Claim Benefit Specialist Jobs

Location: Remote ERGO NEXT's mission is to help entrepreneurs thrive. We’re doing that by building the only technology-led, full-stack provider of small business insurance in the industry, taking on the entire value chain and transforming the customer experience. Simply put, wherever you find small businesses, you’ll find ERGO NEXT. Since 2016, we’ve helped hundreds of thousands of small business customers across the United States get fast, customized and affordable coverage. We’re backed by industry leaders in insurance and tech, and we still have room to grow — that’s where you come in. As a Claims Specialist, you will be deemed a subject matter expert in the Claims department. Your extensive experience in commercial claims will allow you to handle high-severity and high-complexity claims. You will also lead department roundtables and have the opportunity to serve as a valuable peer resource to other team members! What You’ll Do: Extensive policy document and legal contract interpretation Ability to analyze and identify coverage and related coverage issues Leverage a working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management as part of your ongoing adjudication of claims Manage, investigate, and resolve claims within prescribed authority levels Recommend ultimate resolution on assigned cases in excess of authority to claims management Rely on a deep background of litigation handling experience in both General Liability and Casualty files to resolve claims Consistently drive litigation, attend mediations, trials, and other alternative dispute resolution avenues Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper c

Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and

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 The Lead Director, Technology Product Management for Medicare Claims is accountable for shaping the strategy, roadmap, performance, and modernization of the technology products and platforms that support claims administration for more than 4 million Medicare members. As the organization transitions to a product operating model, this leader will help establish and mature the product structure, practices, accountabilities, and cross-functional ways of working needed to improve claims accuracy, automation, timeliness, reliability, compliance, and operating efficiency. The Lead Director will partner closely with business, engineering, data, architecture, operations, and delivery leaders, as well as strategic software vendor partners, to translate claims, regulatory, operational, and technology needs into prioritized investments, aligned roadmaps, and measurable outcomes across a complex enterprise ecosystem. Given the significant role of vendor-provided platforms in the claims product, this leader will influence vendor roadmaps, align modernization priorities, manage critical dependencies, partner with release management on complex releases, and hold internal and external partners accountable for product performance and business outcomes. This role also leads and develops product management colleagues, strengthens product capabilities, and helps teams evolv

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

About THG Ingenuity THG Ingenuity is a fully integrated digital commerce ecosystem, designed to power brands without limits. Our global end-to-end tech platform is comprised of three products: THG Commerce, THG Studios, THG Fulfilment. Each represents a single, unified solution, overcoming challenges and taking brands direct-to-consumer. Our client portfolio includes globally recognised brands such as Coca-Cola, Nestle, Elemis, Homebase, and Proctor & Gamble. What’s the role? Job Title: CX Apprentice - Claims, Post Dispatch & Returns Reports to: Head of CX - Courier & Fulfilment Apprenticeship: Business Administrator Level 3 Duration: 12-18 months, subject to learner progress + End Point Assessment Role Purpose To support the Post Dispatch Communications, Carrier Claims and Returns functions, helping deliver a seamless end-to-end delivery and returns experience for customers and clients, from order dispatch through to resolution of any delivery, claims or return issues. Key Responsibilities Post Dispatch Communications Act as the voice of the customer for delivery excellence, helping improve touchpoints across the order-to-delivery journey for outbound and inbound shipments. Support the day-to-day relationship with our Post Dispatch Communications 3rd party provider (parcelLab), and help manage courier delays to reduce their impact on contact rates. Assist with onboarding new couriers, clients, sites and carrier services, setting up parcelLab/STS configurations and appropriate communication flows and brand tone. Support regular performance reviews of Post Dispatch Communications, maintaining metrics and reporting and helping communicate results and recommendations to stakeholders and clients. Collaborate with cross-functional teams across Ingenuity and PLC to support a seamless experience and identify revenue opportunities. Carrier Claims Support timely, accurate submission of claims to carriers, including requi

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 Quality Assessment Specialist to its growing Claims Operations team. This role is responsible for auditing the accuracy, compliance, and customer experience quality of claims intake and customer interactions — ensuring specialists meet documentation standards, follow SOPs, and deliver a consistent, empathetic experience. You'll balance independent case review with cross-functional calibration, feedback delivery, and process improvement, all in service of operational excellence and an exceptional claims experience for our users. Responsibilities: Conduct structured quality reviews of claims intake calls/tickets and customer-interaction touchpoints against a defined rubric including accuracy of documentation, adherence to SOPs, compliance with privacy/regulatory requirements, tone and professionalism Score interactions using a weighted rubric and maintain consistent, defensible scoring standards across reviewers Meet a defined audit volume/coverage target per week Participate in regular calibration sessions with other QA reviewers, Team Leads, and Sr. Specialists to ensure scoring consistency across reviewers and teams Flag rubric ambiguity and propose rubric updates as workflows or tools change (e.g., new intake fields, new compliance requirements, etc) Deliver clear, specific, and actionable feedback to specialists and Team Leads based on QA findings Partner with Team Leads/Trainers to identify coaching opportunities and recurring error patterns Track and report QA trends (accuracy rates, common errors, compliance gaps) to leadership on a regular cadence Identify systemic issues (tooling, SOP gaps, training gaps) surfaced through QA data and recommend fixes Support special projects such as audits, data reconciliation, and new-product rollouts Experience: 2+ years experience i

