Claim Benefit Specialist Jobs

Help leading insurers rethink how underwriting, claims and operations work The Role Capco is growing its Insurance practice in Hong Kong and is looking for a Principal Consultant to lead transformation initiatives with major Life, Health and General Insurance clients across Hong Kong and APAC. This is an opportunity to work directly with senior insurance leaders to redesign operating models, transform underwriting and claims capabilities, modernise customer journeys, and unlock value through digital, automation, data and AI-enabled solutions. You will play a key role in shaping client outcomes, developing market propositions, and contributing to the continued growth of Capco’s Insurance practice. What You’ll Do Lead end-to-end transformation programmes across Life, Health and General Insurance clients throughout Hong Kong and APAC. Design future-state operating models, process improvements, and customer, underwriting and claims journey enhancements. Partner with senior stakeholders including COOs, Heads of Claims, Heads of Underwriting, Operations Leaders and Transformation Executives to deliver strategic change. Lead multidisciplinary teams across consulting, technology, operations, data and third-party vendors to achieve successful outcomes. Contribute to business development activities, market propositions, thought leadership and the growth of Capco’s Insurance capability. What We’re Looking For 8–12+ years of experience within consulting, insurance operations, underwriting, claims, transformation, or a related discipline. Strong understanding of insurance operating models, process optimisation, underwriting operations, claims operations and policy servicing. Proven experience delivering large-scale transformation programmes within regulated insurance environments. Ability to engage senior stakeholders and translate strategic objectives into practical, measurable delivery plans. Professional fluency in English; Cantonese and/or Mandarin language ski

The Ops Sup Lead Analyst is a senior-level operations professional responsible for managing transaction exception processing, including payment network claims, adjustments, disputes, settlement exceptions, and reconciliation activities for internal Citi business partners. The role is accountable for ensuring the accurate and timely resolution of operational exceptions, maintaining a strong control environment, and overseeing third-party vendors that support these functions. This individual serves as the primary liaison between Operations, Business, Technology, Risk & Control partners, payment networks, and external vendors to ensure operational issues are resolved effectively, controls are maintained, and processes continue to evolve to support business growth and regulatory expectations. The successful candidate will act as a subject matter expert in payment network operations, transaction routing, settlements, reconciliations, and exception management. Responsibilities Lead the end-to-end management and resolution of transaction exceptions, including payment network claims, adjustments, disputes, settlement discrepancies, and other operational exceptions. Oversee settlement and reconciliation processes to ensure the timely identification, investigation, and resolution of breaks, variances, and outstanding items. Monitor operational performance and service level adherence, ensuring all activities are completed accurately, timely, and in compliance with applicable policies and procedures. Serve as the primary operational liaison with internal Citi business partners, Technology, Risk & Control, Compliance, Finance, payment networks, and third-party vendors. Manage vendor relationships supporting claims, adjustments, settlement, and reconciliation functions, including performance monitoring, issue escalation, service delivery oversight, and process improvements. Act as the b

The Beneficiary Services Representative is a Client Service and Sales support position, fully responsible for servicing and supporting internal and/or external clients primarily through inbound and outbound phone calls and adhering to Know-Your-Customer (KYC) and Anti-Money Laundering (AML) procedures for Citi’s Investment and/or Banking clients. The Beneficiary Services Representative takes ownership of the full beneficiary process to provide a seamless, best in class, experience for our clients’ beneficiaries. Responsibilities: Fully accountable for servicing and supporting Citi’s Investment and/or Banking clients Able to clearly articulate business value proposition, matching clients with the correct set of products and services Directly responsible for providing timely responses to client service requests, received via telephone or email Provides exceptional support and issue resolution– all client issues will be owned end to end by the associate and will be treated with a closed loop process Handles all inquiries/requests related to banking and /or investment operations – including placing unsolicited securities trades (Series 7 & 63 required) Ensures customer claims and complaints are handled in accordance with FINRA and firm policy Ensures that KYC/AML and other compliance norms are strictly adhered to Builds a rapport with clients; utilizes Salesforce regularly for communication of issues/tasks/opportunities Builds a rapport with back-office staff and seek out highest level of support from those teams Provides timely feedback to senior management to identify client pain points and barriers to exceptional service; offers suggestions on process improvement Responsible for responding to client requests for investment products, referring clients to Financial Advisors, if requested Accountable for identifying prospective clients int

