Results for "Claims"

Customer Care Representative - Personal Lines

The Customer Care Representative answers questions and resolves problems initiated by insureds and carriers via telephone, mail, and e-mail. Most questions concern coverage, claims, cost, or billing and may require research or referral to resolve. Significantly contributes to business retention efforts. Your Impact: Answers all incoming telephone calls promptly/professionally and documents calls in accordance with department protocols. Identifies and responds to questions or problems presented by insured in a manner that meets or exceeds client service level standards. Provides accurate information to insured in accordance with company policy or research information, when necessary (i.e., use computerized system to verify coverage, payment received, etc.) Immediately reports escalated problems, service errors or anomalies to supervisor to effect prompt resolution. Obtains comparative quotes on personal lines insurance (i.e., automobile, homeowners, renters, etc. and presents to insure

Events Marketing Manager

About Pivotal Health Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. Today, many providers face persistent underpayment from health insurance companies, despite delivering high-quality care. While processes like IDR (Independent Dispute Resolution) were designed to promote fairness, they’re often administrative-heavy, time-consuming, and difficult to navigate without the right tools. Pivotal Health combines software, data, and service into a seamlessly integrated, AI-driven platform that simplifies these complex reimbursement workflows. We help providers efficiently dispute underpaid claims, reduce administrative burden, and recover the reimbursement they’re entitled to; without adding more work to already stretched teams. Our full-service IDR solution is just the starting point. We’re building solutions that enable providers to operate with clarity, control, and confidence acro

Claims Examiner I-Ops

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. ***Remote Role. Highly preferred that candidate resides in the state of CA. Candidates that reside in/or around Los Angeles may occasionally report to the local office. Seeking a candidate with a Pharmacy Tech background.*** Position Purpose: Review claims for adjudication, adjustment, billing, coding, compliance and reimbursement Review, process and resolve pending medical, hospital and prescription claims Maintain appropriate rec

Customer Service Representive

A Customer Service Representative (CSR) provides support to customer accounts and handles any team calls routed to them. Responsibilities include, but are not limited to, assisting customers via phone, chat, and email; processing orders; and issuing credits and return authorizations. The CSR serves as the primary point of contact for customer inquiries. They also support the sales team by answering questions and troubleshooting issues. The CSR is responsible for ensuring timely resolution and closure of all reported issues. Shift will be 9am-6pm. Organizational Relationship This position reports to the Supervisor – Retail Customer Service Accountabilities Effectively communicates with customers team service agents and management. Serves as key interface to MBCI customers in responding to customer inquiries including but not limited to order status product information claims/returns order processing account status and sales program. Assesses customer-related problems or issues to devel

Healthcare Claims Specialist - Remote

Evry Health is seeking a Claims Specialist. Claims Specialists are responsible for the end-to-end claims adjudication process. This includes testing claim configuration and benefit set up to review of the claim form, verification of eligibility, verification of coordination of benefits with other insurance carriers and finalizing claim determination based on the health benefits plan. Claims Specialists have responsibility to audit auto-adjudicated claims to ensure claim accuracy. They also ensure that claims are processed in accordance to State and Federal regulations and meet the company’s contractual obligations. Claims Specialists are responsible for writing and maintaining the desk top procedures associated with claim adjudication. This role reports to the Vice President of Operations with oversight from the Claims Team Leader. About Evry Health and Globe Life We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase acce

Java Integration Engineer

Join Mutual of Omaha’s Workplace Solutions team and help shape the future of claims technology for hundreds of thousands of members. We are in the middle of a major transformation & migrating a 25-year on-premises claims adjudication platform (FINEOS) to its modern SaaS offering in the cloud. This isn’t a lift-and-shift. It’s a ground-up rebuild of the integrations that power short-term disability, long-term disability, life insurance, hospital indemnity, critical illness, and our expanding absence management product line. As a Java Integration Engineer on the ReClaimer’s team, you will own features end-to-end; from intake all the way through to payment; working across a shared technology stack with a cross-functional team of engineers and business analysts. If you want your code to directly impact members at their most vulnerable moments, this is that role. What We Can Offer You Estimated Salary: $138,000 – $158,000, plus annual bonus opportunity 401(k) plan with a 2% company con

