Claims Advocate Jobs

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 Leadership and Team Management: Provide leadership to critical aspects of billing operations while managing smaller teams responsible for day-to-day operations. Team Development: Develop a team focused on managing electronic eligibility responses, timely billing of claims, accurate payment posting, and utilizing an optimized insurance follow up process. Process Documentation: Create process documentation providing clear communication to ensure efficient, accurate, and compliant billing workflows. Cross-Functional Collaboration: Work alongside other business leadership to provide consistent billing guidance and improve the clean claim rate Required Qualifications Candidates will need to have a minimum of 5-7 years of professional experience in healthcare management leading a team of individual contributors. Experience in oversight of projects and processes that require complex resolution within both short and long term timelines. Experience working with legal and compliance partners in support of maintaining proper billing and coding guidelines. Baseline discipline experience as a business analyst, report writer, project manager or similar role. Monitor KPIs and report on variances, risks and improvement process opportunities Preferred Qualifications Epic Professional Billing (P

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

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 is seeking a Senior Manager, Software Engineering to lead, grow, and develop high-performing engineering teams that design, build, and modernize mission-critical systems for our Claims Adjudication and Pharmacy Benefit Management (PBM) organization. This is a people-and-delivery leadership role, accountable for team performance, delivery execution, and engineering excellence. You will own technical direction for teams building scalable, reliable, cloud-native software while continuing to integrate with legacy platforms such as IBMi/AS400 and PBM adjudication systems like RxClaim. In this role, you will advance CVS Health's transition toward modern, AI-driven, cloud-native, microservices-based platforms and open-source engineering practices — championing strong CI/CD, sound architecture, and the responsible adoption of AI and GenAI developer tools (such as GitHub Copilot) that accelerate delivery without eroding engineering fundamentals. You will partner with senior leadership, product, and architecture to translate strategy into roadmaps and dependable execution, leading engineers, engineering leads, and cross-functional partners across software, AI, and quality engineering. This role requires a strong balance of people leadership, delivery execution, technical credibility in Java/Spring and microservices architecture, cloud modernization, and cross-fun

Be at the forefront of innovation with NVIDIA! Our CUDA Libraries & Frameworks Product Marketing Manager role offers an outstanding opportunity to build the future of accelerated computing. This is your chance to join an elite team in Santa Clara, where your contributions will have a lasting impact on technology and society! We are looking for a technical, AI-first CUDA Product Marketing Manager. This is a hands-on PMM role for someone who uses AI coding agents and automation as part of daily execution, not as an occasional productivity aid. Come help craft the story for CUDA, core NVIDIA acceleration libraries like cuDNN, NCCL, NIXL, and AI frameworks like PyTorch, JAX, vLLM, and SGLang. What you'll be doing: Own positioning and messaging for CUDA as a developer platform, including the CUDA programming model, compilers, and core libraries. Make technical capabilities clear, credible, and useful for developers and technical decision-makers. Translate technical features for core libraries such as cuDNN, NCCL, CUTLASS, and TensorRT-LLM into data-driven developer narratives, release messages, proof points, ecosystem informed claims, and field-ready assets. Describe how NVIDIA speeds up AI frameworks and runtimes such as PyTorch, JAX, vLLM, and SGLang, linking low-level platform features to benefits for developers. Use AI coding agents daily to build PMM operating systems: competitive-intelligence agents, automated research pipelines, content auditing, reporting, and partner mapping. Turn documentation, performance benchmarks, GitHub issues, customer signals, and roadmap updates, into messaging assets. Lead go-to-market execution for CUDA launches and core library releases. What we need to see: Bachelor's degree in Computer Science or relevant field (or equivalent experience).

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

Ice Miller is seeking a business litigation associate with 3-6 years of experience to join our Litigation team. The ideal candidate will have experience with sophisticated business disputes involving corporate governance, ownership, fiduciary duties, and transactions. Relevant experience may include disputes arising from mergers, acquisitions, and other corporate transactions, including matters involving purchase agreements, earn-outs, indemnification claims, post-closing adjustments, representations and warranties, valuation issues, or related post-transaction claims. Familiarity with Delaware corporate law or Delaware courts is preferred, but this position can be located in any of the listed offices. In this position, you will: Manage complex matters through all phases of litigation or arbitration, including case strategy, factual development, discovery, motion practice, settlement, and hearing or trial preparation Draft pleadings, briefs, dispositive motions, and other substantive filings Analyze corporate governance documents, transaction agreements, financial records, and other business materials to identify key factual, legal, and damages issues Lead written and fact discovery, coordinate document review and production, prepare witnesses, and take and defend depositions Work directly with clients, financial professionals, and experts to understand business objectives, assess risk, and translate complex corporate and financial issues into practical litigation strategies Prepare for and support trials and arbitrations, including developing exhibits, coordinating witnesses, drafting pre- and post-hearing submissions, and assisting with courtroom or hearing strategy Evaluate corporate transaction documents and develop strategies for disputes involving purchase agreements, earn-outs, indemnification claims, post-closing adjustments, representations and warranties, and related post-transaction matters Requirements: 3-6 years of commercial or business litigation expe

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

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. Job Profile Summary Leads automation and AI transformation strategy across the Payment Integrity, Revenue Integrity, and Grievances and Appeals COEs. Builds and manages a team to ideate, prioritize, and oversee delivery of automation and agentic AI initiatives that improve claims accuracy, recovery, and appeals outcomes. Partners with COE and business leadership to align automation roadmaps to enterprise priorities, governance standards, and measurable business impact. Job Description A Brief Overview Leads a team to drive automation and AI-enabled transformation across Payment Integrity, Revenue Integrity, and Grievances and Appeals. Sets strategic direction for how automation and intelligent workflow opportunities are identified and scaled across these COEs, and ensures successful, on-time delivery through strong program oversight. Balances delivery accountability with team development, ensuring the group operates as a cohesive practice rather than three disconnected initiatives. What you will do Leads and develops a team, setting priorities, allocating capacity across COEs, and holding the team accountable to delivery and quality standards. Sets the automation transformation strategy for Payment Integrity, Revenue Integrity, and Grievances and Appeals in partnership with COE leadership. <

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 Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

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 Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

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. A Brief Overview Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp