Claims jobs in Hoboken, New Jersey - Page 19Create job alerts

The role provides specialized legal and regulatory counsel on alternative risk financing strategies, reinsurance transactions, and insurance and reinsurance claims, including related coverage, regulatory, governance, and external audit matters for Property & Casualty and Financial Services businesse

Job Description: Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. Negotiating settlement of claims within designated authority. Reporting claims to the exc

Job Description: Investigating and confirming the facts of loss for advanced automobile accidents Determines coverage, liability, damages for claims Adjusts and negotiates claims within the authority limit Manages complex claims for Georgia and/or Florida Requirements: Investigates auto claims

Requirements: 5 years of claims management experience or equivalent combination of education and experience required. Job Description: Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to deter

Preferred 3 + years of Healthcare Revenue Cycle experience (Claims, Patient Access, Billing). Preferred Epic Certification in Resolute Hospital Billing and/ or Hospital Claims.

Fraud and Abuse Investigator needed for long-term temporary opportunity. Please have at least 2 years of experience in fraud investigations.

Allstate is looking for a Personal Injury Protection (PIP)/No-Fault Attorney in New York, NY.You will manage a diverse caseload involving no-fault claims, arbitrations, and mediations while ensuring compliance with evolving laws.Responsibilities include overseeing litigation from inception to resolu

Job Description The Doe Fund is a leading New York City non-profit organization that operates the enormously visible Ready, Willing & Able (RWA) program, whose participants clean over 115 miles of streets and sidewalks every day. With an $80 million budget, 500+ staff members, and 46,000 individual donors, The Doe Fund is nationally acclaimed as a work-based model for solving homelessness and criminal recidivism. We empower people to break the cycles of homelessness, welfare dependency, substance abuse, and incarceration through innovative work and housing programs. The Benefits & HR Specialist will provide administrative and clerical support to the HR department, with a focus on employee benefits administration, onboarding, and general HR operations. This role ensures the smooth delivery of benefit programs, supports day-to-day HR activities, assists with recruiting and onboarding efforts, and responds to employee inquiries to provide timely and accurate service. The Benefits & HR Specialist reports directly to the Vice President of People & Culture. Key Responsibilities • Assist with new benefit enrollments, changes, additions, and terminations under the direction of Benefits Administrator., • Support onboarding and recruiting activities, including scheduling interviews, onboarding materials, and assisting with new hire orientation., • Support HR team with filing for active and terminated employees., • Support benefits-related projects, including wellness seminars, health fairs, and employee communications (flyers, emails, etc.)., • Support with updating enrollment materials, benefit communications, and employee benefit folders., • Provide first-level support to employees regarding benefits questions, claim issues (via phone, email, or in person.), • Assist with tracking carrier utilization and preparing basic reports (Commuter, Vision, FSA, etc.)., • Provide administrative support for benefits programs, including Leaves of Absence, FMLA, disability claims, and related paperwork., • Assist with the administrative management of workers’ compensation claims, including initial filing and follow-up., • Perform general administrative duties such as filing, data entry, and responding to routine benefits- or HR-related requests., • Prior HR, Payroll or benefits experience preferred, • Strong attention to detail and organizational skills., • Ability to handle confidential information with discretion., • Good written and verbal communication skills. Before you go, we want to assure you that we are committed to building a diverse and inclusive workplace reflective of individuals who share our mission and who want to join us in working on the cutting-edge of important social issues. We are an equal opportunity employer and we highly encourage applications from candidates regardless of race, color, citizenship, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, veteran or reservist status, or any other category protected by federal, state, or local law.

Job Description: Investigating and confirming the facts of loss for basic automobile accidents.Applies analytical thinking to determine coverage, liability, damages.Adjusts and negotiates claims within limit of authority,.Handles investigation regarding most aspects of auto claims.Requirements:

Job Description: To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. Processes complex auto commercial and personal line claims, including bodily injury and ensures cl

Configure and maintain identity integrations for web, mobile, and API-based applications, including: Client registrations and trust relationships Token claims, scopes, and attribute mappings Certificates, signing keys, and rotation processes Support application modernization efforts by: Migrating le

Job Description: Performs advanced level work related to denial management Processes and follows up on all appeal types, at an expert level, to all payers Takes actionable steps to resolve open claims, as needed, including refiling or appealing claims, or resolving manual tasks assigned to AR for

Job Description: Facilitate discovery sessions and working groups with underwriting, claims, actuarial, operations, and other stakeholders to elicit, clarify, and prioritize business needs. Strong analytical and detail-oriented problem-solving skills, with the ability to synthesize complex inform

Providing Covert Surveillance, Claims Investigations, Net-Sweep Investigations, Remote Controlled Surveillance, and more, we're able to save our clients time and money on insurance fraud cases. Advantage Investigations is seeking a Full Time Private Investigator in the Newark, NJ & surrounding areas

Marshall Investigative Group (MIG), the industry's leading investigative firm, seeks self-motivated individuals with experience in surveillance and mobile investigations to assist in researching insurance fraud claims involving monetary, bodily injury, theft, and property damage claims. At the Marsh