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 Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Monitors service capabilities and collaborate cross- functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed. Educates Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key Providers at regular intervals to ensure service levels meet expectations. Manages the development of agenda, validates materials, and faci

Job Title Global Product Manager- IVP & Launch Excellence Job Description As a Global Product Manager (GPM)- IVP & Launch Excellence , you will build integrated value propositions and standardized launch approaches across Sleep & Respiratory segments ; improve launch planning, commercial readiness, and execution consistency Your role: Develop value propositions, business cases, and product claims (clinical, economic, technical) to support strategic investments, pricing, and product success. Define and maintain product, software, and lifecycle specifications aligned with portfolio strategy and customer needs. Drive product strategy execution with regional teams , ensuring commercial viability, technical simplicity, and margin optimisation. Own the claims roadmap, prioritising validated claims based on market, customer, competitor, and regulatory insights. Engage Key Opinion Leaders (KOLs) through advisory boards and educational initiatives to strengthen product credibility and market influence. Partner with cross-functional teams to develop channel strategies and go-to-market plans that accelerate adoption and revenue growth. Analyse market trends, competitive activity, customer behaviour, and product performance to inform data-driven decisions and roadmap priorities. Ensure regulatory compliance and quality standards throughout the product lifecycle. Support development and refinement of testing protocols to ensure accurate product evaluation. Lead end-to-end product lifecycle management, from concept through launch, ensuring quality, timely delivery, and alignment with business objectives. Drive continuous improvement and innovation initiatives to enhance product performance and maintain market competitiveness. You're the right f

Job Title Global Product Manager- Accelerators Job Description Global Product Manager- Accelerators will lead the incubation of early-stage products and technologies, including internally developed and partnered solutions; translate emerging concepts into scalable new-product opportunities Your Role Own the end-to-end product lifecycle, including portfolio strategy, roadmap development, value propositions, and business case execution. Lead new product development and PDLM governance, ensuring timely, profitable, and compliant product launches. Develop portfolio positioning, claims strategies, and customer segmentation based on market insights, competitive analysis, and regulatory requirements. Partner with R&D, Innovation, Sales, Marketing, Manufacturing, and regional teams to deliver commercially successful solutions. Build and manage KOL relationships to strengthen product credibility, thought leadership, and market adoption. Drive global launch readiness and support regional go-to-market execution. Provide strategic guidance and product expertise to regional marketing and sales teams to accelerate growth and market penetration. Ensure achievement of commercial objectives, portfolio profitability, and Annual Operating Plan (AOP) targets. Oversee product validation and testing activities to ensure quality, performance, and customer satisfaction. You're the right fit if: You’ve acquired 10+ years of experience in an international business environment in the field of product management, marketing, or related commercial/strategic role in medical devices or health technology. Exposure to Regulatory frameworks (FDA, EU MDR) and Reimbursement considerations You have a Bachelor's/ master’s degree in business

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 Senior Analyst, Network Operations is a key role within the Network Operations function. The role is responsible for business operations managing Aetna’s provider network, which accounts for >$30Bn in annual medical claims spend. Business operations includes, but is not limited to, facilitating new provider applications, managing provider inquiries and assistance requests, and ensuring provider data and demographic information is maintained current. The role is a senior individual contributor position. The role will have a broad span of influence over responsible areas, and it will command the need to make accurate decisions on processes and directions for work, interactions with appropriate local market colleagues. The Senior Analyst’s ability to identify, evaluate and act on trends impacting market objectives and demonstrate independent judgement, discretion and authority will be critical for success. The ideal candidate will use their professional and technical experience, extensive Aetna systems knowledge, and internal cross-functional relationships to successfully complete their responsibilities (notably with common, non-standard provider requests and/or situations). The Senior Analyst will use advanced interpersonal skills to interact cross-functionally with multiple business areas to ensure timely completion of work and be r esponsible for achievin

