Claims jobs in Newark, New Jersey - Page 16Crear alertas

Product SME must have DXC SICS core product experience Accounting Claims task management and Integration with upstream and downstream systems.Reinsurance must have FacultativeTreaty Reinsurance Rating system Claim E2E BillingPayment System DownstreamUpstream Integration testing FormsReports systems.

Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it's underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial at

Utilizing cutting-edge technology, our inspectors help assess property damage and prevent further harm until permanent repairs are complete.

Customer Service and Feedback Management: Follow up with customers' post-delivery to ensure satisfaction and address any concerns or returns. Job Title: Customer Service and Quality Assurance Coordinator. Claims Management and Issue Resolution: Act as the primary point of contact for claims received

We are seeking a dynamic Senior Vice President of Claims, Eligibility, and Revenue Operations to play a critical role in our organization. Senior Vice President of Claims, Eligibility, and Revenue Operations. Qualified candidates should possess a Bachelor's degree in a related field (Master's prefer

OR An associate degree (or higher) in a Paralegal/Legal Assistant/Legal Studies program or a certificate in a Paralegal/Legal Assistant program where the degree was granted from a regionally accredited college or university or one approved by the American Bar Association (ABA) AND one year of full-t

Analyze claims workflows and identify bottlenecks or opportunities for automation to streamline processes. Identify and mitigate operational risks within claims and network operations. Minimum of 3 years of experience in health payer operations, particularly in claims and/or provider network operati

A major health insurer is seeking an experienced candidate for a role that includes overseeing vendor performance in claims processing and conducting quality assurance audits. The ideal applicant will have 2-3 years of claims auditing experience, strong analytical skills, and proficiency in MS Offic

The Claims Quality Analyst is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit con

Well versed in all the duties and responsibilities of the Claims Examiner position including data entry and system adjudication of BH claims. The incumbent will coordinate with the ASP Manager to ensure the BH Claims team is able to meet expectations for the timely and accurate adjudication of claim

The Customer Service Coordinator (CSC) must process purchase orders, sample requests, claims, set up new customer data, and handle other inquiries and requests through our system based on our procedures. To provide direct and outstanding customer service by following corporate procedures and ensurin

With 98% of cyber insurance claims in the past five years coming from small and mid-size businesses with revenue under $2B, providing an integrated solution to help manage risk is more critical than ever. At-Bay helps its 35,000+ customers close their security technology and skills gap all through t

The Senior Manager, Consumer Technical Insights & Claims - Skincare leads the development of consumer driven technical insights and scientifically validated claims that shape product design, guide innovation strategy, and strengthen brand competitiveness.