Job Description: Assists associates with leave of absence requests and guides them through the process Processes all leave of absence paperwork according to established procedures and laws Provides timely and accurate responses to associates and all levels of management concerning day-to-day issues

A leading insurance provider is looking for a Property Field Inspection Claim Specialist in Newark, NJ.This remote-field position requires conducting on-site inspections, negotiating claims, and providing exceptional customer service.Candidates should have experience with property claims and strong

Conduct interviews and follow-ups with claimants or their representative who are victims of defective drugs or devices, environmental contamination, or have a general personal injury claim. Point of contact for your claimants, providing updates to their claim. Interprets and disseminates information

A fast-paced healthcare company in New York is seeking a Quality Analyst to manage the medical file review process and ensure excellence in client interactions. The ideal candidate will have strong communication skills, critical thinking abilities, and experience in healthcare or insurance contexts.

Six (6) years of multi-jurisdictional liability (general liability, auto liability, products), subrogation and/or workers compensation claims handling experience or equivalent combination of education and experience required.

Partner with Legal, Compliance, Internal Audit, Claims, Product, Data Science, and State Management to align on risk-based approaches to new and emerging programs led by the Business Development team.

Job Description: Investigates and adjudicates claims within designated authority, ensuring compliance with appropriate statutory laws. Documents claim files and facilitates processing of claims in collaboration with other departments. Evaluates and negotiates claims, recognizes subrogation opport

A leading health organization seeks an investigator for healthcare fraud allegations.Responsibilities include conducting investigations, analyzing claims data, and preparing reports.A bachelor's degree and 1+ years in medical claim analysis are essential.Preferred candidates will have a minimum of 5

A leading insurance and financial services provider is seeking a Senior Counsel to provide expert legal guidance on complex insurance matters.

Job Description About MCU: At Municipal Credit Union, we believe that an incredible culture helps create a happy and motivated team that works hard to achieve the best results for themselves and their members. For more than 100 years, MCU has provided affordable financial products and convenient services to a membership base that is now comprised of over 600,000 individuals. With each new generation we have the pleasure of interacting with, we maintain the credit union promise of people helping people. Our Mission: To help hard-working New Yorkers build better tomorrows Our Vision: Be New York's most loved financial institution by helping our members build their best financial futures Overview: The Compensation & Benefits Analyst supports the delivery and administration of U.S. benefits programs and compensation initiatives. This role partners with HR leadership, HR Business Partners, Talent Acquisition and business leaders to ensure competitive compensation practices, effective benefits delivery and a high standard of data accuracy and reporting integrity. The position requires strong analytical skills, advanced Excel capabilities and the ability to manage multiple vendor relationships and compensation analytics projects. Specific duties include, but are not limited to, the following: Benefits Administration • Deliver U.S. benefits programs end-to-end, ensuring efficient administration and a positive employee experience by coordinating benefit programs including: medical, dental, vision, life insurance, short and long-term disability or any qualified leave, 401(k), & 457(b) retirement plans., • Participate and present at new hire orientation as well as supporting new hire enrollments related to benefits., • Responsible for annual firm wide open enrollment process as well as the annual Health Fair, • Process and administer all leave of absence requests and disability paperwork: medical, disability and FMLA, etc. Support managers and employees through process to ensure adherence to policies and laws while supporting the continuous function of business needs., • Effectively interprets FMLA and ADA implications as they relate to leaves of absences/disabilities., • Main point of contact for all vendors; serve as a liaison between employees and benefit providers, mediating claims issues and escalating concerns when appropriate., • Enroll employees as need as well as ongoingly process any life events., • Maintain benefits-related data and tables within HR systems and databases., • Review and negotiate vendor contracts in partnership with HR leadership and Legal., • Ensure accurate reporting, documentation and compliance with benefits program requirements., • Ensure the accuracy of all benefits enrollments in the HRIS to provide vendors with accurate eligibility information., • Coordinate with the HRIS Analyst and escalate data integrity concerns to senior management as needed. Compensation Administration • Execution and administration of compensation programs (incentive and bonus plans, benchmarking activities, salary survey management, annual merit process, etc.), • Support the design, implementation and ongoing administration of U.S. based salary structures and corresponding job architecture and relevant pay practices., • Support annual compensation planning processes as by conducting compensation modeling and scenario analysis for incentive programs and structural pay changes., • Conduct pay equity and internal alignment analyses and identify trends and recommendations., • Conduct market pricing and compensation benchmarking using survey data and external sources including the ability to complete market data and ad hoc surveys., • Participate in job evaluations and job leveling initiatives., • Partner with HR Business Partners, Talent Acquisition, and business leaders to provide compensation guidance for new hires, promotions, transfers and off-cycle adjustments., • Ensure data accuracy by validating inputs, reconciling discrepancies and maintaining reporting integrity across systems., • Develop and maintain compensation dashboards, reports and workforce analytics., • Maintain job descriptions, including pricing new roles and updating documentation for compliance and organizational changes. Requirements: • Bachelor’s degree in Human Resources, Business Administration/Management required., • 3+ years’ experience in compensation and benefits administration., • SHRM Certified Professional (SHRM-CP) or SHRM Senior Certified Professional (SHRM-SCP) certified credential preferred. CCP or CBP preferred or in process of obtaining., • Extensive knowledge of employee benefits and applicable laws., • Excellent written and verbal communication skills., • Excellent organizational and time management skills., • Proficient with Microsoft Office Suite or similar software., • Ability to perform in a high-volume environment, meet deadlines while maintaining exceptional attention to detail., • Technologically highly-proficient. Why you'll be a good fit: Our Core Values are an integral part of who we are and who we hire. By living our Core Values, every day, we continue to attract the best and brightest talent, achieve unsurpassed results and continuously challenge ourselves to be better than yesterday. These values are at the heart of our organization and within every teammate. To be a great fit, you’ll bring the following Results - We are passionate about winning. Agility - We proactively anticipate, respond and pivot to ensure MCU wins. Integrity - We operate with the highest ethical standards and highest degree of honesty. Belonging - We cultivate a culture of inclusion and teamwork. Ownership - We take personal responsibility and hold ourselves accountable for the results. Why You’ll Love Working Here: The pay range for this position is between $71,600 - $116,550 annually. Actual base pay offered may vary depending on a number of factors such as job-related knowledge, skills, experience, and location. Employees in this position may also be eligible for a discretionary bonus, 401(k) with an 6% employer match per pay period. Benefits for this position include Medical, vision, dental, life, and disability insurance, flexible paid time off and 11 paid holidays annually. Municipal Credit Union (MCU) is an Equal Opportunity Employer. Municipal Credit Union provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by applicable federal, state or local laws. We are committed to hiring, training, cultivating, promoting, and celebrating an environment where we have a welcoming and fulfilling place for all people to call home. Diversity of race, thought, sexual orientation, age, veteran status, religion, and disability will empower us to thrive as individuals, as teams, and as an organization.