Supervisor, Complex Claims

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Supervisor, Complex Claims (Revenue Cycle Operations), you will help ensure daily execution, team accountability, and timely complex claims resolution for assigned client hospital accounts. Every day you will supervise and support team members in meeting productivity, quality, and revenue goals; monitor work queues, claims inventory, and performance metrics to address barriers and prioritize work; and provide hands-on coaching, issue resolution, and escalation support for complex payers and claim challenges. To thrive in this role, you must be an organized,

Utilization Review III

Medica is a nonprofit health plan that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. The Utilization Review III position is responsible for reviewing, investigating, and resolving member and provider appeals and grievances requiring clinical expertise. Requirements Conduct clinical review of member and provider appeals Evaluate medical necessity, appropriateness of care, and benefit coverage using clinical guidelines and evidence-based criteria Investigate grievances by reviewing medical records, claims, and related documentation Benefits Competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits Originally posted on Himalayas

Customer Service Representative Cigna Healthcare

Summary  The Cigna Group is a global Health Service company that is dedicated to helping people improve their health and vitality. Our Medical Proclaim Provider team seeks dedicated, compassionate, and empathetic Customer Service Representatives, who are genuinely interested in helping people at some critical points of their lives, to join our team. The Call Center Customer Service Representative represents the company, and our people make all the difference in our success.    Responsibilities Answer inbound calls from health care providers with inquiries regarding medical claims, benefits, appeals, prior authorizations, and medical codes. An average of 50+ calls are expected daily.   Take inbound calls while toggling through several applications on multiple screens.   Attend 100% of trainings, and the first 90 days of employment.   Resolve customer complaints through independent problem-solving skills and one-call resolution.   Understand and strive to meet or e

Project Manager, GBS Transformation Incentives

Job Description General Motors is seeking a Project Manager to support the GBST Incentives portfolio. In this role, you will drive planning, execution, and cross-functional delivery for key incentives initiatives, including Connected Incentives, CIMS and Claims-related work, Fleet incentives integration, and transformation efforts tied to OTDS and VBARS decommissioning. Key Responsibilities Lead project planning and execution across a portfolio of incentives initiatives involving multiple stakeholders, dependencies, and delivery milestones Build and manage integrated project plans, milestone tracking, RAID logs, decision logs, and executive-ready status updates Partner with business, IT, product, finance, SAP/OTDS, Connected Incentives, CIMS, Claims, and testing teams to align scope, timing, readiness, and issue resolution Drive refinement of business requirements and user stories to support development, testing, deployment, and change readiness Identify risks, remove roadblocks, esca

GTM Finance Lead

1 in 4 people in the US have a treatable mental health condition, but most providers don't accept insurance, making therapy too expensive for most people. Headway ’s mission is to fix this by building a new mental healthcare system everyone can access. We started by solving the biggest barrier to care: insurance. The admin work - credentialing, claims, payment reconciliation - is a nightmare. We've automated that. But we're going further. Over 75,000 providers across all 50 states run their practice on our software, serving over 1 million patients. We are building the best tools for therapists to run their entire practice, reimagining the experience of finding a therapist, and investing in the platform foundations to enable this at scale. We aren't just a billing layer; we are becoming the platform where care actually happens. We're a Series D company with $325M+ in funding (a16z, Accel, Spark Capital, etc.), looking for exceptional people to help us achieve this mission. We want your

Provider Relations Consultant - Remote Idaho (Any city, ID, US, 99999)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary The Provider Relations Consultant supports provider relations operations by assisting healthcare providers, state partners, and internal teams with issue resolution, provider education, claims research, and operational support activities. This role serves as a liaison between the provider community and internal operational teams while helping maintain strong provider relationships, supporting outreach initiatives, and ensuring