Job Description Hi, we're Oscar. We're hiring a Manager, Medical Policy to join our Medical Policy team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: You will lead the clinical research and development of evidence-based medical necessity criteria within the Office of Clinical Affairs (OCA). You will be responsible for the end-to-end clinical lifecycle of medical policies, ensuring that coverage criteria for medical services, devices and technologies are supported by current clinical literature and nationally recognized standards. You will serve as the lead clinical subject matter expert (SME) for medical evidence appraisal, ensuring our clinical policies are evidence-based, compliant, and supportive of optimal health outcomes for Plan members. You will report into the Associate Director, Clinical Policy - Affordability. Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $131,200 - $172,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Lead the review of clinical literature, regulating agency guidance (e.g., FDA, CMS, State/Federal Departments), and specialty society guidelines to develop sound coverage criteria for medical services, devices and technologies., • Conduct and manage health technology assessments for novel medical technologies and complex devices., • Coordinate with internal and external specialty-matching physicians for the clinical review and validation of medical policies., • Translate complex clinical data and evidence-based recommendations into precise, defensible medical necessity criteria and clinical positions or guidance., • Own the end-to-end drafting and maintenance of the medical policy library, ensuring language is clinically accurate, unambiguous, and operationally interpretable., • Responsible for the preparation and presentation of evidence-based medical policies and summaries of changes to the Clinical Advisory Subcommittee (CAS) and internal forums., • Oversee, onboard, develop, and manage a team of clinical FTEs, contractors, and matrixed reports., • Ensure all clinical policy development processes are streamlined and align with the larger departmental and Office of Clinical Affairs (OCA) strategy., • Ensure clinical policy development processes and documentation comply with State, Federal, and NCQA requirements., • Provide support on regulatory audits and quality accreditation surveys as needed., • Compliance with all applicable laws and regulations, • Graduate degree in Healthcare Administration, Public Health, Health Policy, Health Services Research, Epidemiology, or a closely related discipline (such as Nursing or another allied health field)., • 5–8 years in healthcare, with 3–5 years specifically focused on medical policy development, clinical research, or medical writing., • Experience in people leadership, including the ability to manage, mentor, and develop clinical professionals., • Proficiency in leveraging clinical databases (e.g., PubMed) to conduct literature reviews, evaluate evidence, and synthesize findings into defensible medical necessity criteria or recommendations., • Active, unrestricted clinical license (e.g., RN, NP, PA)., • Working knowledge of medical coding (e.g. CPT, ICD-10, HCPCS) and claims., • 2+ years of experience using Excel/Google Sheets and PowerPoint/Google Slides., • Ability to translate technical clinical evidence for both clinical and non-clinical stakeholders., • Experience with Managed Care regulatory requirements, NCQA standards, and ACA marketplace rules., • Background in managed care, utilization management, or evidence-based clinical guideline development. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description The Warehouse Account Manager is a torchbearer of the brand-centric culture at Ship Essential. This role has a hand in everything we do to deliver superior experiences, value, and growth for our brands. The WAM ensures that we are delivering a seamless customer experience across all stages and touchpoints in the customer journey, from onboarding, to day-to-day support, to special projects. Responsible for understanding the unique strategic needs of each of our brands, this role will build and manage solid partnerships and promote the adoption and utilization of Ship Essential tech and services. The WAM will strive to achieve unparalleled levels of responsiveness and care for our brands. They will identify key areas of improvement regarding brand interaction, and will work across various departments to implement measures to ensure such issues are automatically resolved in the future. We pride ourselves on our responsiveness and sense of urgency. To that end, this is an in-person role based at our Sunset Park, Brooklyn location. Manage Day-to-Day Communication With Brands • Answer incoming emails, texts, and calls on a range of topics including: order details and tracking, shipping issues, inventory, special requests, and general account questions or concerns, • Proactively communicate system and process issues, customer feedback, and recurring patterns or concerns with management, • Set appropriate and realistic expectations with brands, • Communicate brands needs to operations team in an efficient manner while maintaining brand standards and customer service, • Clearly understand and respond appropriately to issues that customers present, then proactively solve the issues at hand, • Support the Brand Success team with brand experience, • Evaluate SE customer support processes, devise improvements, measure results, and iterate, • File claims for lost packages with carriers and communicate updates and resolutions with brands, • Demonstrate clear, polite, and professional written communication Promote Service Utilization and Growth • Foster meaningful connections with brands to promote promote widespread utilization of Ship Essential services and technology throughout their organizations, • Understand and document our brands’ long-term business objectives and identify opportunities for cross- and up-selling, • Formulate strategies and collaborate with sales and product teams to achieve revenue goals tied to upsell and expansion, • Work alongside sales, operations, product, and partnerships teams to ensure a unified approach to brand success and account growth, • Identify friction points in the customer journey and coordinate cross-functionally to improve the customer experience, • Working alongside warehouse management, delegate and manage Special Projects and requests for brands, • Audit brand partner invoices to ensure accuracy of value-added-service and resale charges Represent the Voice of the Customer • Act as a brand advocate within the company, conveying brand feedback and collaborating with operations, partnerships, and other teams to prioritize and address client needs, • Cultivate a deep understanding of e-commerce and logistics industry trends, competitive dynamics, and the role Ship Essential plays, • Design and execute a brand retention strategy to reduce churn and maintain high satisfaction levels Experience • 3+ years in customer success, account management, or related roles within e-commerce, logistics, or fulfillment industries, • Proven track record of managing client relationships and driving growth through cross- and up-selling Skills • Strong communication skills, both written and verbal, with a focus on clarity, professionalism, and responsiveness, • Proficient in CRM and WMS systems, with experience in Shopify integration preferred, • Excellent problem-solving abilities, with a proactive approach to identifying and resolving issues Competencies • High attention to detail, particularly in managing day-to-day communications and auditing invoices, • Ability to work collaboratively across departments, fostering teamwork to enhance the customer experience, • Strong organizational skills with the ability to manage multiple projects and deadlines simultaneously Education • Bachelor’s degree in Business, Marketing, Supply Chain Management, or a related field, or equivalent experience. Attributes • A customer-centric mindset with a passion for helping brands succeed, • Adaptability and a willingness to work in a fast-paced, dynamic environment, • Health Care Plan, • Retirement Plan (401k), • Paid Time Off (Vacation, Sick & Public Holidays)

Monitor and ensure the timely processing of workers' compensation claims, providing clerical support to employees throughout the process. Assist in maintaining HR compliance with Occupational Safety and Health Administration (OSHA) regulations and internal safety standards. Help organize and schedul

Customer Service Representative. Exceptional teamwork, communication, and customer service skills are essential as you interact with colleagues and customers. As a CSR, you'll be at the forefront of our customer interactions, processing purchase orders, sample requests, claims, and more, ensuring ti

This role will work closely with internal lawyers and risk managers to manuscript and maintain a national portfolio of auto liability insurance policies for Uber's rides and delivery businesses. Manuscript unique auto liability forms. In depth understanding of auto insurance policies, claims and rel

A leading insurance firm is seeking an experienced Insurance Claims Specialist in New York, NY, to manage and resolve multi-line claims, including Marine Cargo, Property & Casualty, and Auto.