Job Description About Nayya Founded in 2019, Nayya is on a mission to connect people's most important information, so they can thrive in their health and wealth. Powered by AI and advanced analytics, Nayya's platform transforms complex benefits experiences into intuitive, seamless, and ongoing interactions—meeting people's real world needs. As a trusted platform and partner to leading employers, benefits solutions, and HR tech providers, Nayya unlocks long-term value through helping employees live more resilient lives. Backed by strategic investors like ICONIQ, Felicis Ventures, SemperVirens, Workday Ventures, MetLife Nextgen Ventures, and ADP Ventures, Nayya is ushering in the future of health and wealth for all. Nayya is building the future of employee benefits — ensuring smarter, more personal, and genuinely useful benefits experiences for millions of people every year. We're looking for a Benefits Product Specialist to sit at the intersection of deep industry expertise and product innovation. This isn't a traditional role. You'll be the benefits domain authority for our product and engineering teams — the person who can answer the hard questions about self-insured plan mechanics at 10am and review a prototype for a new benefits recommendation flow at 2pm. You'll cut through the noise, accelerate product development, and help the team build things that are genuinely right for employers and employees. If you've spent years in benefits consulting, brokerage, HR, or insurtech — and you're ready to bring that expertise into a fast-moving product environment — this role was designed for you. Role & ResponsibilitiesBe the Benefits Brain Trust • Serve as the internal subject matter expert on employee benefits for product, engineering, and design — fielding questions ranging from "how does stop-loss work" to "what does a TPA actually do with this data", • Build and maintain living documentation on benefits concepts, plan mechanics, and industry norms so the team doesn't have to re-research the same ground, • Review product specs, user flows, and engineering designs for benefits accuracy and flag gaps before they become expensive mistakesAccelerate Product Development, • Work directly with PMs and engineers to translate benefits complexity into clear, actionable product requirements, • Own benefits research so the team can move faster — no more engineers Googling "what is an embedded deductible" mid-sprint, • Help define the "right" answer on ambiguous benefits questions where there isn't one standard, and give the team the confidence to shipPrototype & Innovate with AI, • Build and iterate on benefits-related prototypes using AI tools — you don't need to write production code, but you should be comfortable in a low-code / AI-assisted development environment, • Identify opportunities where AI can improve how employees understand, select, and use their benefits — and bring those ideas to the table with enough specificity to act on, • Stay current on how LLMs and AI tools are reshaping benefits delivery and bring that perspective to Nayya's roadmapMentor & Elevate the Team, • Run informal benefits education sessions for product, engineering, and sales teams, • Help onboard new team members on the fundamentals — and the nuances — of how employer benefits actually work, • Be a resource for customer-facing teams navigating complex employer or member questionsWhat We're Looking ForBenefits Expertise (Required), • 3–8 + years of experience in employee benefits — consulting, brokerage, carrier, TPA, HR, or benefits technology, • Genuine fluency in the fundamentals: fully insured vs. self-insured, stop-loss (specific and aggregate), underwriting, claims data, plan design, COBRA, FSA/HSA/HRA, and EOB interpretation, • Familiarity with how employers actually make benefits decisions — renewal cycles, broker relationships, plan benchmarking, and the role of the CFO vs. HR in those conversations, • Comfort with the messiness of real-world benefits data — inconsistent carrier feeds, plan mapping challenges, formulary changes, and network nuancesProduct & Technology Sensibility (Required), • Experience working in or alongside a product or technology team — whether as a technical PM, a benefits tech implementation lead, or a consultant who's done deep work with HR/benefits platforms, • Ability to translate domain expertise into crisp, actionable requirements that engineers can build from, • Self-starter mentality: you're comfortable making judgment calls, driving toward clarity, and operating with ambiguity, • Demonstrated use of AI tools in your workflow — ChatGPT, Claude, Copilot, Cursor, or similar — and genuine curiosity about where they're headedNice to Have, • Experience writing code or working in a technical capacity (even lightly) — Python, SQL, or prompt engineering all count, • Prior experience at a benefits technology company (Businessolver, bswift, Benefitfocus, League, etc.) or at a large brokerage / consultancy (Aon, Mercer, WTW, Lockton, etc.), • Familiarity with how LLMs work and where they break down — enough to evaluate AI-generated benefits content critically, • You've been the person colleagues come to when a benefits question stumps the room — and you actually enjoy that, • You get frustrated when technology gets benefits wrong, and you have opinions about how to fix it, • You've played with AI tools enough to have a real point of view — not just "it's cool" but "here's how it could change how employees engage with their benefits", • You're ready to leave the comfort of a pure consulting or brokerage role and take ownership in a product environment where your work ships to real users, • You can talk credibly to a CFO about self-insured risk and then turn around and give an engineer a precise data spec — in the same day The salary range for New York based candidates for this role is $130,000- $190,000, commensurate with the broad range of experience for this position. We use a location factor to adjust this range for candidates that are located outside of geographic region of our New York office. Placement within the salary band is determined based on experience. #LI-HYBRID Nayya is proud to be an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics

A reputable law firm in Manhattan, NY is seeking an Insurance Coverage Attorney to join their growing team. The role offers the opportunity to manage complex cases with substantial claims, while working alongside experienced attorneys in a supportive environment.

Position Overview We are seeking a motivated Associate Attorney to join our Workers’ Compensation team in our New Jersey office located in Jersey City. What You’ll Do Attend hearings before the NJ Workers’ Compensation Courts Develop negotiation strategies and settle claims Communicate case up

Daikin US - - Responsibilities: Perform cycle counts daily; Manage inventory procedures daily; Coordinate warehouse activities including record control, shipping and receiving, and transportation compliance; Inspect racks for damage and neatness daily; Process and coordinate warranty claims, includ

Tax Litigation, which can be in Tax Court, Federal District Court or the Court of Federal Claims, or it may be criminal in the event of tax fraud. State and Local Tax, including sales tax issues. Corporate Tax, including Entity formation; Entity funding; Acquisition or sale of all or part of a compa

Overview A financial services firm is looking for a highly organized, discreet, and resourceful Personal Assistant to support members of their leadership team. This is a tactical, hands-on role focused on handling the day-to-day administrative and personal needs of senior leaders so they can operate without friction. The ideal candidate is someone who anticipates needs before they arise, takes pride in the details, and brings a service-first attitude to everything they do no task is too big or too small. What You'll Be Doing • Manage complex calendars, scheduling, and logistics across the leadership team, • Coordinate domestic and international travel including detailed itineraries and accommodations, • Handle day-to-day administrative tasks with speed, accuracy, and a sense of urgency, • Support personal needs including gifting, holiday cards, reservations, and personal appointments, • Assist with healthcare-related scheduling, insurance claims, and administrative follow-up, • Support firm events, special projects, and ad hoc requests as they arise, • Run errands and manage vendor relationships as needed What They're Looking For • 5+ years of experience as a Personal or Executive Assistant in the financial services industry, • Exceptionally organized, responsive, and detail-oriented, • High level of discretion and professionalism comfortable handling sensitive personal and professional matters, • Flexible, proactive, and genuinely service-driven mindset

Starr, a global leader in commercial insurance with over a century of expertise, empowers its employees to innovate, make impactful decisions, and build lasting client relationships worldwide. At Starr, you'll work in an entrepreneurial culture alongside accessible leaders, leveraging our financial strength and vast industry experience to deliver solutions for our clients, no matter how complex. Grow your career with a rapidly growing company that invests in its people and their ability to drive real progress. This position performs financial and operational audits of Managing General Agents (MGAs) and Third Party Administrators (TPAs), who underwrite and administer policies, collect premiums and adjudicate claims on behalf of Starr Companies. • Perform testing, document test results, identify findings as applicable, and work with internal staff to design corrective actions that mitigate risk and ultimately add value., • Responsible for drafting audit report comments for areas under review., • Help prepare work papers documenting work performed and conclusions reached., • Communicate audit results to the auditor in charge and to senior management., • Understand and incorporate elements of post-audit corrective actions into future planning and risk assessments., • Learn to scope out length and difficulty of tasks and projects., • Assist in ensuring proper controls are in place and working effectively., • Develop an understanding of current accounting principles and auditing techniques., • Acquire a working knowledge of Starr Companies' businesses and operations., • Be committed to continuous improvement through empowerment and management of data., • Leverage technology to positively impact quality., • Bachelor's degree required. Accounting degree preferred., • Professional certifications a plus (CPA, CIA, CFE, CISA, CRMA, CFSA)., • Two to four years of experience in audit or related background., • Property & Casualty insurance industry experience a plus., • MGA and/or TPA employment experience a plus., • Excellent project management, analytical, interpersonal, oral and written communication skills., • Professionalism, dependability, integrity and trustworthiness combined with a cooperative disposition is required., • Highly motivated self-starter with the ability to multitask and complete assignments within time constraints and deadlines., • Strong organizational skills and attention to detail. Starr is an equal opportunity employer, which means we'll consider all suitably qualified applicants regardless of gender identity or expression, ethnic origin, nationality, religion or beliefs, age, sexual orientation, disability status or any other protected characteristic. We recruit and develop our people based on merit and we're committed to creating an inclusive environment for all employees. We offer first class training and development opportunities to all employees. Our aim is to grow our own talent and bring out the best in people.

Job Description: Lead the drafting and negotiation of innovative partnership and strategic initiative agreements across the insurance ecosystem. Serve as embedded counsel to the Business Development team on insurance agency agreements, joint ventures, partnerships, and other strategic opportunities. Identify, assess, and mitigate legal and business risk through thoughtful contract drafting, negotiation strategy, and practical counseling for internal stakeholders. Provide clear, actionable legal guidance to senior management and internal stakeholders on insurance regulatory requirements across all 50 states, including statutory and administrative regimes, as well as applicable federal laws and regulations such as GLBA. Partner with Legal, Compliance, Internal Audit, Claims, Product, Data Science, and State Management to align on risk-based approaches to new and emerging programs led by the Business Development team. Prepare high-quality, decision-ready written analyses to support leadership in strategic planning, risk assessment, and issue escalation. Provide practical, timely legal guidance to teams building new products and services across traditional and digital distribution channels. Work closely with cross-functional partners through all phases of product development, implementation, and rollout. Translate evolving regulatory and commercial developments into pragmatic recommendations and risk management strategies. Requirements: Juris Doctor from an ABA-accredited law school and an active bar license in good standing in at least one U.S. state. 7+ years of commercial contracting experience in-house or at a reputable mid-sized or large law firm representing corporate clients. 5+ years of insurance regulatory experience in-house or at a reputable mid-sized or large law firm representing corporate clients. Demonstrated expertise in property and casualty insurance, including prior insurance regulatory and commercial contracting experience. Demonstrated expertise advising insurance entities and distribution partners on issues arising in the insurance agency context, including digital agencies, product flows, and commission structures. Proven ability to deliver strategic legal advice under time pressure, with limited or imperfect information, and to exercise sound judgment in ambiguous situations. Experience influencing senior leaders and partnering effectively with cross-functional teams. Strong track record of embedding with product managers, engineers, actuaries, data scientists, and business development professionals to help launch new products and initiatives. Benefits: Health insurance Flexible work arrangements

Job Description: MAJOR DUTIES & RESPONSIBILITIES Proactively identify and pursue new business opportunities within the Workers' Compensation IME space. Develop and maintain strong relationships with key stakeholders, including insurance companies, attorneys, third-party administrators, and medical professionals. Conduct market research to identify potential clients and understand their needs. Create and deliver compelling sales presentations and proposals tailored to client requirements. Negotiate and close sales agreements to achieve or exceed sales targets. Collaborate with internal teams to ensure seamless onboarding and excellent client service. Maintain up-to-date knowledge of industry trends, competitor activities, and regulatory changes. Attend industry conferences, networking events, and trade shows to represent Dane Street and build a strong professional network. Other duties & special projects, as assigned and based on business needs. Requirements: EDUCATION/CREDENTIALS: An Associate's Degree or Bachelor's Degree is preferred. JOB RELEVANT EXPERIENCE: Business experience in a healthcare and/or insurance setting is preferred. JOB RELATED SKILLS/COMPETENCIES: Proven track record of success in sales, particularly in the Workers' Compensation and IME industries. Extensive industry experience with a deep understanding of Workers' Compensation processes and IME services. Experience with Counter Affidavit market is preferred. Established relationships with stakeholders in the workers compensation space, auto industry, and law firms. Knowledge of Texas Legal Landscape is a plus. Excellent communication, negotiation, and presentation skills. Self-motivated, results-oriented, and able to work independently. Strong analytical and problem-solving abilities. Bachelor's degree in business, marketing, or a related field is preferred. Benefits: Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Job Description: Follow up on insurance denials and aged claims Submit claims to secondary payers and ensure accurate billing information Answer all information requests from payers and trace claims Re-submit claims to government agencies and submit claims appeals with supporting documentation Requirements: 2 years Related work experience in a health care environment. Benefits: Health care benefits (medical, dental, vision) 401(k) Savings Plan with employer matching Life insurance Disability insurance Paid time off (paid parental leave, vacations, holidays, health issues) Voluntary benefits Well-being resources

