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.
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.
Lead a team of experienced claims professionals managing complex workers' compensation claims across California.
Drive claim strategy, customer service, and employee development while overseeing day-to-day team activities.
Coach and empower adjusters to make proactive decisions, with travel up to 35% to support customers and team needs.
Strategic Comp is a leading provider of workers' compensation insurance for large employers, backed by Great American Insurance Group's 150-year history. With over 8,500 employees in the group, our culture emphasizes collaboration, excellence, and shared commitment to customers and one another.
Serve as the department's subject matter expert on stop loss administration, reimbursement, and contract interpretation.
Conduct regular audits of claim submissions and tracking, then implement corrective actions to improve accuracy and efficiency.
Onboard and coach new Stop Loss Specialists while maintaining training materials and leading process improvement initiatives.
Personify Health offers a personalized health platform that brings health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. The company is mission-driven and focused on empowering people to lead healthier lives, with a culture that values diverse perspectives.
Handle inbound and outbound calls to address claimant inquiries and provide detailed information on disability and leave claims.
Accurately document claimant details and resolve routine administrative and technical issues to support claims examiners.
Maintain confidentiality and compassion while managing high volumes of calls in a fast-paced, team-oriented environment.
Reliance Matrix delivers employee benefits, absence management and workforce productivity solutions through a combination of insurance and third-party administration. As a member of the global Tokio Marine Group, they employ thousands across America and foster a culture of collaboration, compassion, empowerment, integrity, and fun.
Lead premium audit strategy and operations to ensure regulatory compliance and financial integrity.
Oversee audit quality, data integrity, and implementation of business-wide improvements.
Manage budgets, workforce planning, vendor relationships, and team development.
The company is an insurance organization specializing in workers' compensation premium audit operations. It fosters a collaborative work environment with a focus on integrity, customer service, accountability, innovation, and employee fulfillment.
Lead daily care coordination operations, assign workloads, and manage caseloads to ensure timely service delivery.
Coach and develop team members through mentorship, feedback, performance reviews, and training.
Monitor performance metrics, resolve escalated issues, and collaborate with stakeholders to improve access to care.
A healthcare services organization that helps members navigate care, connect with providers, and manage transitions. It fosters a collaborative, accountable, and member-centered culture with a focus on quality and compliance.
Accurately review, process, and adjudicate health insurance claims in compliance with company policies and regulatory requirements.
Resolve system edits, audits, and claims errors through research and approved references.
Contribute to team-wide goals by processing claims and reducing daily inventory.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started in 2012 to create the kind of health insurance company we would want for ourselves, and we are a growing team committed to changing health care.
Investigate claim denials, navigate evolving payer requirements, and ensure complex claims are prioritized and resolved accurately.
Partner with cross-functional teams to identify operational and denial trends, optimizing workflows and claim outcomes.
Act as the pod’s go-to expert for payer workflows, claim resolutions, and best practices, supporting new-hire onboarding and team performance.
Rula is a mental healthcare company dedicated to providing quality, evidence-based care and reducing stigma around mental health. It is a remote-first company with a focus on inclusion, employee well-being, and making mental healthcare work for everyone.
Supervise and develop a team handling complex casualty claims within captive insurance programs.
Provide technical guidance on coverage analysis, liability evaluation, and litigation management for high-severity claims.
Partner with clients, brokers, and defense counsel to drive timely claim resolution and maintain strong relationships.
CCMSI is the largest privately-owned Third Party Administrator (TPA), delivering customized claim management solutions to help clients navigate complex risk challenges. As an employee-owned company, CCMSI fosters a collaborative culture where team members take ownership, drive results, and make a meaningful impact.
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.
Research and resolve premium payment exceptions and discrepancies in premium reports.
Process premium payments through approved electronic systems, including E-Pay and Virtual Terminal.
Communicate with insureds, producers, and internal departments to support accurate and timely premium administration.
Protective helps protect customers against life's uncertainties by providing insurance and financial protection. It fosters a culture focused on employee wellbeing, offering comprehensive benefits and an inclusive workplace.
Oversee the quality of disability claim documentation and physician reports, ensuring completeness and alignment with client requirements.
Review medical evidence to verify it substantiates physicians' clinical determinations for short- and long-term disability claims.
Communicate directly with clients and physician reviewers to clarify information and meet strict service deadlines.
US Security & IT provides IT and security solutions to partner organizations. The company fosters a remote-first culture and values accuracy, quality, and collaboration.
Manage an assigned caseload of commercial property claims with guidance and oversight.
Coordinate with independent adjusters, underwriters, legal, and reinsurance partners on coverage, investigation, and reserves.
Develop technical expertise in global, excess and surplus, and layered and shared market placements.
A rapidly growing specialty insurance company delivering commercial property and casualty products on a non-admitted and admitted basis. Operates through eight underwriting divisions with an agile culture focused on a niche strategy.
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.
Resolves medical claims that are not automatically adjudicated, ensuring timely and accurate processing.
Investigates and communicates to obtain needed information, and interprets contract benefits.
Works from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota.
Arkansas Blue Cross and Blue Shield is a health insurance provider that resolves medical claims and supports member health and wellness. The company is consistently ranked as a best place to work in Central Arkansas, with an average tenure of 10 years and an inclusive culture.
Reviews claim notices, policies, and state requirements to determine coverage and compensability.
Conducts timely claim investigations and coordinates return-to-work efforts with involved parties.
Manages claim documentation, settlement evaluations, and collaboration with internal teams and attorneys.
EMC Insurance is a property and casualty insurer providing workers' compensation and other insurance solutions, with over 105 years of financial strength. The company fosters a collaborative culture that empowers team members, and has been recognized as a top workplace.
Contact insurance companies to check claim status and appeal submissions via payer portals and phone calls.
Manage administrative tasks such as gathering medical records, processing mail, and maintaining filing systems.
Build foundational knowledge of healthcare claims, ERISA regulations, and Commercial and Managed Care insurance policies.
Ternium specializes in resolving complex healthcare insurance claim denials and delays, helping hospitals and health systems optimize their revenue cycles. We are a growing, mission-driven team focused on professional development, inclusion, and improving healthcare outcomes.
Provides administrative support to clinical teams including building medical management records and managing authorizations.
Conducts fax and telephonic outreach to members and providers for status updates and engagement.
Supports compliance monitoring and documentation in the medical management system.
Capital Blue Cross is a health insurance provider dedicated to improving the health and well-being of its members and communities. They are recognized as one of the "Best Places to Work in PA" with a culture focused on support, flexibility, and community involvement.