Become a part of our caring community The Counsel provides a full range of legal advice and services. The Counsel work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Counsel typically a Legal generalist or provides counsel in a combination of disciplines. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact Responsibilities: Be a part of the legal team -- use your legal expertise to drive healthcare strategy. Humana is seeking legal counsel who will support Humana and its management by: Providing legal advice and support for Humana’s Medicare Advantage lines of business; Advising on Medicare Advantage rules and regulations and related health care fraud and abuse laws, including the Anti-kickback statute and False Claims Act; Drafting contract provisions to address regulatory concerns; and Collaborating and consulting with leaders throughout the company in order to ensure full compliance with applicable laws and regulations, and protection against external risk. Required Qualifications: Juris Doctorate, with licensing in at least one state At least 3 years of experience in health law at a law firm or in-house health care organization Experience in Medicare, Medicaid, or similar regulatory work Strong legal research, analytical, and writing/oral communication skills Experience negotiating contracts </l

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&#43;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

About the team The Frontier Assurance team strengthens OpenAI’s safety decisions through independent expertise, rigorous assessment, and public transparency. We coordinate external evaluations of frontier models and safeguards, develop approaches such as embedded auditing, and manage the misalignment disclosure process and safeguard testing. Our work helps independent experts scrutinize OpenAI’s safety approach and ensures their findings inform consequential decisions about advanced AI systems. About the role As a researcher on Frontier Assurance, you will build the technical foundations for rigorous assessments of frontier AI risks. You will help design technical assessments with external evaluators and internal teams: identify consequential safety claims to test, define the evidence and methods needed to assess them, and address gaps in coverage. You will work closely with external evaluators and embedded auditors, helping them understand the systems they are assessing and access the models, data, and technical information their work requires. Where direct access is not possible, you will conduct experiments and analyses on their behalf, with methods and results they can meaningfully scrutinize. This role combines research engineering, experimental design, and close technical collaboration. You will move between investigating specific safety questions, navigating complex internal systems, and building reusable tools that make assessments more thorough and efficient. Your work will help turn independent scrutiny into concrete evidence about model capabilities, safeguards, and remaining risks. In this role, you will: Help design assessments with external evaluators and internal teams: identify consequential safety claims to test, define the evidence and methods needed to assess them, and address gaps in coverage. Support the technical execution of third-party assessments and embedded audits focused on frontier risks, working with evaluators to translate research que

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. CVS Health's exciting and impactful Claims Adjudication Software Engineering & Transformation organization is seeking a Director to lead the Eligibility portfolio for the PBM business, including the modernization of eligibility processing from legacy on-premises systems to a cloud-based data platform and API layer that serves member demographic and coverage data to enterprise consumers. The Director leads a multi-team engineering organization covering platform and API engineering, client onboarding and data integration, legacy system operations, and quality assurance, and is accountable for delivery, production stability, and modernization across the portfolio. This role reports to the Executive Director, Adjudication Software Engineering & Transformation. Responsibilities Own strategy, delivery, architecture, and operational stability for the eligibility platform, APIs, client onboarding and data integration, and legacy eligibility systems. Lead the modernization of eligibility processing from legacy on-premises platforms to cloud-based data services, including migration of clients onto the modern platform and retirement of legacy components. Own release management, deployment safety practices, and incident response for production-critical services, including postmortems and correc

This role is responsible for leading the company's insurance activities, ensuring comprehensive coverage for the group’s assets, new acquisitions, and projects. This role includes overseeing the insurance renewal process, preparing detailed Request for Proposals (RFPs), handling claims, managing relationships with local insurers and reinsurers, and ensuring compliance with insurance policies. Source: Adani Group | Job ID: 60009

