Leads claims quality assurance strategy and execution to ensure accurate, timely payments and compliance with Medicare, Medicaid, and regulatory requirements.
Drives continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration.
Directly supervises team members, evaluates performance, and identifies training gaps to strengthen workflows.
WelbeHealth serves vulnerable seniors through shared intention, pioneering spirit, and the courage to love. It is a growing healthcare organization focused on team culture and mission.
Independently adjudicate complex life and health claims, including contestable, accidental death, and accelerated death benefit cases.
Collaborate with claimants, attorneys, reinsurers, and internal teams to gather evidence and determine liability.
Analyze medical records, underwriting evidence, and investigative findings to make well-supported claim decisions.
Banner Life Insurance Company provides life insurance and financial protection products, focusing on long-term customer and community impact. The company values meaningful work, professional development, and a collaborative culture of ambition and wellbeing.
Analyze high-value and complex claims, ensuring alignment with carrier guidelines and regulatory requirements.
Oversee delegated claims operations and third-party administrators, monitoring compliance and quality.
Provide subject matter expertise and process improvements to strengthen claims governance and outcomes.
They are an insurance organization focused on claims governance, compliance, and operational performance. They are a growing company that prioritizes accountability, service quality, and effective risk management.
Investigate, evaluate, estimate, and process property claims primarily by phone or internal communication channels.
Handle personal and commercial losses including structure, contents, ALE, scheduled property, and business income coverage.
Review independent adjuster and contractor work, assist with contents valuation, and maintain adjuster licensing.
Encova Insurance is a property and casualty insurance provider offering personal and commercial coverage to customers. The company fosters a collaborative culture focused on trust, inclusion, and delivering excellent results through its associates.
Process medical claims and appeals accurately and timely, following health plan policies and procedures.
Maintain detailed notes, research claim issues, and communicate outcomes with claimants and teams.
Support customer success teams, escalate operational issues, and help improve claims processes.
Sana is a health plan solution built for small and midsize businesses, with integrated primary care services to make healthcare easy. Founded in 2017, the company is remote-first with a fully distributed team across the U.S., and values curiosity, ownership, and speed.
Acquire investigative techniques and work with experts to determine accident causes and fault.
Independently manage a claims inventory, including investigations, medical record reviews, and damage evaluations.
Resolve cases by negotiating settlements with individuals or attorneys.
Liberty Mutual is a leading property and casualty insurer helping people embrace today and confidently pursue tomorrow. They are a Fortune 100 company recognized as a Great Place to Work and one of Forbes' best employers for diversity and new graduates.
Manage an inventory of workers' compensation claims to evaluate compensability and liability.
Plan and conduct investigations to confirm coverage, determine damages, and negotiate settlements within authority limits.
Maintain detailed claim files, authorize timely payments, and represent the company at arbitrations, mediations, or trials.
National Interstate, a member of Great American Insurance Group, provides commercial transportation insurance and alternative risk transfer programs across all 50 states. Its dedicated team has earned multiple Top Workplace honors, with a culture built on integrity, transparency, collaboration, and employee development.
Investigate and resolve high-severity property claims with empathy and decisive action.
Conduct on-site inspections, create detailed estimates using Xactimate, and manage claim files.
Negotiate fair settlements and collaborate with internal and external stakeholders.
Mercury Insurance helps people reduce risk and overcome unexpected events. With over 60 years of experience, it is a midsize company that fosters growth, inclusion, and teamwork.
Serve as a subject matter expert in initiating Auto and Property claims with precision and professionalism.
Provide clear, expert counsel to customers on coverage, filing options, and the claims process.
Accurately capture First Notice of Loss documentation and coordinate resources to advance claim resolution.
Liberty Mutual is a Fortune 100 insurance company that helps people safeguard their assets and navigate life's uncertainties through a wide range of insurance products. With a large, inclusive workforce, the company values diverse perspectives and supports employees through comprehensive benefits and professional development opportunities.
Guide customers through designing benefits packages and selecting the right plans for their teams and stage.
Own the end-to-end enrollment process, submitting insurance forms accurately and keeping systems current.
Manage the client lifecycle at renewal, communicate proactively, and solve ambiguous benefits issues.
Mercury is a fintech company that provides financial software for startups, and its recent acquisition Central handles payroll, benefits, HR, compliance, and government filings. The company values diversity, belonging, and deep customer empathy, aiming to make complex processes feel simple and human.
Conduct investigations and inspections to assess damage, estimate costs, and determine settlement amounts.
Analyze medical, financial, and job information to determine eligibility for benefits based on statutory criteria.