Job Description: Lead and manage post-treatment financial operations, including insurance payments, patient payments, refunds, and medical record requests Improve efficiency and accuracy in the payment posting process to ensure patient and insurance payments are recorded correctly Review workflows and identify opportunities to reduce manual work and processing delays Transition insurance and patient payments from paper checks to electronic bank payments whenever possible Oversee the setup of electronic payment arrangements with payers that still send payments by mail Provide additional support to patients who have questions or concerns about their bills, refunds, or insurance payments Handle escalated patient concerns with professionalism, empathy, and clear explanations Ensure refund requests are reviewed, approved, and issued accurately and timely Supervise and support direct report teams responsible for: Patient refunds, Payment posting, Charge entry, Medical record requests Collaborate with billing, insurance, and customer service teams to ensure accurate claims processing and follow-up Monitor performance metrics and implement process improvements to support timely reimbursement Requirements: Previous experience managing or supervising teams, preferably in a healthcare or medical billing environment Strong background in medical insurance, healthcare billing, or healthcare financial operations Solid understanding of the full healthcare revenue process, from insurance claims submission through final payment and patient billing Excellent de-escalation and communication skills when working with upset or confused patients Ability to explain insurance payments, patient balances, and refunds in clear, simple language High level of attention to detail to ensure payments and claims are processed accurately Comfortable reviewing processes, identifying issues, and implementing improvements Ability to work across teams and lead through change

JOB TITLE: Claims SME JOB LOCATION: Remote WAGE RANGE*: $48hr to $50hr w2 JOB NUMBER: 26-00767 REQUIRED EXPERIENCE: Medicaid Management Information Systems (MMIS) in: *Claims front end, back end, pricing, edits/audits, EDI Requirements gathering and system design Waterfall Software Development Life

Benefit from our 32 years of experience in business: We have an AWESOME training program and its FREE!! Part time $35,000 or full time $150,000 + Looking to fill Management position that are available GREAT money to be MADE!! Duties can be performed REMOTELY; TIME FREEDOM -work RIGHT From HOME!! We

Job Description: Audit and authorize reimbursement of specific and/or aggregate medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Analyze and adjudicate stop loss claims and request appropriate reimbursement from carrier. Recognize cost mitigation opportunities. Authorize and release stop loss claims reimbursement checks at or below pre-set authority limits. Initiate claims investigations and vendor referrals. Interpret plan language, and identify experimental services and subrogation opportunities. Identify need for follow-up on pended claims and resolution. Communicate effectively with carriers, vendors, and management. Provide full claims service to both phone and written inquiries. Generate and maintain claims system reports to adjust reserves, identify pending and backlog claims, and provide renewal and enrollment/premium history. Develop new and review old stop loss claim forms. Assist with internal auditing of claims auditors, and training of claims auditors. Requirements: Required Education: Associate's Required Work Experience: 6 years of managed care or reinsurance claims experience. Preferred Skills and Abilities: Analyzes laws, regulations and contract language. Evaluates issues and develops recommendations. Handles confidential and sensitive information. Investigates assigned claims. Proposes claims adjustments and refunds. Works claims caseloads. Aggregate claims experience. Benefits: Subsidized health plans Dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more

Job Description: Engage with Local Chain Account and Operator Customers, and be accountable for delivering business targets for the assigned Territory including Turnover, Reach & Penetration & digital, FPO (Fully Profiled Operators), Digital Engagement, Demos, Sampling etc. Execute CBP (Customer Business Plans), Win & Retain funnel, Contact Matrix and execute Multi touchpoint contact strategy on and off-line. Ability to convert Business Insights to Solution Selling to highlight Unilever’s ability to be ahead of the food trends. Develop and execute Joint Business Planning (JBPs) with Selected Trade partners including Trade Term agreements, Sell out activities and DSRs & Trade team engagement & KPIs. Engage trade customers to gain alignment for Secondary Sales Data (SSD) partnerships with proof of value addition. Close collaboration with Food Solutions Trade & eComm team to implement promotions by ensuring adequate stock availability and customer related activity to drive Sell-out. Ensure timely submission & settlement of distributor trade claims. Responsible for 100% engagement on automated warm leads & targeted leads driven via CRM. Drive conversion of leads in territory. Accountable for penetration strike rate target achievement based on automated Accounts & SKU prioritization. Drive digital buying behavior via ecommerce platforms (Webshop/trade Partner Webshop/pure players). Drive Social Media Engagement & attendance of UFS Webinars. Data Enrichment – continuously enrich all operator data to ensure personalized content. Implement Omni channel (On and Offline) contact strategy for your territory. Requirements: 4 year College Degree or Equivalent Culinary Degree and/or Corporate Experience 2+ years of experience in foodservice sales Additional experience in the Culinary industry a plus! Proven track record of developing strategic relationships with decision makers for both operator and distributor customers Proficiency and drive to become a proficient user of our systems (Blacksmith/Forge, Salesforce.com, Power BI) Negotiation skills and strong business acumen Passion for driving results with a strong interest in the food industry. Benefits: health insurance (including prescription drug, dental, and vision coverage) retirement savings benefits life insurance and disability benefits parental leave sick leave paid vacation and holidays access to numerous voluntary benefits

