Claims Advocate 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

ABOUT US Nestem Technologies is ISO 9001:2008 Certified and Govt Registered Leading Healthcare BPO Service Provider. Medical Coding and Billing Job offered For US Healthcare BPO. MEDICAL BILLING Medical Billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government sponsored programs Self Supportive Training will be provided for Freshers with Placement. BILLING INDUSTRY Employment is expected to grow faster than average. Job prospects is very good; persons with a strong background in medical billing and coding will be particularly high demand. PLACEMENTS & PAY DETAILS FOR TRAINED After successful completion of the Training job offer will be provided in Leading MNC's. Placements will be in Chennai. 9000/- to 12000/- PM initially with assured career growth (Excluding Special Allowances & Other Benefits). For further Information Call us on 979 1196 983 / 044-2481 4757.

ABOUT US Nestem Technologies is ISO 9001:2008 Certified and Govt Registered Leading Healthcare BPO Service Provider. Medical Coding and Billing Job offered For US Healthcare BPO. MEDICAL BILLING Medical Billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government sponsored programs Self Supportive Training will be provided for Freshers with Placement. PLACEMENTS & PAY DETAILS FOR TRAINED After successful completion of the Training job offer will be provided in Leading MNC's. Placements will be in Chennai. 9500/- to 12000/- PM initially with assured career growth (Excluding Special Allowances & Other Benefits). For further Information Call us on 9791196983

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

Workers Compensation Manager Company: The Boeing Company The Boeing Company is seeking a Workers Compensation Manager to lead the Workers’ Compensation Administration group located in Seattle, WA or Mesa, AZ . This manager will provide strategic direction, oversight, and continuous improvement for the company’s workers compensation claims programs, ensuring compliance, operational excellence, and alignment with enterprise objectives. Reporting to the Director Compensation and Benefits Delivery, this role will manage a team of professionals and collaborate across functions to drive program success. Position Responsibilities: Strategic Leadership and Program Management Develop, implement, and refine the workers compensation strategy, policies, and procedures to ensure regulatory compliance and achievement of program goals Lead the Workers’ Compensation Administration team, setting clear objectives, coaching, and developing staff to maximize performance and engagement Oversee financial and operational performance, including claims costs, lost time injury metrics, and program budgets. Provide regular analysis and insights to senior leadership Cross-Functional Collaboration Partner with Corporate Risk Management, Environmental Health and Safety, HR Services, Finance, Operations, and external agencies to integrate workers compensation initiatives and optimize claim management processes Represent Boeing in interactions with the Washington Department of Labor and Industries and other regulatory bodies Vendor and Claims Oversight Direct management of sensitive claims, including approval of reserve changes and settlements within delegated authority <li

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 Specialty Pharmacy has an opportunity available for a full-time Medical Billing & Accounts Receivable Representative. As a Medical Billing & Accounts Receivable Representative, you will ensure timely and accurate billing and follow-up for outstanding claims while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. As part of the billing and reimbursement team, you will work in a fast paced and team focused environment to ensure timely and accurate billing to insurance providers. We will support you by offering all the tools and resources you need to be successful in a collaborative team based environment. The key responsibilities of the Medical Billing & Accounts Receivable Representative are: Creating and submitting medical claims to insurance companies within timely filing and ensuring accuracy within payer guidelines and preferred bill methods (i.e., 837, website, spreadsheets, and CMS-1500). Validating coverage and eligibility prior to claim billing. Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors. Maintaining supporting and chronological notes that detail action taken to resolve billing edits. Maintain updated information within the necessary AR/CVS

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&#43; 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 Inspects and provides accurate claim information to support savings optimization for claims. Responds to customers on benefit inquiries. Maintains customer service standards. Administers policies and procedures for medical cost management. Coordinates support functions for claim adjudication. Required Qualifications Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers. Follows area protocols, standards, and policies to provide effective and timely support. Reviews provider billing practices to identify trends and cost savings opportunities. Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors. Tests automated code review programs. Takes direction to execute techniques, processes, and responsibilities Preferred Qualifications Working knowledge of problem solving and decision making skills 5&#43; years work experience Education High school diploma or equivalent required. Anticipated Weekly Hours 40 </p

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

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. What you will do: Client Support Perform and support plan changes. Perform ID card facilitation. Complete any necessary reporting (scheduled, ad-hoc). Conduct inbound phone calls. Complete any assigned invoices. Perform any assigned group terminations. Complete documentation requests. Serve as a presence throughout the implementation process. Facilitate and participate in external-facing meetings. Member Support Perform overrides as needed. Oversee prior authorization and accessibility processes. Conduct inbound phone calls. Oversee resolution of claims issues. Perform manual eligibility adds and terminations. Service warranties as assigned. Required Qualifications 5&#43; years of experience in a pharmacy, PBM ( Pharmacy Benefit Management ), and/or insurance setting. Ability to travel up to 25% of time within the continental United States. Preferred Qualifications </