Claims Specialist Jobs

We are looking for a Senior Partner Solutions Architect to lead technical engagement with independent software vendors (ISVs) and strategic technology partners. You will help partners build, embed, deploy, validate, and go to market with MongoDB-based solutions that create repeatable customer value and accelerate MongoDB adoption. This role combines enterprise architecture, partner engineering, technical pre-sales, solution assurance, and go-to-market enablement. You will work across the complete partner lifecycle—from opportunity discovery and business-value alignment through architecture, validation, design wins, launch readiness, and post-launch reuse. You will be successful in this role if you can move fluidly between a partner’s product architecture, a customer’s business problem, MongoDB’s technical capabilities, and the field motion needed to scale the outcome. We're looking to speak with candidates based in Mexico City for our hybrid working model. What you will do Serve as the senior technical advisor for strategic ISV and technology-partner engagements, including embedded software, SaaS, BYOA/BYO-EA, AI, and agent products Lead technical discovery and architecture reviews that clarify the partner’s workload, adoption path, deployment model, customer segment, success criteria, and MongoDB value proposition Guide partners through a repeatable technical validation and solution-assurance process covering architecture, deployment, security, compliance, performance, scale, resilience, operability, upgrades, support ownership, and lifecycle management Establish evidence-based readiness gates and partner maturity assessments; distinguish clearly between tested, supported, recommended, and go-to-market-approved claims Design reference architectures, integration patterns, sizing guidance, deployment blueprints, quickstarts, demos, troubleshooting guidance, and partner-facing documentation Help partners build MongoDB into shipped products, SaaS platforms, AI applicat

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 Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members. Aetna Better Health of Maryland is seeking an experience leader with vast operational knowledge of Medicaid for its state-wide managed Medicaid business in the role of Chief Operations Officer (COO). The COO role will be strategic and committed to developing colleagues as well as relentlessly pursuing change that is best for the organization and its customers. The COO role will collaborate with the CEO to develop the strategic vision of the Health Plan, policies & procedures, and operational objectives including leading RFP readiness efforts. The COO will oversee high level strategic and operational activities of various plan functional areas which include traditional service operations (Claims, Provider Services, Information Technology, Grievance & Appeals and Member Services) as well as Medical Management (Quality, Netw

Become a part of our caring community The Grievances and Appeals Representative 4 role in the Internal Review Team is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partners. Key Responsibilities: Manage Level 1 appeal cases , ensuring accuracy, completeness, and compliance with CMS requirements Review clinical documentation to support appeal determinations and escalation decisions Coordinate with clinical teams and internal partners to finalize appeal outcomes Investigate and resolve member and provider issues with a focus on timely resolution Maintain high productivity and quality standards in a production-driven environment Ensure strict adherence to confidentiality and compliance regulations Independently prioritize and manage multiple high-volume case assignments Proactively embraces change and supports smooth transitions in a dynamic work environment Use your skills to make an impact Required Qualifications: 1+ year of grievance & appeals and/or customer service experience Strong data entry skills Proficiency in Microsoft Office Applications Experience in a production-driven environment Experience prioritizing and delivering multiple assignments Strong commitment to confidentiality and high-quality results Preferred Qualifications: Associate's or Bachelor's degree 2–4 years of grievance and appeals experience Medical claims processing experience Previous inbound call center experience Experience wi

Job Title Service Network & Technical Operations Manager Job Description Job title: Service Network & Technical Operations Manager Your role: • Consumer Care & Service Network Management: Manage and strengthen the consumer care and authorized service network to ensure high-quality and timely service support. New Product Introduction (NPI) Training: Plan and conduct technical training for service centre teams on new product launches, product features, repair procedures, and troubleshooting. Spare Parts Management: Ensure availability and proper management of spare parts across service centres, including forecasting, inventory monitoring, and resolution of critical shortages. Safety Case Management: Identify, monitor, investigate, and coordinate closure of product/service-related safety cases in accordance with company safety standards and escalation procedures. Technical Product Knowledge: Develop and maintain strong technical knowledge of products, including functionality, installation, troubleshooting, repair, and common failure modes. Service Centre Claim Management: Manage service centre claims related to warranty repairs, spare parts, labour, and other service activities. Ensure claims are accurately validated, processed, and resolved within defined timelines. Service Quality Improvement: Monitor service performance and identify recurring technical issues, driving corrective and preventive actions with relevant teams. Cross-functional Coordination: Coordinate with Product Development, Quality, Supply Chain, Sales, and Customer Care teams to resolve technical and service-related issues. Performance Monitoring: Track key service network KPIs such as turnaround time, first-time fix rate, repeat complaints, claim closure