Intake Specialist

Job Description Based on established guidelines, the Intake Specialist processes a variety of internal and external member/provider requests and transactions. Receives, screens, and enters data in preparation for review. Complies with timeliness standards and reduces unpaid claims and rework by accurately processing requests. May also assist on special projects as needed. This role is designated as Remote Flex – no standard weekly in-person onsite expectations. There may be opportunities to meet on campus up to 2 times per year. What You’ll Do Process a variety of requests, inquiries and transactions via phone, email, fax, and mail Review requests to ensure accuracy Support internal & external customers via phone or email Document all pertinent information related to the call/inquiry, attach supporting information as applicable and if unable to resolve route to appropriate area for follow up as applicable Gather and analyze data to provide feedback to Team Leads on employee develo

Consumer Protection Attorney

Join Our Team as a Consumer Protection Attorney at Axiom We are currently seeking Consumer Protection Regulation Attorneys to work for some of the world's leading technology companies. This is an existing vacancy. Responsibilities: Provide guidance on meeting legal compliance obligations related to consumer protection regulations, with a focus on product safety, liability, and youth protection. Deliver legal advice on product liability issues, including defending against consumer claims and ensuring compliance with warranty and safety obligations. Provide strategic counsel on platform integrity, digital safety, and trust & safety initiatives, ensuring compliance with consumer protection laws and regulatory requirements. Assist internal teams in product development, marketing, content moderation, and customer service to ensure their activities align with company goals and applicable consumer protection regulations. Qualifications: Licensed U.S. attorney with 7+ years of focused exp

Senior Associate - Healthcare Compliance Analyst - HTS

We do Consulting Differently The Healthcare Compliance Analyst position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Analyst at the Associate or Senior Associate level. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. The work of a Healthcare Compliance Analyst will involve execution of engagement work streams that will primarily involve supporting the compliance team as the team audits provider claims and provider clinical documentation with a particular focus on govern

AVP, ESL & Managed Care Programs

Crum & Forster Company Overview Crum & Forster (C&F) , with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+"(Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: www.cfins.com. Job De

Senior Incident Response Analyst

About us Coalition is the world's first Active Insurance provider designed to help prevent digital risk before it strikes. Founded in 2017, Coalition combines comprehensive insurance coverage and innovative cybersecurity tools to help businesses manage and mitigate potential cyberattacks. Opportunities to make an impact with bold thinking are real—and happening daily at Coalition . About the role Coalition Incident Response (CIR) UK is hiring a Senior DFIR Analyst to lead digital forensics and incident response investigations for policyholders facing active cyber incidents. In this role, you will investigate threats such as business email compromise, ransomware, data theft, and web compromise, helping organizations move from uncertainty to clear, defensible next steps. You will work closely with the UK IR Lead and cross-functional partners across Claims, MDR, security engineering, and external counsel to deliver high-quality incident response in the UK and across Coalition ’s global c

Cyber Claims Manager, France (M/W)

About us Coalition is the world's first Active Insurance provider designed to help prevent digital risk before it strikes. Founded in 2017, Coalition combines comprehensive insurance coverage and innovative cybersecurity tools to help businesses manage and mitigate potential cyberattacks. Opportunities to make an impact with bold thinking are real—and happening daily at Coalition . About the role Coalition is seeking an experienced and highly motivated Cyber Claims Counsel (M/W) - Responsable sinistres cyber (H/F), with strong expertise in insurance and cyber incident coverage, to join its fast-moving and growing international team as the first Claims professional for the French market. The Claims team at Coalition stands out for its outstanding customer service and deep expertise in handling cyber claims for its insureds. As a team, we focus on partnering with our clients to resolve cyber incidents quickly and find practical, business-focused solutions to cyber risk. As we continue t

