Claims Advocate Jobs

About Anthropic Anthropic’s mission is to create reliable, interpretable, and steerable AI systems. We want AI to be safe and beneficial for our users and for society as a whole. Our team is a quickly growing group of committed researchers, engineers, policy experts, and business leaders working together to build beneficial AI systems. About the role Anthropic's Business Risk & Insurance (BRI) team, part of Treasury, safeguards the company's balance sheet, people and physical assets. We are the financial and operational safety net for a company building some of the world's most advanced AI systems, from large-scale compute and data center infrastructure to our offices and the products we put in customers' hands. The team is scaling quickly as Anthropic grows. As a Risk & Insurance Specialist, you'll build operational excellence across contracts, claims, and day-to-day insurance operations, using AI and automation to streamline processes wherever you can. You'll work closely with Compute, Engineering, Finance, Legal, Security, Product and Payroll to spot emerging risks early, help structure global insurance programs, support our risk-financing strategy and drive loss prevention. This is a rare chance to insure one of the fastest-growing companies, where parts of the risk landscape are still being defined, and to help Anthropic pursue its mission boldly by keeping our operations resilient and protected. Key responsibilities Insurance review of contracts: Review insurance and indemnity requirements in customer, vendor, lease, and compute agreements, and advise Legal and business partners on compliant, practical positions. Insurance operations: Manage claims intake and tracking, certificates of insurance, broker coordination, and policy administration. Build a data warehouse / repository and repeatable processes as volume scales. Data gathering and reporting: Collect and maintain exposure data (property values, payroll, revenue, headcount, etc.) for renewals, au

Become a part of our caring community The Senior Risk Management Professional identifies and analyzes active and potential sources of loss to analyze, estimate, and minimize risk. The Senior Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Risk Management Professional estimates the potential consequences of an occurring loss, develops and implements controls and cost-effective approaches to minimize the organization's risks, assesses and communicates information regarding business risks with functions across the organization. Begins to influence department’s strategy and makes decisions on moderately complex to complex issues regarding technical approach for project components. Work is performed without direction, and considerable latitude is used in determining objectives and approaches to assignments. In this role, you will use your experience to partner with business owners to support compliance within the Humana Pharmacy Solutions organization. You will work with Risk Operations, Humana Pharmacy Solutions, Humana Enterprise, and vendor teams to identify, track, resolve, and report out on compliance issues and risks identified in the Humana Pharmacy Operations space. Success in this role requires experience in compliance, risk management, or internal audit, and/or significant experience in pharmacy claims operations, including risk identification, issue remediation tracking, monitoring, audit support, and compliance reporting. The Senior Risk Management Professional will: Design, implement, and perform targeted monitoring to identify risks, promote consistency, and support remediation of issues within the Pharmacy space. Support audit and readiness activities through identif

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 Sr. Manager, Medical Policy Quality Assurance (QA) & Rework Remediation is responsible for managing the day-to-day operations of the Medical Policy quality assurance and remediation program. This role oversees quality reviews, issue intake, defect investigation, root cause analysis, corrective action implementation, remediation tracking, and closure validation activities to ensure the accuracy and integrity of Medical Policy implementation and policy coding. The Manager works collaboratively with Medical Policy, Clinical Operations, Configuration, Claims, Payment Integrity, Informatics, Compliance, Appeals, and Operational business partners to identify, investigate, remediate, and monitor policy-related defects and quality concerns. The role is accountable for maintaining audit-ready documentation, supporting governance processes, monitoring defect trends, and ensuring remediation activities are completed timely and effectively. This position serves as the operational leader responsible for executing the Medical Policy QA and remediation workflow and ensuring identified issues are addressed through sustainable corrective and preventive actions. Quality Assurance Management Manage the day-to-day execution of Medical Policy quality assurance activities. Oversee ongoing reviews of policy coding, implementation accuracy, operational w

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 Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. - Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. - Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. - Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management and eligibility. - Assessments include the member’s level of work capacity and related restrictions/limitations. <

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. Remote RN Case Manager 100% Remote | Nationwide Opportunity | Monday–Friday Schedule Are you a Registered Nurse passionate about helping members navigate complex healthcare needs? Join our Case Management team and make a meaningful impact by guiding members toward better health outcomes through personalized care planning, advocacy, and coordination. What You'll Do Conduct telephonic assessments to evaluate members' medical, behavioral, and social needs Develop individualized care plans that support improved health outcomes and overall wellness Identify barriers to care and implement strategies to reduce risk and improve member engagement Coordinate care across providers, programs, and community resources Review clinical information, claims history, and benefit eligibility to support appropriate interventions Utilize motivational interviewing and clinical judgment to engage members and support goal achievement Collaborate with multidisciplinary teams to address complex cases and facilitate optimal outcomes Ensure compliance with regulatory requirements and company case management standards WHAT YOU BRING - REQUIRED Active, unrestricted RN licens