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 Lead, Senior Decision Scientist serves as a strategic analytics and ideation leader supporting Payment Integrity Affordability initiatives with a primary focus on Fraud, Waste & Error (FWE) and Special Investigations Unit (SIU) programs. This role provides leadership and guidance to a team of Decision Scientists while driving the development, evaluation, and implementation of innovative opportunities that improve affordability outcomes and strengthen Payment Integrity capabilities. The Lead Decision Scientist is responsible for establishing analytical frameworks, managing ideation pipelines, defining success metrics, and identifying cross-functional opportunities that create enterprise value across Payment Integrity programs. Required Qualifications 7+ years of experience in healthcare analytics, Payment Integrity, Fraud, Waste & Error (FWE), Special Investigations, or related healthcare operations. 5+ years of experience leading analytical projects or providing technical leadership within a healthcare environment. Demonstrated experience working with healthcare claims platforms including ACAS, QNXT, HRP, or comparable systems. Experience using SAS, SQL, Python, R, or other analytical and statistical programming languages. Experience performing advanced data analysis, opportunity identification, trend analy

Job Title Product Manager, G&B Digital Products, PHDSI Job Description Job title: Product Manager , G&B Digital Products, PHDSI Your role: The Product Manager will be responsible for driving the product management activities for digital propositions within Grooming & Beauty, with an initial focus on the Lumea program. The role will work closely with Business, R&D, Digital, UX, Data/AI, Marketing, Regions and Platform teams to ensure strong product definition, roadmap alignment, business value realization and successful delivery of digital experiences. The role requires a strong balance of business understanding, digital product thinking, stakeholder management and execution focus. Own and drive Product Management activities for assigned G&B digital propositions, ensuring alignment with business strategy, consumer needs, market priorities and portfolio direction. Define and maintain the product roadmap, including value proposition, feature priorities, release scope, claims, business case inputs and market readiness needs. Translate business and consumer needs into clear product requirements, working closely with Product Owners, UX, architects, engineering teams, data/AI teams and marketing stakeholders. Ensure strong connection between upstream product strategy and downstream execution across app, cloud, data, AI and connected propositions. Drive prioritization of features and capabilities based on consumer value, business impact, technical feasibility, regulatory needs, cost, performance and delivery timelines. Support development and realization of the business case, including value creation, adoption, engagement, proposition performance and contribution to business outcomes. Lead cross-funct

About the Team OpenAI’s mission is to ensure that artificial general intelligence benefits all of humanity. Our Communications team supports that mission by explaining our technology, our values, and how we safely build powerful AI. We help business leaders see what AI can make possible for their organizations, show how customers use OpenAI’s products, and explain how AI is changing the way people work. About the Role We are looking for a senior product communications leader to own OpenAI’s B2B product story across business, trade, and nontraditional media. You will lead B2B communications for major product and platform moments, translate technical capabilities into clear business value, and build a sustained editorial program grounded in customer proof. Your work will help business leaders understand the problems our products solve and the outcomes they can enable using frontier intelligence. This is an exceptionally fast-paced, hands-on role that spans every altitude of communications. You will move from setting strategic positioning and shaping executive narratives to writing launch materials, developing media pitches, and delivering the details that make a story land. Working closely with Product, Research, Marketing, Sales, and our central Product Communications team, you will identify buyer needs, substantiate our claims, and carry a clear, consistent B2B story into the market. This role reports to the Head of Business Communications. In this role, you will: Set the positioning for OpenAI’s business products, connecting new capabilities to customer needs, the work they enable, and the evidence behind our claims. Lead business storytelling for priority launches across Codex, ChatGPT Work, API and developer capabilities, agents, and other enterprise products, in partnership with central Product Communications and product owners. Build a sustained editorial program between launches, using customer stories, explainers, and executive perspectives to show how our pr

About Forma.ai: Forma.ai is a Series B startup that's revolutionizing how sales compensation is designed, managed and optimized. We handle billions in annual managed commissions for market leaders like Edmentum, Stryker, and Autodesk. Our growth has been fuelled by our passion for fundamentally changing and shaping how companies use sales intelligence to drive business strategy. We’re welcoming equally driven individuals who are excited about creating something big! About the team: Engineers on this team build the application our customers and internal teams use to configure, operate, manage, and visualize complex incentive compensation workflows. This role sits within Forma’s ICM Operations platform, spanning areas such as Core Services, Business Intelligence, workflows, automation, APIs, claims management, next-generation reporting, and data exploration capabilities. There are many complex and difficult areas across the product, especially across frontend architecture and user experience, because of high data volumes, wide configurability, complex business logic, and mission-critical operational workflows. The work is not just about building screens; it is about helping users understand, act on, and trust complex compensation data and operational processes. We are low on meetings and high on accountability. Most of the team is in the EST timezone, with some teammates in PST and Central. We are far from maintenance or simple progressive evolution in many areas; there is a lot of room to make a meaningful impact on the overall user experience, product architecture, and frontend design patterns. What you'll be doing: Reporting to the VP of Engineering the Senior Frontend Engineer will play a key role in building, evolving, and scaling Forma’s customer-facing and internal operations experiences. You’ll work closely with product, design, engineering, operations, and leadership partners to deliver intuitive, performant, an

About THG Ingenuity THG Ingenuity is a fully integrated digital commerce ecosystem, designed to power brands without limits. Our global end-to-end tech platform is comprised of three products: THG Commerce, THG Studios, THG Fulfilment. Each represents a single, unified solution, overcoming challenges and taking brands direct-to-consumer. Our client portfolio includes globally recognised brands such as Coca-Cola, Nestle, Elemis, Homebase, and Proctor & Gamble. What’s the role? Job Title: CX Apprentice - Data Reports to: CX Analytics and Performance Director Apprenticeship: Data Analyst Level 4 Duration: 12-18 months, subject to learner progress + End Point Assessment Role Purpose To support the Customer Service department in turning core operational data into clear, actionable insight — covering everything from divisional headcount and budgets through to CS performance metrics, carrier claims and returns — helping the business understand performance and identify where the customer experience can be improved. Key Responsibilities Support core CS operational performance reporting across the department, including divisional headcount, budgets and key performance metrics such as CSAT and APH. Collect, clean and validate data from multiple internal and external sources across CX/CS operations, including carrier claims, returns (e.g. ZigZag), post-dispatch communications and customer contact systems. Build and maintain dashboards and reports (e.g. Power BI) tracking department-wide CS metrics, from workforce and budget data to claims and returns performance. Write and run SQL queries to extract and manipulate data from relational databases in support of departmental reporting. Identify trends and patterns across headcount, budget, claims, returns and delivery data, flagging root causes and opportunities for improvement. Support CS leadership and wider teams with ad hoc analysis to inform decision-making, resourcing

WPP is the trusted growth partner for the world’s leading brands. We unite cutting-edge media intelligence and data solutions, world-class creativity, next-generation production, transformative enterprise solutions and expert strategic counsel in a single company – powered by exceptional talent and our agentic marketing platform, WPP Open, to help our clients navigate change, capture opportunity and deliver transformational growth. We work with the world's most valuable brands and have global reach across 100+ markets, with deep local expertise. Our people are the key to our success. We're committed to fostering a culture of creativity, belonging and continuous learning, attracting and developing the brightest talent, and providing exciting career opportunities that help our people grow. For more information, visit WPP.com. Job Summary - To manage travel and expense reimbursement of employees in an organization and ensure timely payments of all expense claims. Key responsibilities - Educate employees about travel program policies and correct procedures. Verification of T&E Expense claims in Macanomy. Reconciliation and Clearing of T&E GL accounts and month end accrual reports. Posting of Macanomy claims and preparing Reconciliation file and sharing with the Payment team. Employee profile creation and Modifications. Service now tool query handling. Monitoring generic mailbox and follow up with employees. Amex reconciliation file and sending inputs to process payments as per deadlines. Monitoring Generic Mailbox. Report generation and Allocation within the team on daily basis. Skills/Experience Minimum 4-6 years of experience in Travel & Expense – Accounts Payable. Bcom Graduate. Should be an experienced problem solver with excellent written and verbal communication skills. Flexible attitude to achieve results. Excell