Opportunity Overview: We're seeking a Director, Solutions Architecture to lead our team of Solution Architects within Cohere Health's PaaS Delivery organization. In this player-coach role, you'll set the technical and business standard for how Cohere designs solutions for complex healthcare clients running large, mission-critical platforms like claims systems and utilization management infrastructure. You'll partner closely with Solution Owners, Forward Deployed Engineers, Technical Program Managers, Platform Configuration, and QA to keep solution design in sync with delivery. This is a remote-first role that may require travel to Boston, MA for new hire onboarding and occasional in-person team meetings and company events. What you’ll do: Manage a team of 8 Solution Architects — hiring, coaching, performance management, and career development Set the standard for solution design quality across the team: how SAs guide clients to existing functionality, document the BRD/FRD, and design future-state workflows Foster a culture of engaging with customers where they are — saying yes where we can, and pushing back constructively when we can't Own escalations when a solution design is contested, technically infeasible, or in tension with a commercial commitment Balance workload and account assignments across the team as new implementations continue to ramp up Partner with Solution Owners, FDEs, Platform Configuration, QA, and TPMs across the Delivery org to keep solution design in sync with delivery timelines Represent Solution Architecture in cross-functional planning and with client executive stakeholders on complex or escalated accounts Build repeatable training materials, templates, and playbooks so solution quality doesn't depend on any one architect What you’ll need: 12+ years in solution architecture, technical consulting, or similar client-facing technical roles, including significant healthcare experience 3+ years directly managing a technical team — solution

About the Team OpenAI Presence, part of Enterprise Engineering, builds a platform for reliable AI agents that carry out high-volume business workflows. We focus on specific use cases such as customer support, sales, and insurance claims, helping organizations put agents to work in production. The Presence platform supports the agent development lifecycle, including evaluation, deployment, and improvement through real interactions. It connects agents to company systems and supports voice and chat experiences, with policies, guardrails, and human handoffs to help businesses stay in control. Read the launch announcement . About the Role We’re looking for an engineer to help shape the foundations of Presence and build the systems that make AI agents dependable in everyday business operations. You’ll help set the platform’s technical direction while staying close to the code, taking architecture from early decisions through to systems that perform reliably at scale. You’ll bring deep backend expertise and the product judgment to connect what we build with how businesses use it. The work centers on the services that power Presence and extends across the stack—giving you scope to shape both the underlying systems and the experiences they enable. In this role, you will: Provide hands-on technical leadership, guiding architectural decisions and implementation across the Presence platform. Design and build backend systems for reliable, high-volume agent workflows in support, sales, and other enterprise use cases. Develop platform capabilities that support agent development and learning from real-world use. Identify and address reliability bottlenecks as agent workflows become more complex and usage grows. Work across backend infrastructure and product experiences as needed, collaborating with other engineers to turn evolving requirements into working software. Your background might look something like: 9+ years of professional engineering experience, excluding internships, in

Location: Hong Kong | Practice Area: Insurance | Type: Permanent Lead transformation at the heart of insurance – shaping better operations, stronger customer outcomes, and sustainable business performance. The Role As an Insurance Managing Principal at Capco, you will play a senior leadership role in growing and delivering our Insurance practice in Hong Kong, with a particular focus on insurance operations transformation across claims and underwriting. You will work closely with senior client stakeholders to shape and deliver complex transformation programmes that improve operational effectiveness, customer outcomes and business performance. Bringing deep insurance expertise and consulting experience, you will connect strategy with execution, helping clients rethink operating models, processes and capabilities across the insurance value chain. Alongside client delivery, you will contribute to the continued growth of Capco’s Insurance business by developing trusted client relationships, identifying opportunities and supporting the development of our people and propositions. What You’ll Do Lead complex insurance operations transformation engagements, with particular focus on claims, underwriting and end-to-end operational improvement. Partner with senior insurance executives to define transformation strategies, target operating models, business cases and implementation roadmaps. Shape and deliver programmes that simplify processes, improve customer and employee experiences, strengthen controls and enhance operational performance. Build trusted senior client relationships, identify emerging business challenges and develop opportunities that contribute to the growth of Capco’s Insurance practice. Provide leadership across multidisciplinary teams, supporting colleagues through coaching, knowledge sharing and high-quality delivery. What We’re Looking For Significant experience within insurance consulting, transformation or senior insurance operations roles, with st