Test Manager

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. Requirements 9 or more years of Network Healthcare Testing experience Experience in Claims, Provider and Enrollment Domains Experience in Handling Complex E2E projects Hands on Automation Engineer, preferably experience with Selenium Experience with Test Management tools Client Management Benefits Flexible vacation policy 401(k) employer match Comprehensive health benefits Educational assistance Originally posted on Himalayas

Claims Officer Nassau

CG ATLANTIC GENERAL INSURANCE LTD ABOUT US | A leading regional player in the retail insurance sector, Coralisle Group Ltd., with over 600 employees and offices in Bermuda, the Bahamas, Barbados, the British Virgin Islands, the Cayman Islands, Turks & Caicos Islands, Anguilla, Antigua and Barbuda, Montserrat, Dominica, St. Lucia, St. Vincent, Saint Maarten, Grenada, Trinidad and Tobago, Guyana, Curacao, Aruba, Jamaica and Belize, we offer a complete range of premier financial and insurance services to our individual and corporate clients. We know that our products make a real difference to our clients and their families. THE ROLE | The primary duties for the Claims Officer will include but not be limited to interviewing clients about their claims, recording all relevant information, liaising with S&G Claims Engineers and repairers, and overseeing claim settlements. Other duties will include customer service, administrative, and clerical duties to support the primary duties as

Internship 2026, Corporate Communication - Communications and Governmental Affai

Support implementation of corporate brand initiatives to strengthen Bosch brand in Thailand Support implementation of internal communication activities such as town hall meeting, internal PR, etc. Social media monitoring, proofread Facebook content, support campaign launch on social media Ensure the implementation of corporate design in all visual appearances Coordinate all CSR related activities and events in Thailand Administrative support such as expense claims, etc. 3rd-4th year students in any fields able to start work from January 2026 onward (at least 3 months period) Excellent communication skills with the ability to think strategically Good command both Thai and English Ability to perform multi tasks, meet deadlines, strong time management Creative thinking Intermediate skills in Microsoft Office Graphic design and video editing skills are a plus Your future job offers you 5 Working days, Multinational working environment. Flexible working hour Make it happen Apply a job with

Turfgrass Horticulturalist Agronomist - Product Innovation & Support - REMOTE

Vice President DRG

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year

Clinical Marketing Director

Our Company Genomenon is an AI-driven genetic intelligence company on a mission to save and improve lives by making biomedical information actionable. Rare diseases and cancer affect more than 30 million people in the U.S. alone and hundreds of millions globally, yet most patients still face long diagnostic journeys and limited treatment options. Our goal is clear and ambitious: to deliver the information that shapes diagnosis and treatment for every rare disease and cancer patient. We sit at the intersection of AI, genomics, and real world evidence. Genomenon transforms the global scientific literature into a literature derived, real world evidence (RWE) engine for precision medicine—combining large-scale AI with expert human curation to deliver clean, clinically actionable datasets. This approach fills critical gaps left by EHR and claims data, especially in rare disease and oncology, by showing how patients actually present, progress, and respond to therapy. We turn vast, complex

Staff Backend Engineer Core Product

About Kalepa: Insurance is a $7T global industry built on professional labor: underwriting, claims, pricing, operations, and distribution. Kalepa is building AI that can perform that work. We create professional-grade AI systems for insurers: software that can read, reason, decide, and act inside real workflows and operate over long-time horizons. Kalepa begins by augmenting professionals with the tools to succeed at their jobs. That earns us the right to learn from real decisions, capture decision traces, and automate what can be automated successfully over time. Our products are already in production with leading insurers, driving measurable outcomes and expanding across functions. The opportunity is far broader than any single workflow: to build the AI operating system for decision-making across insurance. For people who want to work on AI that matters, in a sector where correctness, trust, and real-world impact count, Kalepa is just getting started. Kalepa is backed by leading inve

Remote Insurance Producer