Account Coordinator, PBM Capital Rx, Inc.Account Coordinator, PBMNew York, NY$69,200–$86,500 / yearBy delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. Position Summary: Judi Health is looking for a results-driven Account Coordinator, PBM to support the PBM Commercial account teams with large and jumbo commercial clients in the health system, employer, labor/union, and public sectors.
Supervisor, Appeals Pharmacist Capital Rx, Inc.Supervisor, Appeals PharmacistNew York, NY$128,000–$160,000 / yearBy delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. Perform day to day clinical pharmacy functions including prior authorization and appeal reviews, override requests, and inbound and outbound member and provider education calls.
Trainer I Horizon Healthcare ServicesTrainer INewark, New Jersey56,200 - $75,285 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This position is responsible for delivering service training programs across enterprise sites and remote vendor locations while supporting the development and continuous improvement of learning solutions.
Quality Analyst - Data Mining, Payment Integrity ExlService Holdings IncQuality Analyst - Data Mining, Payment IntegrityNYRemote$75,000–$90,000 / yearThis position is responsible for reviewing completed audit findings, validating overpayment opportunities, confirming claim repricing accuracy and supporting documentation, and ensuring audit work aligns with client requirements, coding guidelines, pricing rules, and claim payment methodologies. The ideal candidate brings strong healthcare claims knowledge, analytical thinking, attention to detail, and the ability to provide clear feedback that supports auditor performance, continuous improvement, and stronger recovery outcomes.
Privacy Intern XpansivPrivacy InternNew York, NY$20–$25 / hourTrusted worldwide, Xpansiv enables stakeholders to deliver transparent, credible, and auditable environmental claims to address the growing global demand for assurance and accountability on climate action and sustainability performance. Currently pursuing a later-stage undergraduate degree or a graduate degree (Master’s or Juris Doctor / law degree preferred) in a related field (e.g., law, privacy, compliance, risk management, information security, public policy, or business).
AVP - Financial Lines, Middle Market D&O, EPL Starr CompaniesAVP - Financial Lines, Middle Market D&O, EPLNew York, NY$185,000–$220,000 / yearYour role will involve analyzing and evaluating claims and coverage, implementing effective claims processes for your assigned accounts, ensuring compliance with industry regulations, serving as a brand ambassador, and leading a team of claims professionals while assisting with the development of junior team members. Job Summary: As the Assistant Vice President of Financial Lines, Middle Market D&O and EPL Claims at Starr Insurance Companies, you will be responsible for Middle Market Directors & Officers and Employment Practices Liability claims for highly valued insureds.
Insurance Account Position - State Farm Agent Team Member Joe Nachbaur - State Farm AgentInsurance Account Position - State Farm Agent Team MemberJersey City, NJFull timeAs our Sales Producer, your knowledge of insurance products and industry trends equips you to communicate directly with customers, identify their needs, and market products or services that maximize value. State Farm Agent, Joe Nachbaur is searching for a competitive Producer who can recognize opportunities and strategically turn leads into long-lasting customer relationships.
Claims Manager Normann StaffingClaims ManagerRye Brook, NY$70,000–$110,000 / yearManage auto estimating processes, auto service management, auto body repair coordination, water damage restoration assessments, mold remediation evaluations, construction inspection reports, and automotive repair claims. This position offers an engaging opportunity for professionals experienced in insurance claim management who are committed to excellence in customer service while ensuring regulatory compliance across diverse claim types including workers' compensation, automotive repairs, medical billing, and property restoration projects.
Director Configuration, Benefit Administration HealthfirstDirector Configuration, Benefit AdministrationNew York, NY$154,600–$236,555 / yearThis role implements the configuration structure within Healthfirst's technology platforms to administer benefits taking in coordination with Provider Contracting, Claims Operations, Provider Data Management, Clinical Operations, Payment Integrity, and Information Technology. The objective of this role is to ensure that the benefit structure implementation delivers the intended experience through claim adjudication, including benefits, authorizations, reference data, claims editing, regulatory requirements, payment policies, and overall claim system functionality.
Dir Configuration, Benefit Administration HealthfirstDir Configuration, Benefit AdministrationNew York, NY$154,600–$236,555 / yearThis role implements the configuration structure within Healthfirsts technology platforms to administer benefits taking in coordination with Provider Contracting, Claims Operations, Provider Data Management, Clinical Operations, Payment Integrity, and Information Technology. The objective of this role is to ensure that the benefit structure implementation delivers the intended experience through claim adjudication, including benefits, authorizations, reference data, claims editing, regulatory requirements, payment policies, and overall claim system functionality.
