Claims Specialist Jobs

XO Health believes healthcare is fixable. Become part of the community changing the face of the industry. XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone – from those who receive care, to those who deliver it, to those who pay for it. We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation. XO Health Product Manager, Claims - India (Remote) About the Role : XO Health believes healthcare is fixable. Become a part of the community changing the face of the industry. XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone, from those who receive care, to those who deliver it, to those who pay for it. We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation. XO Health is building its own claims processing platform to power a new generation of claims adjudication, pricing, and payment. The Product Manager for Claims will own the product vision and strategy for this build, translating complex claims operations, EDI, and payer requirements into a clear roadmap the technical team can execute against. This role sits at the intersection of the business and engineering. The Product Manager will partner closely with Claims Operations, EDI, Network, and Compliance stakeholders to understand real-world claims workflows, translate that knowledge into detailed, clear business requirements, and serve as the primary liaison between the business and the technical build team throughout design, development, testing, and launch. This position requires strong product management fundamentals, deep curiosity about claims and healthcare operations, and the judgment to set realistic timeline goals

Who We Are At Justworks, you’ll enjoy a welcoming and casual environment, great benefits, wellness program offerings, company retreats, and the ability to interact with and learn from leaders in the startup community. We work hard and care about our most prized asset - our people. We’re helping businesses get off the ground by enabling them to focus on running their business. We solve HR issues. We’re data-driven and never stop iterating. If you’d like to work in a supportive, entrepreneurial environment, are interested in building something meaningful and having fun while doing it, we’d love to hear from you. We're united by shared goals and shared motivations at Justworks. These are best summed up in our company values, which are reflected in our product and in our team. Our Values If this sounds like you, you’ll fit right in. Who You Are As a Senior Claims Manager of Workers Comp (WC), you will work collaboratively within Justworks’ Workers Compensation Team as well as cross-functionally with teams across Justworks including: Customer Success, Technology, Engineering & Product, Accounting, Business Intelligence, Onboarding, Legal, and Finance. You will carry your own caseload of complex and/or high exposure claims while providing day to day guidance and oversight to a small claims team. Operating within our PEO environment, you will serve as the first point of contact for escalations for the claims team, be a trusted resource for customer facing claim inquiries and a key contributor to process improvement initiatives. We’re helping businesses get off the ground by enabling them to focus on running their business. We’re data-driven and never stop iterating. If you’d like to work in a supportive, entrepreneurial environment, are interested in building something meaningful and having fun while doing it, we’d love to hear from you. Your Success Profile What You Will Work On Supervise and support a small claims team providing daily direction, workload

Who We Are At Justworks, you’ll enjoy a welcoming and casual environment, great benefits, wellness program offerings, company retreats, and the ability to interact with and learn from leaders in the startup community. We work hard and care about our most prized asset - our people. We’re helping businesses get off the ground by enabling them to focus on running their business. We solve HR issues. We’re data-driven and never stop iterating. If you’d like to work in a supportive, entrepreneurial environment, are interested in building something meaningful and having fun while doing it, we’d love to hear from you. We're united by shared goals and shared motivations at Justworks. These are best summed up in our company values, which are reflected in our product and in our team. Our Values If this sounds like you, you’ll fit right in. Who You Are As a Senior Claims Manager of Workers Compensation (WC), you will work collaboratively within Justworks’ Workers Compensation Team as well as cross-functionally with teams across Justworks including: Customer Success, Technology, Engineering & Product, Accounting, Business Intelligence, Onboarding, Legal, and Finance. You will carry your own caseload of complex and/or high exposure claims while providing day to day guidance and oversight to a small claims team. Operating within our PEO environment, you will serve as the first point of contact for escalations for the claims team, be a trusted resource for customer facing claim inquiries and a key contributor to process improvement initiatives. We’re helping businesses get off the ground by enabling them to focus on running their business. We’re data-driven and never stop iterating. If you’d like to work in a supportive, entrepreneurial environment, are interested in building something meaningful and having fun while doing it, we’d love to hear from you. Your Success Profile What You Will Work On Supervise and support a small claims team providing daily direction, w

Senior Manager, Software Development Engineering (Claims Adjudication) — TX - Richardson. Apply via Workday.

Senior Manager, Software Development Engineering (Claims Adjudication) — TX - Richardson. Apply via Workday.