A major public transportation authority in New York City is looking for an Analyst for Owner Controlled Insurance Programs.

The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our

Manage claims adjudication by identifying contractual variances between posted and expected reimbursement for Article 28, Managed Care, Commercial Insurance and other payers.Analyze, audit and recover outstanding receivables.Identify trends in payments, underpayment/overpayments and denials.Work wit

Retrieve from DBL voicemail detailed messages for processors; provide status of disability claims and processing procedures to the members and their representatives.Prepare and submit daily attendance report to management.Create, update and maintain excel spreadsheets for staff daily Disability prod

Competitive pay & benefits - As an Accounts Receivable Rep at Impact Advisors, you will: Perform follow up on unpaid and underpaid insurance claims and review claim status through payer portals, IVR systems and clearinghouses; Manage work queue and meet productivity expectations; Analyze remittance

Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt?. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out

Job Description** Job Summary Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Reevaluates medical claims and

AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston. By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. Are you ready to embark on a dyn

Minimum of 8 years experience handling general liability claims, including New York Labor Law and catastrophic bodily injury claims, with some experience managing coverage-related matters filed by or against the insurer. As a Senior Claims Specialist, you will manage an assigned pending of claims ar

A leading financial services provider in Newark, NJ seeks an experienced Long Term Disability Claims Manager.The role involves delivering exceptional customer service, analyzing claims, and ensuring compliance with contract provisions.Candidates must have at least 4 years of experience in claim mana

A reputable insurance claims firm in Rutherford, NJ, is seeking Independent Insurance Claims Adjusters to join their team. As a Licensed Claims Adjuster, you will help individuals and businesses recover from unforeseen disasters.

The New York City Housing Development Corporation is seeking an Insurance Administrator to support the daily servicing of mortgage portfolios. This role involves managing insurance records, contacting brokers, and ensuring proper funding and payments. The ideal candidate will have a degree, experien

At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you wh

With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your f

A leading IT consulting firm is looking for a Business Analyst with Policy Center experience to work in Jersey City, NJ.Responsibilities include providing support for client projects and coordinating with global delivery teams.The ideal candidate should have a GWCP Certification and experience with

Mentors less experienced Billing staff and assists Billing Manager/FPA Manager in training new staff. Experience in medical billing or health claims, with experience in EPIC & IDX billing systems in a health care or insurance environment preferred. Newsweek's "The World's Best Smart Hospitals" ranks

Manage first-and third-party cyber claims. Timely and accurately analyze and address coverage issues under cyber policies. Prior cyber claim handling experience a plus.

The team serves as a claims technical resource, as well as provides assistance and expertise across Hiscox by identifying and promoting claims best practices and facilitating required improvements. This is a high-impact role suited for an experienced insurance claims compliance professional or attor

Maintain and enforce bus evacuation plan and coordinates bus evacuation activities as appropriate * Immediately reports any incidents or claims to Operations Manager or Shift Lead * Refuel and maintain shuttle equipment and fuel use logs * Maintain a clean work environment, disinfecting shuttle afte

As the Business Office Manager, you will play a critical role in overseeing and managing the administrative and financial operations of our ASC. Your primary responsibility will be to ensure the smooth functioning of the business office, including billing, coding, insurance claims, accounts receivab

Excess Construction Claims Consultant. Investigate and manage Excess Construction claims from initiation to resolution. Assess the validity of claims and determine appropriate reserves.

CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions,

As part of Munich Re Group, we are a unique organization providing expertise in specialty and marine lines of insurance as well as surety risks and customs bonds with in-house claims solutions. We are seeking a Temporary Employee - Client Support, Surety Bonds to join the Roanoke Insurance Group div

Are you ready to embark on a dynamic and in?demand career as an Independent Insurance Claims Adjuster? Join a thriving industry with endless opportunities for growth and advancement.Current surge in storm?related events creates an urgent need for new adjusters to meet escalating demand.As a Licensed

AOE/COE, Auto, or Homeowners Investigations.

Oversee a unit of claims experts to review, reconcile and resolve claims inquiries, handling all claims inventory, appeals and special handling: hire, develop, mentor, train staff; clearly communicate expectations; monitor and provide feedback; ensure appropriate levels of staffing; complete perform

Senior Claims Examiner/h2pBerkley Professional Liability is seeking a Senior Claims Examiner to join their team. Claims Examiner is responsible for managing complex claims across Public and Private Directors Officers (DO), Financial Institutions, Employment Practices Liability (EPL), and Fiduciary

A leading insurance provider based in New York is seeking a Senior Liability Adjuster to expertly manage high-stakes commercial general liability claims.

In this role, you will serve as the backbone of our compliance strategy—owning regulatory review across product development, labeling, and advertising claims to ensure everything is compliant, credible, and science-backed. Own and maintain all regulatory documentation. Lead the regulatory review a