Claims Specialist Jobs

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

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

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 Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. Lyft is looking to add a Claims Operations Specialists to its growing Risk Team. The Operations Specialist position is an integral role assisting with the processing of claims and responding to inquiries to expedite the handling of claims. The focus of these roles will be cross-functional collaboration and enhanced customer communication focused on the best claims experience for our users. You’ll balance day-to-day responsibilities between independent claims processing and working with our cross-functional teams with a focus on customer obsession and operational excellence. Responsibilities: Create initial loss reports and assist with overall processes for Lyft Healthcare, as well as Lyft Bikes and Scooters Respond and assist with customer inquiries relating to claims Requests additional information, where necessary, for completion of claim processing Manages and coordinates next steps for Accidents; including missing claim searches, adjuster contacts, and enhanced customer experience Coordinate with cross functional teams regarding claims processes, system updates, and customer experience Gathers investigative material and general support to assist adjusters and internal claims teams Develops and delivers effective written and oral communications/reports to management Supports various Risk, Safety, Bikes & Scooters, Express Drive, Legal, Lyft Rentals, and Finance Teams regarding all aspects of insurance claims Supports and facilitates a team environment of continuous feedback and idea sharing with all team members and stakeholders Assist with special projects, including and not limited to auditing and data reconciliation Seeks out opportunities to gain broader insurance knowledge and cross-training Experience: 2+ years experience handling and solving customer support issues - ideally in a

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

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

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

Work Flexibility: Remote Staff Regulatory Affairs Specialist, Mako and Enabling Technologies (Remote) Join Stryker’s Ortho Tech Business and support a portfolio that spans robotics, navigation, imaging, software, and capital equipment technologies. In this role, you will provide regulatory leadership throughout the product lifecycle, partnering with cross-functional teams to support global product development, regulatory submissions, market access, and ongoing regulatory compliance across U.S. and international markets. Work Flexibility: This is a remote position, with a preference for candidates located in the U.S. Eastern Time Zone What You Will Do Develop and execute global regulatory strategies for new products, product changes, and lifecycle management activities. Participate in product development teams to ensure U.S., European, and international regulatory requirements are incorporated throughout all development phases. Evaluate product classifications, regulatory pathways, and jurisdictional requirements for medical devices and related technologies. Author and submit regulatory filings, including FDA submissions, international registrations, and supporting documentation required for product approvals. Review quality, preclinical, and clinical documentation to ensure submission readiness and regulatory compliance. Partner with global regulatory affiliates to support registrations, market expansions, and post-market regulatory activities. Lead interactions with regulatory authorities and notified bodies, including preparation of responses, submissions, and agency communications. Review product labeling, marketing materials, and product claims for compliance with applicable regulatory requirements and mentor junior regulatory team members on regulatory

At ClickUp, we're building the future of work: the first truly converged AI workspace unifying tasks, docs, chat, calendar, and enterprise search, all supercharged by context-driven AI. We are an AI-native company. Every team member is expected to leverage AI daily, and we evaluate AI fluency as part of our hiring process. Join us and help redefine what's possible. 🚀 ClickUp is looking for a Senior Partner Sales Support Specialist based in the Philippines. This role is a critical enablement function supporting our Enterprise Partner Managers worldwide. You’ll be the operational backbone that keeps our partner sales motion running smoothly, helping Enterprise Partner Managers close deals faster by handling sales support activities across all regions. This is a high-impact, globally-scoped role that sits at the intersection of partner operations, sales enablement, and deal support. The candidate will be customer and partner-facing (on Zoom). The role: Provide day-to-day partner support to Enterprise Partner Managers across all regions (AMER, EMEA, APAC, LATAM), including deal registration processing, pipeline management, and opportunity tracking. Own and process smaller partner-sourced deals end-to-end, managing them through internal systems to ensure fast, accurate closure. Manage internal system administration (Salesforce, deal desk, CPQ) to remove friction from the partner deal cycle, including quote generation, order processing, and approval routing. Coordinate and manage partner onboarding logistics, ensuring new partners are set up in systems, trained on tools, and equipped to transact effectively. Maintain partner CRM data hygiene, ensuring accurate pipeline inputs, deal stage progression, and timely reporting for leadership. Act as the internal point of contact for partner deal escalations, liaising with Deal Desk, Legal, Finance, and RevOps to unblock and accelerate closures. Process MDF (Market Development Fund) submissions, track claims, and ensure timely

Airbnb was born in 2007 when two hosts welcomed three guests to their San Francisco home, and has since grown to over 5 million hosts who have welcomed over 2 billion guest arrivals in almost every country across the globe. Every day, hosts offer unique stays and experiences that make it possible for guests to connect with communities in a more authentic way. The Community You Will Join: Global Operations: AirCover: Scaled Ops & Optimization is dedicated to building the world's most loyal travel community through exceptional service. Our vision is to design and deliver unmatched products and services so everyone can host and travel with confidence. Our objectives are to provide Aircover for Hosts, Guests and Travel Insurance. The Difference You Will Make: The Supervisor Aircover is directly accountable for the performance of their team of assigned specialists and for working to drive efficiency and quality, in collaboration with peers and cross-functional stakeholders, to achieve the objectives and strategic vision set by the Global Service Manager. Supervisors are responsible for the coaching and development of specialists on their team and for connecting our functional strategy into specific, meaningful goals and measurable results for the day-to-day work of their teams. The Claims team Lead will also work closely with Legal, Communications, Public Policy, Public Affairs, and other cross-functional teams to inform the policies, programs, and systems that improve the overall quality and performance of the department and support the Airbnb community. A Typical Day: Manage the day-to-day operations of your team through driving key performance indicators on a team and individual level (productivity, quality, operational health) whilst maintaining a superior level of team support and wellness. This includes: Volume/SLA management Supporting your team in the handling urgent escalated cases Manage the day-to-day operations of your team through

