim/events-related issues or client service concerns to resolve complex issues with insurers on claims notifications, updates, information requests, the hiring of professionals, queries, acknowledgements or other issues, payment issues, keeping all relevant parties informed, as appropriate, of any potential problems, contentious claims or general claims trends. Reviews incoming documentation and new claims notifications of a complex nature or for large and/or complex clients, informs all relevant parties of any potential problems or contentious claims, and refers to Claims Advocates as needed.
NewClaims & Customer Solutions Rep- Temporary Position Deseret Mutual Benefit AdministratorsClaims & Customer Solutions Rep- Temporary PositionSalt Lake City, UTFull timeMinimum Qualifications:• High School Diploma or equivalent• Advanced knowledge of claims processing and health plan design• Strong judgment, problem-solving, and communication skillsPreferred:• Familiarity with IT systems and project management• Broader healthcare operations knowledge (membership, medical management, provider contracting)• Professional verbal and written skills• Alignment with DMBA's mission to support missionariesWhat We Offer:Competitive payRich medical, vision and dental benefits with low premiums. DMBA (Deseret Mutual Benefit Administrators) is a non-profit organization that administers benefits for companies owned or affiliated with The Church of Jesus Christ of Latter-day Saints.