About the Company: Sigmoid enables business transformation using data and analytics, leveraging real-time insights to make accurate and fast business decisions by building modern data architecture using cloud and open-source technologies. Some of the world’s largest data producers engage with Sigmoid to solve complex business problems. Sigmoid brings deep expertise in data engineering, predictive analytics, artificial intelligence, and DataOps. Offices: New York | Dallas | San Francisco | Lima | Bengaluru. The role below is for our Bengaluru office. Why Join Sigmoid? Sigmoid provides the opportunity to push the boundaries of what is possible by seamlessly combining technical expertise and creativity to tackle complex business problems and convert them into straightforward data solutions. You will work in a fast-paced, high-impact environment and help shape data, analytics, and AI-led transformation for leading global insurance enterprises. About the Role: Sigmoid is looking to board a Leader for our Insurance Consulting Practice who can bridge the gap between high-level strategy and granular operational reality. A true expert in the insurance space must understand the interconnectedness of insurance products, claims ecosystems, underwriting dynamics, customer journeys, regulatory requirements, and operational processes. In this role, you will drive strategic initiatives, foster innovation, and provide visionary direction to our insurance practice with a strong focus on insurance analytics and AI-led transformation. The role requires a strong portfolio leader responsible for managing strategic accounts across new business development and account growth, while partnering with senior client stakeholders to define analytics use cases across Data Engineering, Data Science, Product Engineering, and Consulting. Roles and Responsibilities: Strong understanding of Insurance sub sectors operating model, value drivers and underlying mechanics Insurance Operations - Ability to

Who are we? Cohere is the leading security-first enterprise AI company. We build cutting-edge foundation AI models and end-to-end products that are designed to solve real-world business problems. We’re training and deploying frontier models for enterprises who are building AI systems. We believe that our work is instrumental to the widespread adoption of AI and we are looking for folks that want to be part of that. We obsess over what we build. Each one of us is responsible for contributing to increasing the capabilities of our models and the value they drive for our customers. Cohere is a team of researchers, engineers, designers, and more, who are all passionate about their craft. We are a global technology company headquartered in Toronto with key offices in London, New York City, San Francisco, Montreal, Paris, Berlin and Seoul. Join us! About the Role Are you passionate about secure-by-design software engineering? Do you want to be at the forefront of AI innovation and enterprise security? Cohere's North team is seeking a Software Engineer with a focus on security to join our mission and make a significant impact. This isn't a review-and-advise role, you'll own and ship production security features that customers rely on every day. Your Role: As a Senior Software Engineer with a security focus, you'll play a pivotal role in building and securing North's architecture. Your responsibilities will include: Software Development: Contributing to the core development of security features such as OIDC/OAuth flows and session management, ensuring North's AI agents are secure Secure Coding: Writing secure code to handle OIDC tokens, user claims, and sensitive data, adhering to best practices for JWT validation and encryption Authentication and Data Protection: Implementing authentication mechanisms including user login, token management, and authorization checks to maintain data integrity Tool Integration: Pulling in new tools to enhance North's security capabilities Dev