WHO WE ARE: Zinnia is the leading technology platform for accelerating life and annuities growth. With innovative enterprise solutions and data insights, Zinnia simplifies the experience of buying, selling, and administering insurance products. All of which enables more people to protect their financial futures. Our success is driven by a commitment to three core values: be bold, team up, deliver value – and that we do. Zinnia has over $180 billion in assets under administration, serves 100+ carrier clients, 2500 distributors and partners, and over 2 million policyholders. WHO YOU ARE: Accounts Payable Specialist is responsible for performing daily accounts payable activities including invoice processing, expense claims processing, payment runs & vendor account reconciliations. This is a new position and will take on interesting and challenging responsibilities as our organization grows. This position will report to Assistant Manager, Finance and work closely with India team. WHAT YOU’LL DO: • Processing of PO based invoices in Tally and matching them to correct GRN. • Processing of non-PO based invoices & ensuring that they are authorized in line with company policy and that they have the correct general ledger code, budget center, client / project details etc. for proper information gathering. • Process all invoices in a timely manner to ensure they are processed in line with supplier payment terms and reporting requirements. • Reconcile supplier statements and resolve any queries relating to the same. • Maintain invoice query log and resolve queries on a timely basis. • Process supplier payments using internet banking facility on a weekly basis. Reconcile and process invoices against the company credit card and ensure invoices are received for all payments made. • Process staff expenses on a weekly basis • Maintain complete documentation accurately, in accordance with company policy and accepted accounting practices. • Perform var

At Trustpilot, we're on an incredible journey. We're a profitable, high-growth FTSE-250 company with a big vision: to become the universal symbol of trust. We run the world's largest open customer review platform, and while we've come a long way, there's still so much exciting work to do. Come join us at the heart of trust! The Procurement & Accounts Payable (AP) Administrator bridges both areas, covering operational and administrative volume that sits below Business Partner and AP Specialist scope threshold. The role exists to free Procurement Business Partners for commercial, category, and vendor relationship work, while removing low-value administrative activity from AP. This is a junior, development-focused role, trained from scratch, with a clear progression path into either Procurement or AP. The Administrator does not negotiate contracts, manage supplier relationships commercially, or make approval decisions; those remain with the Business Partners and AP Manager, respectively. What you’ll be doing: Procurement support Triage Zip intake submissions, validating completeness, financial coding, and correct routing. Manage vendor onboarding administration, including document chasing, compliance checks, and record maintenance. Issue purchase orders and P-Cards for spend up to £25,000, escalating anything outside policy thresholds to the relevant Business Partner. Administer contracts, including filing, expiry tracking, and document control. Handle stakeholder enquiries and low-value administrative requests. Run routine operational reporting from Zip, covering PO coverage, open requests, and intake volumes, for the team, Finance, and FP&A. Accounts payable support Process invoices, matching against POs and delivery confirmations. Manage the AP inbox, triaging emails and resolving or escalating queries. Process employee expense claims in line with policy, and process credit card expenses. Support month-end activity, including statement reconciliations and ac

Claim Benefit Specialist — 52 Locations. Apply via Workday.

Claim Benefit Specialist — 51 Locations. Apply via Workday.

Entry Level Supply Chain Specialist Company: The Boeing Company The Boeing Company has a long tradition of aerospace leadership and innovation, and Boeing Global Services (BGS) continues this tradition today by delivering unparalleled aftermarket support and services for customers worldwide. Boeing Global Services (BGS) is seeking an Entry Level Supply Chain Management Specialist to join our team in Hazelwood, MO . Position Responsibilities: Assists in analyzing postproduction supply chain data to define reorder points and quantities. Enters, tracks, monitors and coordinates customer material and delivery requirements and customer orders. Processes material returned from customers. Assists in the analysis of supplier and/or customer data regarding products or services to include repair capabilities, capacity and performance. Processes documentation associated with repair items and warranty claims Basic Qualifications (Required Skills/Experience): 0 to 2 years of experience in finance, supply chain, project management, supplier management, or accounting 0 to 2 years of experience working with asset management, forecasting, order management, expediting, supply chain software systems, supply chain modeling & simulation tools, enterprise resource planning systems and/or sales & operations (S&OP) processes Experience with Microsoft Office Products like Outlook, PowerPoint, Excel, and Word Export Control Requirements: This position must meet export control compliance requirements. To meet export control compliance requirements, a “U.S. Person” as defined by 22 C.F.R. §120.15