Become a part of our caring community The Senior Data & Reporting Professional supports the Michigan Integrated Long-Term Services and Supports (MI LTSS) program through advanced analytics, operational reporting, performance monitoring, regulatory compliance reporting, and strategic data management. You will transform complex clinical, operational, quality, and financial data into actionable insights that support program oversight, state contract compliance, quality improvement initiatives, and executive decision-making. Your work assignments involve moderately complex to complex issues where analysis of situations or data requires an in-depth evaluation of variable factors. You will work independently, exercises considerable latitude in determining objectives and approaches to assignments, and begin to influence departmental strategy. The Senior Data & Reporting Professional partners closely with LTSS Care Management, Utilization Management, Quality, Finance, Compliance, Provider Operations, and Market Leadership to monitor program performance, identify operational opportunities, and support achievement of LTSS program requirements. Develop and maintain operational, clinical, quality, compliance, and executive dashboards supporting the MI LTSS program. Integrate and validate data from multiple systems, including care management platforms, quality monitoring tools, provider networks, claims data, assessment systems, and regulatory reporting sources. Create recurring and ad hoc reports supporting operational performance, regulatory compliance, quality improvement initiatives, and strategic program planning. Monitor LTSS performance indicators including Health Risk Assessments, InterRAI assessments, Nursing Facility Level of Care Determination (NFLOCD) completion, Person-Centered Service Plans, Integrated Care Team (ICT) participation,

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 CVS Health has a powerful purpose – “Bringing our heart to every moment of your health.” To enable this purpose, we have several initiatives, existing and new, that are re-inventing pharmacy and enabling better health outcomes. In the Merchandising Organization, we support our company’s purpose and our Pharmacy and Consumer Wellness vision to be America’s most trusted health, wellness, and pharmacy care partner, delivering differentiated omnichannel experiences and meeting consumers where they are. As the Senior Analyst, Category Promo & Coupon Planning & Execution, you will use your interpersonal skills to build strong relationships with partners to influence and execute strategies that positively impact the company. As an Associate Manager you will partner with your leader to execute and report on the promotional strategies for our divisional merchandising teams, partnering closely with other leaders in Category Promo & Coupon Planning & Execution and Promotion Optimization. You will impact our business in the following ways: Support your leader in participating in the building and execution of category-level bi-weekly promotional plans deliver on event criteria, themes/claims, or strategically pre-defined category promo KPIs, as established based on the impact promotion has for that category relative to other categories. Pa

CLEAR is building THE secure identity company of the future. Our mission is to make experiences safer and easier—physically and digitally. With more than 43 million Members and a growing network of partners across the world, CLEAR's secure identity platform is transforming the way people live, work, and travel. Whether it’s at the airport, stadium, or throughout your everyday life, CLEAR unlocks the magic of frictionless experiences. The Employee Relations Lead serves as the centralized employee relations (ER) partner for our Airport Operations team. In this role, you're the consistent thread ensuring employee relations issues are handled the same way, every time, no matter where they happen. You're the person leaders lean on to make good calls, and the person team members know is invested in their success. This role puts you in the middle of it all - maintaining oversight across the entire fleet while coaching station leaders, resolving employee relations issues with consistency and fairness across the field, and building an exceptional team member experience that helps CLEAR thrive. What you'll do: Own employee and labor relations across your stations: run investigations, dig into root causes, and land on outcomes that are fair, defensible, and consistent, working closely with Legal along the way. Lead timely, thorough, and objective workplace investigations involving employee complaints, misconduct, policy violations, and other employee relations matters. Coach and advise leaders on corrective action, conflict resolution, policy interpretation, and consistent employment practices, so issues are addressed early and handled appropriately and consistently. Manage and ensure consistency in workers’ compensation, leave of absence (LOA), and accommodation cases, including reviewing claims and requests, with our Leave Administrators, Legal, and ensuring decisions align with company policy and applicable laws (e.g., FMLA, ADA, state and local leave laws). Support