Settle claims in accordance with standards and negotiate with all parties involved to ensure smooth processing.
Desjardins Group is the largest cooperative financial group in North America, offering a full range of financial products and services. With over 52,000 employees and named one of Canada's top employers, they foster a people-first culture and are committed to equity, diversity, and inclusion.
Lead quality assurance, training, and professional development initiatives for medical management teams.
Design and maintain onboarding programs, continuing education, and audit calibration processes.
Analyze operational metrics and audit results to drive process improvements and enhance member support.
This partner company specializes in medical management and healthcare operations, providing quality assurance and professional development for client organizations. It operates as a remote-first organization with a culture focused on employee support, continuous improvement, and cross-functional collaboration.
Evaluate, negotiate, and settle low to high complexity bodily injury claims to prevent unnecessary exposure.
Investigate and analyze medical records, law enforcement reports, and witness statements to determine liability and damages.
Coordinate settlement, mediation, and arbitration with attorneys, ensuring compliance with state laws and regulations.
Mercury Insurance helps people reduce risk and overcome unexpected events, providing insurance products and claims services for more than 60 years. They emphasize a collaborative, inclusive culture where team members are encouraged to grow, have fun, and make a meaningful impact.
Resolve denied claims by reviewing supporting documentation, calculating benefits due, and composing appeal letters.
Analyze claims to determine validity of denial/recovery options and draft convincing correspondence to effect reimbursement.
Build relationships with insurance carriers, patients, attorneys, and employers while documenting all actions to resolution.
Xsolis is an AI-driven technology company reducing administrative waste in healthcare by enabling smarter collaboration between providers and payers. Recognized on the Inc. 5000 and Deloitte Technology Fast 500 lists, it is one of the fastest-growing privately-held companies in North America with a passionate, fast-moving culture.
Adjudicate high-end General Liability claims involving serious injuries, complex coverage scenarios, and legal disputes.
Develop case strategies for satisfactory resolution, coordinating with local counsel, clients, and medical or legal experts.
Work in a remote, flexible environment with opportunities for career growth and comprehensive benefits.
Sedgwick is the world's leading risk and claims administration partner, helping clients navigate the unexpected with expertise and AI-enabled technology. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides a caring culture, professional development, and work-life balance.
Administer benefits, wellness, retirement, and payroll support for US employees.
Manage end-to-end leave processes including FMLA, ADA, and state-mandated leaves.
Ensure accurate benefits enrollment, reconciliation, and compliance with federal/state regulations.
Ventra is a leading business solutions provider for facility-based physicians, focused on revenue cycle management. The company fosters an inclusive, culturally diverse workplace and rewards great work through performance-based incentives.
Answer member inquiries, perform outreach, and build rapport with client representatives to resolve insurance and benefits questions.
Research issues, coordinate with providers and carriers, and log resolutions to ensure timely follow-up and quality outcomes.
Collaborate with service team members, run reports, and lead onboarding calls to support client members and improve service.
IMA Financial Group is an independent insurance brokerage providing insurance solutions, employee benefits, retirement plans, and wealth management. It is a national, employee-owned company with a collaborative culture and recognition as a best place to work.
Own the month-end, quarter-end, and year-end close for the TPA entity, including journal entries, reconciliations, and accruals under US GAAP.
Apply ASC 606 to TPA contracts, evaluate performance obligations and variable consideration, and track performance guarantee exposure.
Reconcile and audit large data sets across ERP, TPA systems, and third-party reports, resolving discrepancies at the root cause.
Personify Health provides a personalized health platform that combines health plan administration, wellbeing solutions, and care navigation. The team is mission-driven and focused on empowering healthier lives, with a culture that values diversity and impact.
Acts as a central point of contact and provides analytical problem-solving support to Commercial and Medicare Appeals and Grievances staff.
Researches, analyzes, and implements changes to processing procedures to increase department efficiency and meet regulatory compliance.
Supports training, documentation, and compliance activities while serving as a subject matter expert on appeals module configuration.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, providing health insurance and wellness programs. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."
Lead advanced compliance activities for healthcare administrative products including HSAs, FSAs, HRAs, and COBRA.
Apply expert regulatory judgment to risk assessments, compliance monitoring, investigations, and corrective actions.
Collaborate with stakeholders to integrate compliance requirements into strategic initiatives and leverage AI-powered tools.
HealthEquity empowers healthcare consumers by providing administrative solutions like HSAs, HRAs, FSAs, and COBRA. The company is a large, mission-driven organization that values inclusion and connects health and wealth for American families.