Job Description: Provide administrative and customer service support to the account team, Producer, and/or assigned group of accounts Work with minimal direction from an Account Manager (AM), Account Executive (AE), or Producer Independently resolve moderately complex customer service problems and manage smaller-sized accounts or those with less complexity Maintain technical competence and industry expertise Assist in directing day-to-day activities and workflow of Team Support/Receptionist, Account Assistant, and/or Account Associate Handle customer service requests, policy administration, billing, claims, and coverage analysis Manage policy expirations and renewals Conduct client research, gather underwriting information, perform loss run analysis, prepare submissions, evaluate and negotiate coverages and pricing, prepare and present proposals, bind coverage, and follow up for policy issuance Process tasks accurately and within required timeframes Assist in reviewing contracts to ensure proper coverages are included Monitor reports and take action on delinquent accounts, collecting outstanding balances Maintain agency management systems and carrier/vendor platforms, ensuring data accuracy and completeness Monitor and maintain activity/suspense to ensure timely completion Maintain frequent, transparent communication with the account team regarding workload status and any issues Deliver excellent service, proactively anticipate needs, and respond quickly to service requests Stay updated on company policies and procedures Seek and adopt best practices to improve individual and team performance Demonstrate integrity and leadership Requirements: 7 + years of customer service experience in the insurance industry Thorough knowledge of insurance brokerage and client needs Required active licensing; professional designation preferred Strong analytical, problem-solving, and decision-making skills Exceptional customer service, communication, multitasking, and organizational skills Proficiency in MS Office (Outlook, Word, Excel) High School Diploma (or equivalent) Benefits: Competitive salaries and bonus potential Company-paid health insurance Paid holidays, vacations, and sick time 401K with employer match Professional growth and career progression opportunities Respectful culture and work/family life balance Community service commitment Supportive teammates and a rewarding work environment

Job Description: You will be answering calls regarding healthcare benefits.Assist members with Medicare enrollments, billing, claims, benefits & other services.Manage a steady volume of incoming calls regarding Benefits, Enrollment, Eligibility, Invoicing, Claims, and related topics.Fully exp

Job Description: Responsible for data entry, analysis and file preparation as it relates to client benefit deductions and reconciliation for billing including associated customer service; researching customer concerns; payroll deduction/billing/remittance reconciliation. Assists the Sr. Account Managers and Account Managers with the back-end production of files and file manipulation. Completes data management of files/census data and ensures proper employee deductions are occurring by completing weekly/month reconciliations of payroll deductions comparing with expected deductions. Reconcile carrier premium invoices with received payroll deductions. Research and resolve discrepancies. Coordinate consolidated billing set-up and implementation including EasyPay clients, with the Sr. Account Managers and Account Managers. Responsible for ensuring the billing system is up to date with enrollment data and demographic information by pulling data from carrier systems and Benefit Administration systems. Provides timely customer service for client issues. Works with Benefit Service Center to resolve customer service tickets relating to deduction and billing. Works with Sr. Account Managers and Account Managers to ensure all processes are being followed accordingly for each individual customer. Other Duties as assigned Requirements: Associate degree in a business/accounting or related field or High School diploma plus 5 years of related experience. Health and Life license required within 180 days of employment. 3 or more years of billing and claims experience. Expert computer skills, including Microsoft Word, advanced Excel, Outlook, Acrobat, and Internet Explorer; Web site content management systems; databases; and web-based contact management systems. Excellent telephone, oral and written communication, proof-reading and organizational skills. Excellent analytical skills and ability to research problems. Ability to professionally and appropriately communicate with a diverse client base.

Job Description: Represent injured employees in North Carolina workers' compensation claims Manage cases across all phases, including pre-litigation, discovery, settlement negotiations, and appeals Litigate cases before the Deputy Commissioner, Full Commission, and North Carolina Court of Appeals Draft pleadings, motions, discovery, and appellate briefs Negotiate settlements and advocate for favorable outcomes on behalf of clients Guide clients through the legal process with clarity and confidence Oversee and collaborate with case managers and paralegals Requirements: J.D. from an accredited law school Licensed to practice law in North Carolina Minimum of 2 years of experience in workers' compensation (plaintiff or defense; plaintiff-side preferred) Experience handling complex workers' compensation claims Strong understanding of medical issues and hearing processes in these cases Excellent analytical, writing, and communication skills Highly organized, detail-oriented, and able to manage multiple priorities in a fast-paced environment Self-motivated with the ability to work independently Experience with Litify is a plus

Job Description: Investigating and confirming the facts of loss for advanced automobile accidents Determines coverage, liability, damages and adjusts and negotiates claims Recognizes body parts of a vehicle and potential property damage Handles investigation regarding all aspects of advanced auto