POSITION SUMMARY: Join Natera as the Director of Development for our Early Cancer Detection (ECD) In Vitro Diagnostic (IVD) products. You will take ownership of the development, verification, and validation of our early cancer detection (ECD) Next Generation Sequencing products from feasibility exit through regulatory submission and post-market support. Every test represents a real person, and you will lead a team of scientists and managers to execute the performance data packages supporting PMA submissions. You will serve as the technical subject matter expert in FDA interactions, partnering across functions to deliver design-controlled diagnostic products that directly impact patient care. PRIMARY RESPONSIBILITIES: Own the execution of the technical strategy and phase-gated process of of development, design verification, and validation studies for ECD IVD devices utilizing cfDNA, methylation and other potential analytes Ensure rigorous compliance with applicable FDA Class III (PMA) design and development requirements Take ownership of the analytical performance strategy (limit of blank/detection, precision, linearity, interference, stability) for ECD assays, partnering directly with Regulatory Affairs (RA), biostatistics, bioinformatics and research teams Contribute to the robust transfer of assays to the commercial laboratory and manufacturing in support of the design transfer and operations teams Partner with clinical and biostatistics leaders on statistical analysis plans required for approvable device performance claims in clinical intended-use populations Think team by partnering directly across bioinformatics, biostatistics, software engineering, clinical, regulatory, and commercial functions to align development efforts with business goals, and drive resourcing and go/no-go recommendations at phase gates Deliver the analytical performance data package supporting Class III PMA submissions, developing a comprehensive approval strategy with RA Serve as t

POSITION SUMMARY: Join Natera as the Senior Director of Development for our Early Cancer Detection (ECD) and Multi-Cancer Early Detection (MCED) portfolio. You will take ownership of product development strategy and execution, guiding Next-Generation Sequencing (NGS) and cell-free DNA-based (cfDNA) In Vitro Diagnostic (IVD) products from feasibility through FDA Premarket Approval (PMA) and post-market support. Every test represents a real person, and you will build an organization of scientific contributors and managers to deliver robust clinical tools. You will establish priorities, allocate resources, and represent development with the FDA and executive leadership, ensuring that scientific rigor and data drive all regulatory and portfolio decisions. PRIMARY RESPONSIBILITIES: Define and own the multi-year assay development strategy and technical lifecycle for the ECD and MCED portfolio, in alignment with corporate and R&D strategy Take accountability for the phase-gated execution of all ECD and MCED programs, overseeing the development, design verification, and validation of NGS-based cancer detection IVD devices using cfDNA, methylation and other analyte classes. Set team priorities, allocate people, budget, and laboratory resources, and make or recommend go/no-go decisions to executive leadership Establish the analytical verification and validation strategy for the portfolio to ensure robust assays transfer seamlessly to commercial manufacturing Partner with clinical, medical, and biostatistics leaders to support approvable pivotal and prospective study design, statistical analysis plans, and performance claims for screening-population use in both the ECD and MCED intended-use claims Define regulatory pathways and evidence requirements for PMA submissions for ECD and MCED in an evolving regulatory landscape. Be facile in representing the Development approach and activities in senior-level engagement with the FDA (e.g., pre-submission meetings and advisory pan

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 Would you like to join CVS Health, a Fortune 5 company, on our multifaceted Pharmacy Benefits Management (PBM) Underwriting team? In this high-level individual contributor role, you will utilize your business, industry, competitive, client, and technical knowledge to formulate pricing strategy and to execute financial modeling of comprehensive pricing offers that include retail network, mail order, specialty, and pharmaceutical manufacturer rebates for PBM client contracts. Additional responsibilities to include but not limited to the following: Model and develop Truecost pricing proposals for Health Plan Clients Collaborating with PBM Sales and Account Services to provide recommendations on pricing and negotiation strategy to achieve revenue and profitability targets for new business growth and margin retention; and Applying advanced Excel modeling techniques to analyze large sets of pharmacy claims data and build forward looking financial forecasts and profit and loss (P&L) statements; and Presenting financial analyses to Executive Leadership during Executive Underwriting Approval Calls and responding to financial questions in real-time; and Supporting Underwriting Managers and Sr. Managers with ad-hoc financial analyses

Titan Security is built on serving our clients and building careers – just like yours. We are trusted by some of the most well-known companies and properties in the country while remaining dedicated to building personalized security solutions that solve the needs of every customer we support. Named as a nationally recognized Top Workplace in 2024 and 2025 by USA Today, Titan's customized approach to security services will provide you with the opportunity to learn, grow and succeed. Our core values of being Unified, Transparent, Innovative, Committed and Accountable help us in providing unparalleled service and support in all that we do. If you are looking for a meaningful career, a culture of excellence, and the ability to make a difference, we want to talk to you! Titan Security is currently hiring a Security Account Manager to work at a location in Burns Harbor, Indiana. The Security Account Manager reports to the Director of Operations and is primarily responsible for supervising the day-to-day security operations of assigned Client sites. Responsibilities of the Security Manager include but are no limited to: Manage a team of Security Officers, Site and Shift Supervisors including hiring/selection, scheduling, payroll, training, coaching, development and support. Ensure the client site is provided with high quality security services to protect people and property. Build, improve and maintain effective relationships with both client and employees. Coordinate necessary support services to effectively manage client site to meet or exceed financial and operational goals and provide quality customer service. Handle any escalated security issues or emergency situations appropriately. Conduct annual reviews for on site staff. Monitors the quality of staff performance including coordinating and conducting exit interviews, assisting with unemployment claims review of disciplinary actions, recommendations for suspension or termination as well as ensuring a re