At Lyft, our mission is to improve people's lives with the world's best transportation. To accomplish this, we start with our community by creating an open, inclusive, and diverse organization. About the Team The Risk Tech engineering organization is committed to tangibly reducing accident frequency, saving lives, and managing costs to enhance the safety and affordability of rides. Claim Management is a core financial function for Lyft. Each claim touches complex workflows, multiple stakeholders, sensitive data, financial reserves, regulatory processes, and significant financial liabilities. This role offers the opportunity to define a leading claims management system for the industry. Our vision is to establish a single, Unified Risk Platform where comprehensive claims workflows across all business lines are efficiently administered, communications are consolidated, and data is structured to facilitate data-driven insights and decisions.This enables cost-efficient claims operations, mitigates risks and expenses as Lyft scales, and ensures people receive assistance proactively and accurately. About the Role We are seeking a Senior Software Engineer to contribute to the technical direction, drive architectural decisions, and lead the development of a highly reliable, scalable, and intelligent Risk Management Information System that powers our insurance platform. You will collaborate with passionate colleagues from Engineering, Data Science, Product and Claim Operations to deliver end-to-end solutions. Responsibilities: Define and drive the long-term technical roadmap for claims management systems, aligning priori

At Lyft, our mission is to improve people's lives with the world's best transportation. To accomplish this, we start with our community by creating an open, inclusive, and diverse organization. About the Team The Risk Tech engineering organization is committed to tangibly reducing accident frequency, saving lives, and managing costs to enhance the safety and affordability of rides. Claim Management is a core financial function for Lyft. Each claim touches complex workflows, multiple stakeholders, sensitive data, financial reserves, regulatory processes, and significant financial liabilities. This role offers the opportunity to define a leading claims management system for the industry. Our vision is to establish a single, Unified Risk Platform where comprehensive claims workflows across all business lines are efficiently administered, communications are consolidated, and data is structured to facilitate data-driven insights and decisions.This enables cost-efficient claims operations, mitigates risks and expenses as Lyft scales, and ensures people receive assistance proactively and accurately. About the Role We are seeking a Senior Software Engineer to contribute to the technical direction, drive architectural decisions, and lead the development of a highly reliable, scalable, and intelligent Risk Management Information System that powers our insurance platform. You will collaborate with passionate colleagues from Engineering, Data Science, Product and Claim Operations to deliver end-to-end solutions. Responsibilities: Define and drive the long-term technical roadmap for claims management systems, aligning priori

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 growing DSNP business has created an opportunity for an individual with claims experience, who is familiar with the 837 standard claims format. This individual will own 837 file transmissions to the states, manage and act on state response files, ensuring that all transactions transmitted are complete and error free. Manage and complete error corrections to meet state requirements. Required Qualifications 1&#43; year of experience with encounter data, medical claims, or Medicare/Medicaid. 1&#43; year of experience using FTP and data transfer software. 1&#43; year of data management experience. Preferred Qualifications Experience with Microsoft Access Databases. Analytical skills with the ability to identify and resolve data discrepancies. Working knowledge of the 837 claims files. Education Bachelors degree or equivalent work experience Anticipated Weekly Hours 40 Time Type Full time Pay Range <p s

Who we are About Stripe Stripe's mission is to increase the GDP of the internet. We build the most powerful and flexible tools for running an internet business — handling billions of dollars each year and enabling millions of businesses worldwide to scale faster by building on Stripe. That means you have an unprecedented opportunity to put the global economy within everyone’s reach while doing the most important work of your career. About the team Our tax team works with Stripes across the company to develop an efficient operating model as our international business scales and expands into new markets and launches new products. EMEA Tax supports Stripe’s growth across the region by helping the company meet its tax obligations, manage tax risk, and make well-supported decisions as Stripe’s products, systems, and operations evolve. You will be based in Dublin and report to the EMEA Tax lead, who is located in Dublin. This role will develop and lead a best-in-class global R&D incentives programme. What you’ll do You will be Stripe’s European R&D incentives lead, responsible for developing and leading Stripe’s R&D incentives programmes in Ireland and the UK. You will support Stripe’s US federal and state research-credit programme and will explore new opportunities as Stripe continues to expand globally. You will build trusted relationships with engineering and product teams, establish repeatable processes for identifying and documenting qualifying work, and ensure Stripe can support its global R&D incentives claims with contemporaneous evidence. You must be able to work effectively with cross-functional teams and independently lead complex, high-impact work. You will translate complex technical activity into clear documentation, and help Stripe enhance its global R&D incentives processes. Responsibilities Act as Stripe’s European lead and technical expert for R&D incentive and grant claims. Support the annual US fed