Comprehensive Project Manager Solera Holdings LLCComprehensive Project ManagerNJTravel to loss locations throughout the U.S. to create physical inventories of damaged contents, often in difficult conditions (i.e., fire damaged homes without heat/electricity) • Correspond with adjusters, insureds and other points of contact to coordinate claim documentation and damage assessment, via email and phone • Correspond with teammates regarding scheduling, travel expenses, and project coordination / updates, via email, phone and MS Teams • Oversee the valuation process including identifying high value items for special processing • Track and log time and expenses daily for both billing and utilization purposes • Update tasks within our Contents Express system and follow detailed process flows • Comb through large volumes of supporting documents (receipts, prior appraisals and photographs) to match to damaged items • Cross-reference lists for duplication and additional detail, merge information as needed • Review completed contents valuation inventories for accuracy, deliver reports to adjuster, and follow up on adjuster questions • Proactively manage up to 20+ claims in various stages of the process, maintaining timely communication and claim momentum even when traveling or onsite. • This position requires frequent travel, both local and overnight, up to 60% of the time, often on short notice • Ability to physically inspect damaged contents, including maneuvering heavy contents in tight storage spaces and itemizing contents in homes without heat or electricity, for up to 8 hours a day • Experience working in the insurance industry or around a high-end property industry such as interior design, art, or fashion and/or equivalent education in the relevant areas • Experience in leadership and/or project management is a plus • The successful candidate will exemplify professionalism, have excellent written and verbal communication skills, and be a team player • Person must be extremely detail-oriented and possess excellent problem-solving and organizational skills • Ability to sit for multiple hours at a time and to remain alert and focused for multiple hours a day at a computer keyboard • Ability to track and document time and expenses daily • Excellent MS Office (including Excel), Outlook, and computer skills • Bachelors or Graduate Studies in Business, Art, Art History, Fashion, Interior Design or related field desired • Valid REAL ID and drivers license.
Billing Specialist LOA Zufall HealthBilling Specialist LOADover, NJ$19.50–$22.61 / hourUnder the direct supervision of the Revenue Cycle Manager, the Billing Specialist LOA will be responsible for reviewing eligible claims for submission to the State (LOA). Validating/Confirming patient payments is a part of Billing meetings regarding loss of revenue due to missing payments.
NewCPC Investigator Horizon Healthcare ServicesCPC InvestigatorNewark, New JerseyThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. $70,500 - $94,395 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Senior Accountant RhinoSenior AccountantNew York, NY$90,000–$115,000 / yearHandle complex accounting areas such as revenue recognition (ASC 606), prepaid/accrued expenses, equity, and insurance-related balances (e.g., premiums receivable, claims reserves, carrier settlements, carrier payables, and fiduciary assets/liabilities) across multiple carrier programs while serving as the primary finance liaison to insurance operations and actuarial teams. This is a great role for someone who wants broad exposure across a fast-growing fintech/insurtech business - including the interesting accounting that comes with insurance products, premiums, and claims.
Forensic Accountant Selby Jennings LtdForensic AccountantLong Island, NYExcellent written and verbal communication skills with the ability to explain complex financial concepts to non-financial audiences. Review financial statements, revenue trends, expenses, invoices, inventory records, and supporting documentation to determine and support claim values.
Pharmacy Technician ICARE PHARMACY PLUSPharmacy TechnicianPaterson, NJFull timeJob Description: Icare Pharmacy Plus in Paterson, NJ is looking for a highly motivated and detail-oriented Pharmacy Technician to join our dynamic team. The successful candidate will support the pharmacist in preparing and dispensing medications, delivering exceptional customer service, and ensuring full compliance with all relevant laws and regulations.
Medicaid Billing Administrator - Intern (Unpaid) Neuropath Healthcare SolutionsMedicaid Billing Administrator - Intern (Unpaid)Union, New JerseyThe Medicaid Billing Administrator Internship at Neuropath Behavioral Healthcare is designed to provide students and recent graduates with practical training and exposure to healthcare billing processes. Interns will gain hands-on experience in Medicaid claims processing, billing compliance, and healthcare administration while working under the direct supervision of experienced billing professionals.
Commercial SME(Commercial Analytics Consultant (Pharmaceutical Domain DS TechnologiesCommercial SME(Commercial Analytics Consultant (Pharmaceutical DomainPiscataway, New JerseyProvide functional leadership on the management and utilization of Longitudinal Access and Adjudication Data (LAAD), ensuring the successful integration of longitudinal data to support patient-centric commercial activities. Act as the primary SME for commercial operations, providing insights and leadership in Sales, Marketing, Incentive Compensation (IC), Patient Data Management, Longitudinal Access and Adjudication Data (LAAD), and Claims.
Manager of Clinical Appeals and Grievances HealthfirstManager of Clinical Appeals and GrievancesNJ$103,400–$149,430 / yearProvides guidance in the preparation of case preparation for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798.
NewProduct Management Senior Advisor - Express Scripts - Hybrid CignaProduct Management Senior Advisor - Express Scripts - HybridMorris Plains, NJ$113,200–$188,600 / yearThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.