Insurance Claims Operations Associate

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. As the Team Lead, Collections, you own the end-to-end process for past-due receivable collections — installment payments, short-rated policies, claim deductibles, audit surcharge fees, and additional premium from mid-term endorsements or end-of-policy audits. You are accountable for Pie's overall bad debt recovery rate and for driving collection, litigation, and settlement outcomes against internal targets. You lead a team of individual contributors alongside BPO and offshore partners, set the strategy for how every dollar of exposure gets pursued, and continuously find upstream improvements that reduce Pie's exposure before receivables ever reach collections. You set and enforce service-level agreements across the collection lifecycle and are accountable for the performance of your team, your vendors, and your BPO and offshore partners against defined KPIs. You partner with Accounting to establish and maintain allowance processes and month-end financial close recommendations and documentation. You are the decision-maker for collection referrals and vendor preference, and you make sure collection progress is visible and tracked across Pie's systems and vendor systems. This is a role for someone who wants to own a function, build it, and be measured on results. How You’ll Do It Own recovery outcomes across every policy in collections Own Pie's bad debt recovery rate. You're accountable for driving collection success against internal collection-rate and recovery targets, and for the outcomes of litigation and settlement. Set and enforce service-level agr

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. Lyft is looking to add a Claims Operations Specialists to its growing Risk Team. The Operations Specialist position is an integral role assisting with the processing of claims and responding to inquiries to expedite the handling of claims. The focus of these roles will be cross-functional collaboration and enhanced customer communication focused on the best claims experience for our users. You’ll balance day-to-day responsibilities between independent claims processing and working with our cross-functional teams with a focus on customer obsession and operational excellence. Responsibilities: Create initial loss reports and assist with overall processes for Lyft Healthcare, as well as Lyft Bikes and Scooters Respond and assist with customer inquiries relating to claims Requests additional information, where necessary, for completion of claim processing Manages and coordinates next steps for Accidents; including missing claim searches, adjuster contacts, and enhanced customer experience Coordinate with cross functional teams regarding claims processes, system updates, and customer experience Gathers investigative material and general support to assist adjusters and internal claims teams Develops and delivers effective written and oral communications/reports to management Supports various Risk, Safety, Bikes & Scooters, Express Drive, Legal, Lyft Rentals, and Finance Teams regarding all aspects of insurance claims Supports and facilitates a team environment of continuous feedback and idea sharing with all team members and stakeholders Assist with special projects, including and not limited to auditing and data reconciliation Seeks out opportunities to gain broader insurance knowledge and cross-training Experience: 2+ years experience handling and solving customer support issues - ideally in a

At Lyft, our mission is to improve people's lives with the world's best transportation. To accomplish this, we start with our community by creating an open, inclusive, and diverse organization. About the Team The Risk Tech engineering organization is committed to tangibly reducing accident frequency, saving lives, and managing costs to enhance the safety and affordability of rides. Claim Management is a core financial function for Lyft. Each claim touches complex workflows, multiple stakeholders, sensitive data, financial reserves, regulatory processes, and significant financial liabilities. This role offers the opportunity to define a leading claims management system for the industry. Our vision is to establish a single, Unified Risk Platform where comprehensive claims workflows across all business lines are efficiently administered, communications are consolidated, and data is structured to facilitate data-driven insights and decisions.This enables cost-efficient claims operations, mitigates risks and expenses as Lyft scales, and ensures people receive assistance proactively and accurately. About the Role We are seeking a Senior Software Engineer to contribute to the technical direction, drive architectural decisions, and lead the development of a highly reliable, scalable, and intelligent Risk Management Information System that powers our insurance platform. You will collaborate with passionate colleagues from Engineering, Data Science, Product and Claim Operations to deliver end-to-end solutions. Responsibilities: Define and drive the long-term technical roadmap for claims management systems, aligning priori

At Lyft, our mission is to improve people's lives with the world's best transportation. To accomplish this, we start with our community by creating an open, inclusive, and diverse organization. About the Team The Risk Tech engineering organization is committed to tangibly reducing accident frequency, saving lives, and managing costs to enhance the safety and affordability of rides. Claim Management is a core financial function for Lyft. Each claim touches complex workflows, multiple stakeholders, sensitive data, financial reserves, regulatory processes, and significant financial liabilities. This role offers the opportunity to define a leading claims management system for the industry. Our vision is to establish a single, Unified Risk Platform where comprehensive claims workflows across all business lines are efficiently administered, communications are consolidated, and data is structured to facilitate data-driven insights and decisions.This enables cost-efficient claims operations, mitigates risks and expenses as Lyft scales, and ensures people receive assistance proactively and accurately. About the Role We are seeking a Senior Software Engineer to contribute to the technical direction, drive architectural decisions, and lead the development of a highly reliable, scalable, and intelligent Risk Management Information System that powers our insurance platform. You will collaborate with passionate colleagues from Engineering, Data Science, Product and Claim Operations to deliver end-to-end solutions. Responsibilities: Define and drive the long-term technical roadmap for claims management systems, aligning priori

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. The Risk Tech engineering organization is committed to tangibly reducing accident frequency, saving lives, and managing costs to enhance the safety and affordability of rides. Claim Management is a core financial function for Lyft. Each claim touches complex workflows, multiple stakeholders, sensitive data, financial reserves, regulatory processes, and significant financial liabilities. This role offers the opportunity to define a leading claims management system for the industry. Our vision is to establish a single, Unified Risk Platform where comprehensive claims workflows across all business lines are efficiently administered, communications are consolidated, and data is structured to facilitate data-driven insights and decisions. This enables cost-efficient claims operations, mitigates risks and expenses as Lyft scales, and ensures people receive assistance proactively and accurately. We are seeking a Senior Software Engineer to contribute to the technical direction, drive architectural decisions, and lead the development of a highly reliable, scalable, and intelligent Risk Management Information System that powers our insurance platform. You will collaborate with passionate colleagues from Engineering, Data Science, Product and Claim Operations to deliver end-to-end solutions. Responsibilities: Define and drive the long-term technical roadmap for claims management systems, aligning priorities with Product, Claim Operations, Data Science, and other stakeholders. Provide architectural leadership, make informed design tradeoffs, and guide strategic decisions across multiple engineering teams. Understand claim handling workflows, identify bottlenecks and multiply their productivity by driving platform innovations and resolving pain points with AI automation solutions Deliver scalable, reliable