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: The AirCover team is charged with managing and growing the AirCover business inside of Airbnb. We have a responsibility to our community of Hosts and guests to be there when things don’t go exactly as planned with their reservations. We have a lot of work to do in the coming years and we are looking for someone who will help us manage all of the things that need to be done to deliver best-in-class services to our community. The Difference You Will Make: As a Vendor Manager focused on operational vendor support, you will own the end-to-end management and performance of a portfolio of third-party partners that deliver critical operational services (e.g., third-party claims adjusting). Applying deep expertise in vendor management, SLA frameworks, and operational risk, you will exercise independent judgment across multiple sources of data to structure trade-off decisions, resolve complex and ambiguous problems, and hold vendors accountable to service, delivery, and cost outcomes for guests and hosts. You will operate with minimal oversight, act as a trusted advisor and resource to less experienced colleagues and internal stakeholders, and may lead vendor management projects or programs that shape how the broader function operates. A Typical Day: Own the day-to-day management and performance oversight of an assigned portfolio of vendors within established team strategy and governance. Lead daily/weekly performance forums, synthesizing multiple sources of operational and financial data to diagnose root causes, structure trade-off decisions, and drive action plannin

End to end responsible for: • budget governance and cost predictability by driving planning, reforecasting and variance controls across SBUs/projects. • cost-to-complete and contingency discipline with early-warning insights to protect margins and cashflows. • financial impact assessment of changes, claims and VE decisions to enable faster approvals and risk control. • standardized MIS and corrective action tracking for leadership reviews. Source: Adani Group | Job ID: 59137

The Lead - Billing (MEP) will be responsible for end-to-end billing, quantity surveying, contract administration, and commercial management for Mechanical, Electrical, Plumbing (MEP), Fire Fighting, HVAC, ELV, and Utility works. The role involves preparation and certification of RA bills, contractor and subcontractor billing, client billing, variation management, claims administration, BOQ reconciliation, and cost monitoring for large-scale construction projects including high-rise buildings, industrial plants, data centers, commercial developments, and infrastructure projects. Source: Adani Group | Job ID: 59172

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 Manager, Project Management is responsible for leading and overseeing Coordination of Benefits projects and operational initiatives that improve payment accuracy, reduce overpayments, enhance compliance, and drive process efficiency across the organization. This role manages a portfolio of complex, cross-functional projects and collaborates with stakeholders across Claims, Enrollment, Provider Services, Operations, Technology, Analytics, and Vendor Management to ensure successful delivery of strategic business objectives. The Senior Manager is accountable for defining project scope, objectives, timelines, resource requirements, and success measures while ensuring initiatives are delivered on time, within budget, and aligned with organizational goals. This role leverages data analytics and business intelligence to identify trends, assess risks, develop solutions, and implement process improvements that enhance operational performance and the provider and member experience. In addition to project leadership, the Senior Manager directly manages staff, providing day-to-day leadership, coaching, performance management, and professional development. Responsibilities include establishing team priorities, allocating resources, managing workload distribution, fostering collaboration, and creating a culture of accountability, innovation, and continuous improvement. The role

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

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. We are looking for experienced backend software engineers to join our claims tech engineering team. Our vision is to tangibly reduce risk on the Lyft platform, and by extension reduce insurance cost. Our team is dedicated to centralizing the entire claims operation onto a unified risk platform. This consolidation of data, workflows, and communications aims to foster proactive measures, enhance efficiency, ensure consistency, and provide valuable insights. These efforts are designed to effectively reduce claims costs as Lyft's operations expand. Additionally, our team is responsible for maintaining robust relationships with our third-party insurance partners, guaranteeing timely, proactive, and precise sharing of claim data. Responsibilities: Write well-crafted, well-tested, readable, maintainable code Own feature from product spec to successful high quality development, deployment and maintenance Participate in code reviews to ensure code quality and distribute knowledge Respond to external questions and requests. Unblock, support and communicate with stakeholders to achieve results Experience: 3+ years of relevant professional experience Experience with object-oriented programming Experience in distributed systems Experience working with databases, relational or NoSQL Write clear, scalable and clear design documentation Design, build and improve a set of team owned components Benefits: Extended health and dental coverage options, along with life insurance and disability benefits Mental health benefits Family building benefits Child care and pet benefits Access to a Lyft funded Health Care Savings Account RRSP plan with company match to help save for your future In addition to provincial observed holidays, salaried team members are covered under Lyft's flexible paid time off policy. The policy allows