About Inspira Education Inspira Education Group is one of the fastest-growing edtech startups in the US. We started with a simple mission to democratize access to high-quality coaching so that every student in the world has an equal opportunity to access the best opportunities. As the world’s leading network of top admissions coaches in medical, legal, business, and college studies, we’re building software and services in one place—disrupting long-entrenched application processes with products and experiences that strive to provide an equal platform for candidates from diverse backgrounds worldwide. As one of the fastest-growing edtech firms in the world, we are backed by some of the leading venture capital firms and investors in the world, including Zeev Ventures, Quiet Capital, Craft Ventures and Jeff Fluhr (Founder of Stubhub). The Role We’re looking for a Junior Content Editor to help keep everything we publish accurate, clear, and polished. You’ll work alongside our senior editors, SEO team, writers, and subject-matter experts to take drafts from rough to publish-ready across our blogs, guides, and marketing content. This is a great fit if you have a sharp eye for detail, love making sentences better, and want to grow into a more strategic editorial role. You’ll learn how content gets found and cited by search engines and AI tools, and you’ll build real skills in editorial process, style, and feedback. Please note: This role is open to candidates based remotely in Canada. What You’ll Do Edit for quality Catch spelling, grammar, factual, and formatting errors before content goes live. Rewrite passive constructions into active voice and replace jargon with plain language. Tighten wordy sentences without losing the point. Check that headings are logical and accurately reflect the content beneath them. Verify stats, claims, and quotes against primary sources, and flag anything unverified. Apply our style guide Apply Inspira’s house style consistently ac

Trade Surveillance Analysts Location: Glasgow (Hybrid) | Practice Area: Finance, Risk, Regulatory & Financial Crime | Type: 3 x Permanent and 2 x 12 month FTC Play a key role in delivering critical Corporate Actions operations that support global financial markets. The Role We're looking for a Analyst to join our Finance, Risk, Regulatory & Financial Crime practice, supporting a leading global financial institution within Trade Surveillance. You'll work within a fast-paced environment where attention to detail, collaboration, and continuous improvement are key to delivering operational excellence. What You'll Do Manage the end-to-end processing of corporate action income events across equity and fixed income products, ensuring accuracy throughout the event lifecycle. Review and reconcile payables, receivables, ex-date, record date and payment date activity while investigating and resolving outstanding claims. Partner with traders, counterparties and internal stakeholders to resolve exceptions, identify P&L impacts and support operational delivery. Identify opportunities to improve controls, enhance processes and contribute to change initiatives alongside project teams. Support mandatory corporate action events and tax reclaim activities while escalating risks or issues where appropriate. What We're Looking For Good understanding of financial markets and products Strong financial background in finance or economics Ability to manage multiple priorities, meet tight deadlines and maintain exceptional attention to detail in a dynamic environment. Strong communication skills with experience building effective relationships across trading desks, operations, counterparties and clients. Good working knowledge of Microsoft Office applications and an understanding of regulatory and operational controls, including CASS. Bonus Points For Experience using Easyway, Gloss or Broadridge BPS. Knowledge of Repo and Securities Lending activities. Experience sup

Celonis is the trusted platform to industrialize Enterprise AI. At our core is the Celonis Context Model — which combines process data, business knowledge, and intelligence into a living digital twin of the enterprise that AI can actually understand, turning AI's operational blind spots into operational clarity. World's leading companies trust Celonis and its global ecosystem of partners to make their AI agents, people, systems, and processes work together, achieving transformational outcomes. We believe there's a massive opportunity to unlock global productivity and sustainability by giving AI the context to understand how every business process really works. Join our mission to make processes work for people, companies, and the planet. The Team: Value Engineering is responsible for our largest Fortune 500 customers and owns their transformation journey by working on the very frontier of what’s possible with data and AI on the Celons Platform. Partnering closely with the Sales team, Value Engineering is responsible for ensuring that the Celonis Platform is deployed to tackle the most strategic business challenges, fits into the right place in our customers’ technology stack and most importantly generates strong ROI through deep and broad deployments. The Role: As a Senior Value Engineer, you will spearhead AI and data-driven business transformation within the Insurance sector by contributing to your customer’s end-to-end value journey using the Celonis Context Model. Working alongside Lead and Principal VEs, you will combine technical execution with consulting and project management. As an AI-fluent operator, your core mandate is to orchestrate complex roadmaps and execute targeted transformation initiatives that improve how these businesses operate across their Operations & Claims Management ecosystems. The work you’ll do: Value Selling & Realization: Uncover the real issues by peeling back layers of organizational complexity. Own the Outcome from first di