ABOUT BASETEN Baseten powers mission-critical inference for the world's most dynamic AI companies, like Cursor, Notion, OpenEvidence, Abridge, Clay, Gamma, and Writer. By uniting applied AI research, flexible infrastructure, and seamless developer tooling, we enable companies operating at the frontier of AI to bring cutting-edge models into production. We're growing quickly and recently raised our $1.5B Series F , led by Altimeter Capital, Conviction Partners, and Spark Capital. Join us and help build the platform engineers turn to ship AI products. THE ROLE This role owns Baseten's relationships and market intelligence across hyperscalers and strategic neoclouds, including NVIDIA cloud partners. This is a technical and commercial role in equal measure: you'll evaluate capacity from the GPU to the data center, negotiate cost and terms with suppliers, and stay close enough to the market to develop and defend a real point of view on where it's heading. Given current market conditions, Baseten needs a much stronger pulse on this part of the market so we can track pricing, stay close to the right relationships, and move fast the moment more capacity is needed. This is a senior, experienced hire who will also help pair with and develop 1-2 junior to mid-level teammates covering the same space. WHAT YOU'LL DO Build and maintain deep relationships across hyperscalers and strategic neoclouds (including NVIDIA cloud partners), working each organization from top to bottom rather than a single point of contact Maintain a consistent, "top of mind" presence with key accounts so Baseten is positioned to move quickly when capacity needs arise Evaluate capacity from the GPU to the data center — hardware generation, rack and node configuration, interconnect, power density, and cooling — so you know what a configuration will actually deliver, not just what the spec sheet claims Live in compute pricing daily: track rates by GPU generation, region, and contract term to keep Baseten inf

ABOUT BASETEN Baseten powers mission-critical inference for the world's most dynamic AI companies, like Cursor, Notion, OpenEvidence, Abridge, Clay, Gamma, and Writer. By uniting applied AI research, flexible infrastructure, and seamless developer tooling, we enable companies operating at the frontier of AI to bring cutting-edge models into production. We're growing quickly and recently raised our $1.5B Series F , led by Altimeter Capital, Conviction Partners, and Spark Capital. Join us and help build the platform engineers turn to ship AI products. THE ROLE We're looking for a hands-on Operations Manager to own the operational and analytical supply side of our GPU fleet. Key focus areas: GPU fleet lifecycle, health, observability, utilization monitoring, and remediation across our neocloud and bare metal environments. We contract for a fixed amount of compute capacity. GPUs drift from healthy to unhealthy over time, and this role minimizes that downtime to keep the maximum number of GPUs healthy at any given moment. This is an operator role, not people management. You'll drive execution through clear processes, metrics, reporting, vendor coordination, and cross-functional alignment.. RESPONSIBILITIES Core Responsibilities: Drive suppliers to keep the maximum amount of the GPU fleet online and healthy. Maintain a live reconciliation of contracted vs. provisioned vs. healthy vs. utilized capacity, broken out by supplier and by cluster maximizing the number of healthy GPUs. Supplier-attributed fleet health accountability: own replacement SLAs, mean time to repair (MTTR), and RMA cycle times for every in-scope supplier. SLA monitoring, credit claims, and remedy enforcement: track SLA performance against contract terms, file and pursue credit claims, and drive remediation plans when suppliers fall short. Drive internal communications where suppliers need to perform maintenance to ensure all Baseten stakeholders are aware of activities that impact availability. Scope and

About the Team Governance, Risk, and Compliance (GRC) is foundational to Security delivering mission outcomes at OpenAI. The GRC team provides security assurances and builds compliance for OpenAI’s technology, people, and products. We are technical in what we build but operational in how we do our work, and we partner deeply with Product, Security, Legal, Privacy, GTM, and Field Security to help OpenAI move quickly while maintaining trust with customers, auditors, regulators, and the public. About the Role We are looking for an experienced Product Lifecycle Assurance IC to help scale OpenAI’s GRC function across our product stack to ensure products address customer and regulatory compliance requirements at launch and regressions are detected promptly and corrected. You will partner closely with Product, Security, Legal, and Privacy teams to make sure OpenAI can move quickly while maintaining our security, privacy and compliance claims and giving customers, auditors, and regulators assurance about how OpenAI handles user data. You are responsible for product assurance end-to-end from inception to post-launch (continuous) monitoring. You leverage existing workflows, reviews, and data and enhance, augment and build the components needed to create an end-to-end product assurance program. This role is not about supporting SOC or ISO audits; it's a highly cross-functional and deeply technical operations role to ensure that OAI products meet the compliance bar at launch, regressions are prevented and detected, and our compliance state can be evidenced. This role also helps ensure that our product launch governance program operates effectively across key safety, privacy, legal and security stakeholders and lessons-learned from incidents and regressions are used to improve the program. You or in partnership with engineering teams, build key controls in our infrastructure stack, developer workflows and launch tooling to provide developers with guardrails, perform CI/CD confor