Job Description: Respond to member inquiries via phone, email, or chat with professionalism and empathy Resolve member level issues related to pharmacy benefits, claims, eligibility, and other service needs Escalate complex cases to senior support staff as needed Document all member interactions accurately to ensure compliance and service quality Identify recurring issues and share feedback with leadership for process improvement Work closely with Client Support Supervisors and Account Managers to ensure seamless service delivery Participate in team huddles and training sessions to stay informed on product updates and policy changes Maintain a positive and solutions-oriented approach in all member interactions Review general team processes for accuracy and recommend updates to leadership Engage in ongoing training to build skills in customer service, systems navigation, and healthcare knowledge Seek mentorship and feedback to grow into more advanced support or account-facing roles Requirements: 1–2 years of experience in customer service, healthcare, insurance, or benefits Strong verbal and written communication skills Ability to manage member issues with empathy and attention to detail Associate's degree in Business, Healthcare Administration, or related field preferred Familiarity with CRM platforms, call center tools, or SOP documentation preferred Interest in career growth within client support or account management Benefits: medical, dental, and vision coverage paid time off retirement savings options wellness programs other resources, based on eligibility

Job Description: Lead the design and development of advanced statistical and machine learning models that improve claims outcomes, operational efficiency, and risk management. Serve as the technical authority for complex modeling initiatives including fraud detection, claims severity prediction, litigation risk modeling, and recovery optimization. Develop predictive and prescriptive models using structured and unstructured claims data, including adjuster notes, medical records, and policy documentation. Architect modeling approaches that leverage modern techniques such as gradient boosting, deep learning, NLP, anomaly detection, and probabilistic modeling. Partner with AI Engineering teams to productionize models and integrate them into enterprise AI platforms and operational systems. Design feature engineering strategies and modeling pipelines using large-scale enterprise datasets. Establish best practices for model development, experimentation, validation, and reproducibility. Lead advanced analytical techniques such as causal inference, scenario simulation, and risk scoring methodologies. Build and maintain model evaluation frameworks that measure accuracy, bias, stability, and business impact. Monitor deployed models for drift, degradation, and changing data distributions, and recommend recalibration strategies. Provide technical guidance to data scientists and analysts across the organization. Mentor junior team members on statistical methods, machine learning techniques, and analytical rigor. Translate complex analytical findings into clear, actionable insights for business leaders and operational teams. Collaborate with Claims Operations, Finance, Risk, and IT stakeholders to identify high-impact analytical opportunities. Evaluate external data sources and third-party analytical solutions that enhance predictive capabilities. Ensure analytical methodologies align with enterprise governance standards and regulatory expectations. Contribute to Sedgwick's broader AI and advanced analytics strategy by identifying emerging technologies and modeling approaches. Lead research and innovation initiatives that advance Sedgwick's predictive analytics capabilities. Requirements: Master's or PhD in Data Science, Statistics, Mathematics, Computer Science, Economics, or related quantitative discipline. 8–12+ years of experience in data science, statistical modeling, or advanced analytics roles. Deep expertise in machine learning algorithms, statistical modeling techniques, and predictive analytics methodologies. Strong programming skills in Python, R, or similar analytical languages. Extensive experience working with large, complex datasets in enterprise environments. Proven experience designing and implementing end-to-end modeling pipelines. Strong understanding of model validation, feature engineering, and performance evaluation techniques. Experience collaborating with engineering teams to deploy models into production systems. Familiarity with distributed data processing tools and modern data platforms preferred. Experience in insurance, claims management, healthcare, or financial services analytics preferred. Ability to communicate advanced analytical concepts to both technical and non-technical stakeholders. Demonstrated ability to lead complex analytical initiatives that drive measurable business value. Strong mentoring and technical leadership capabilities. Benefits: Work-life balance Professional development opportunities

Job Description: Serve as an audit team member for a health plan(s) which currently administers benefits to Medicaid members across multiple lines of business including acute, behavioral health, individuals with developmental disabilities, and children in out-of-home care. Audit records on a routine basis, as well as records for audits (requested on an ad hoc basis) for all lines of business, in order to ensure coding and documentation meet regulatory standards. Coordinate audit documentation and reports for review for internal and external staff and stakeholders. Identify aberrant billing patterns and potential FWA, reporting this to internal staff. Assisting with further investigation and/or reports to state regulators through the utilization of developed critical thinking skills. Assist with the development and implementation plan for prospective and retrospective FWA avoidance, detection, and referral. Assist with the creation and submission of regulator deliverables through completion of timely audit activities. Provide technical assistance and education to providers including training on regulatory requirements, as well as coding and documentation rules. Maintain compliance with company policies and procedures. Perform other duties as assigned. Requirements: 3-5 years of experience in reviewing and interpreting claims data, as well as medical records and appropriate documentation. 3-5 years of experience with standard industry coding guidelines such as CPT, HCPCs, and ICD-10. Willingness to work Monday-Friday from 8am-5pm Arizona Time Zone. Must possess an active CPC ( Certified Professional Coder ), CCS ( Certified Coding Specialist ), or CPMA ( Certified Professional Medical Auditor ) license. Previous auditing experience. Previous Medicaid and/or health plan experience, including AHCCCS ( Arizona Health Care Cost Containment System ). Previous experience with QuickBase. Strong analytical and critical thinking skills. Strong attention to detail. Ability to collaborate and work with a team, as well as work independently as needed. Excellent presentational and strong communication skills, both written and verbal. Ability to be adaptable in a flexible environment. Benefits: medical, dental, and vision coverage paid time off retirement savings options wellness programs and other resources