Why Jencap? We are one of the largest wholesale insurance intermediaries in the United States with expertise in wholesale brokerage, binding authority, and program management. The common thread woven throughout our success story is our collaborative and driven team of people. Our teams are empowered and work together to find solutions. We have a passion culture – with teamwork, collaboration and a focus on growing individuals and giving them the tools & development opportunities to have a successful career. MiniCo has nearly 50 years of experience in program management, underwriting, binding authority, and claims, offering a portfolio of exclusive programs to address even the most unique risk exposures. Our dedicated program teams provide niche underwriting process and flexibility, industry specialization, and unparalleled customer service. Today, MiniCo is a member of the Jencap Program Administrators division, offering multiple specialty property and casualty insurance products for a variety of unique industries and exposures. MiniCo is looking for a dynamic and customer-driven individual to join our team! MiniCo offers a hybrid work environment. Under General supervision, the position is responsible for evaluating and resolving routine property damage claims for the Tenant Protection Plan Program within assigned authority limits. This role will provide exceptional customer service through coverage analysis and damage assessment. The Property Damage Claims Adjuster will work a hybrid schedule from our Phoenix AZ. Responsibilities : Review coverage and handle routine personal property damage of tenant property stored in storage facility. Review tenant protection plan agreement and determine damage eligibility and settlement recommendations Examine photographs, estimates, repair invoices and other damage-related documents Maintain regular communication with customers regarding status and next steps Settle damages within assigned autho

Associate - Insurance - P&C Claims 5A — TOWER -4, JHARSA. Apply via Workday.

Associate - Insurance - P&C Claims 5A — 22A, STPI. Apply via Workday.

Analyst - Process Analytics - Claims & Underwriting 5A — TOWER -4, JHARSA. Apply via Workday.

Front Line Manager - Insurance - P&C Claims Ready to turn bold ideas into real-world impact? At Genpact, we don’t just adapt to change, we lead it. AI and digital innovation are transforming the way businesses work, and we’re at the forefront of it. Genpact’s AI Gigafactory , our industry-first accelerator, exemplifies how we scale advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. Whether tackling complex challenges through large-scale models or agentic AI , our breakthrough solutions tackle companies’ most complex challenges. If you thrive in a fast-moving, innovation-driven environment, love building and deploying cutting-edge AI solutions, and want to push the boundaries of what’s possible, this is your moment. Genpact (NYSE: G) is an agentic and advanced technology solutions company. We leverage process intelligence and artificial intelligence to deliver measurable outcomes. With a strong partner ecosystem and decades of client trust, we provide innovative solutions that transform how businesses run. Powered by a team with an active learning mindset and client centricity at its core, we deliver lasting value for the world’s leading enterprises. Get to know us at genpact.com and on LinkedIn , YouTube , X , and Facebook . Job Description Responsibilities: ·

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 Leads and manages the QA team by setting strategic objectives and ensuring the implementation of effective quality assurance processes. Collaborates with cross-functional teams to define testing requirements, develop test plans, and ensure timely and thorough testing of software products. Analyzes testing metrics, provides reports to stakeholders, and drives continuous improvement in QA practices to deliver high-quality and reliable software solutions. Required Qualifications 5-7 years work experience in a claims or claims audit position. Adept at execution and delivery (planning, delivering, and supporting) skills Adept at business intelligence Adept at problem solving and decision making skills Adept at collaboration and teamwork Adept at growth mindset (agility and developing yourself and others) skills Preferred Qualifications 5+years of quality management, audit, compliance or operational quality experience Adept at growth mindset (agility and developing yourself and others) skills Demonstrated experience using quality metrics, KPIs, dashboards, and business intelligence tools to identify trends and present recommendations to senior leadership Experience leading root-cause analysis, corrective and preventive action (CAPA), risk mitigation, and co

XO Health believes healthcare is fixable. Become part of the community changing the face of the industry. XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone – from those who receive care, to those who deliver it, to those who pay for it. We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation. XO Health Product Manager, Claims - India (Remote) About the Role : XO Health believes healthcare is fixable. Become a part of the community changing the face of the industry. XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone, from those who receive care, to those who deliver it, to those who pay for it. We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation. XO Health is building its own claims processing platform to power a new generation of claims adjudication, pricing, and payment. The Product Manager for Claims will own the product vision and strategy for this build, translating complex claims operations, EDI, and payer requirements into a clear roadmap the technical team can execute against. This role sits at the intersection of the business and engineering. The Product Manager will partner closely with Claims Operations, EDI, Network, and Compliance stakeholders to understand real-world claims workflows, translate that knowledge into detailed, clear business requirements, and serve as the primary liaison between the business and the technical build team throughout design, development, testing, and launch. This position requires strong product management fundamentals, deep curiosity about claims and healthcare operations, and the judgment to set realistic timeline goals

Senior Manager, Software Development Engineering (Claims Adjudication) — TX - Richardson. Apply via Workday.

Senior Manager, Software Development Engineering (Claims Adjudication) — TX - Richardson. Apply via Workday.