Claims Trainer Jobs

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

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. CVS Health Specialty Pharmacy has an opportunity available for a full-time Medical Billing & Accounts Receivable Representative. As a Medical Billing & Accounts Receivable Representative, you will ensure timely and accurate billing and follow-up for outstanding claims while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. As part of the billing and reimbursement team, you will work in a fast paced and team focused environment to ensure timely and accurate billing to insurance providers. We will support you by offering all the tools and resources you need to be successful in a collaborative team based environment. The key responsibilities of the Medical Billing & Accounts Receivable Representative are: Creating and submitting medical claims to insurance companies within timely filing and ensuring accuracy within payer guidelines and preferred bill methods (i.e., 837, website, spreadsheets, and CMS-1500). Validating coverage and eligibility prior to claim billing. Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors. Maintaining supporting and chronological notes that detail action taken to resolve billing edits. Maintain updated information within the necessary AR/CVS

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Acts as the primary resource for assigned, high profile providers and/or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding Medicaid policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships. Monitors service capabilities and collaborate cross- functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed. Educates Medicaid providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures. Meets with key Providers at regular intervals to ensure service levels meet expectations. Manages the development of agenda, validates materials, and faci

Job Title Global Product Manager- IVP & Launch Excellence Job Description As a Global Product Manager (GPM)- IVP & Launch Excellence , you will build integrated value propositions and standardized launch approaches across Sleep & Respiratory segments ; improve launch planning, commercial readiness, and execution consistency Your role: Develop value propositions, business cases, and product claims (clinical, economic, technical) to support strategic investments, pricing, and product success. Define and maintain product, software, and lifecycle specifications aligned with portfolio strategy and customer needs. Drive product strategy execution with regional teams , ensuring commercial viability, technical simplicity, and margin optimisation. Own the claims roadmap, prioritising validated claims based on market, customer, competitor, and regulatory insights. Engage Key Opinion Leaders (KOLs) through advisory boards and educational initiatives to strengthen product credibility and market influence. Partner with cross-functional teams to develop channel strategies and go-to-market plans that accelerate adoption and revenue growth. Analyse market trends, competitive activity, customer behaviour, and product performance to inform data-driven decisions and roadmap priorities. Ensure regulatory compliance and quality standards throughout the product lifecycle. Support development and refinement of testing protocols to ensure accurate product evaluation. Lead end-to-end product lifecycle management, from concept through launch, ensuring quality, timely delivery, and alignment with business objectives. Drive continuous improvement and innovation initiatives to enhance product performance and maintain market competitiveness. You're the right f

Job Title Global Product Manager- Accelerators Job Description Global Product Manager- Accelerators will lead the incubation of early-stage products and technologies, including internally developed and partnered solutions; translate emerging concepts into scalable new-product opportunities Your Role Own the end-to-end product lifecycle, including portfolio strategy, roadmap development, value propositions, and business case execution. Lead new product development and PDLM governance, ensuring timely, profitable, and compliant product launches. Develop portfolio positioning, claims strategies, and customer segmentation based on market insights, competitive analysis, and regulatory requirements. Partner with R&D, Innovation, Sales, Marketing, Manufacturing, and regional teams to deliver commercially successful solutions. Build and manage KOL relationships to strengthen product credibility, thought leadership, and market adoption. Drive global launch readiness and support regional go-to-market execution. Provide strategic guidance and product expertise to regional marketing and sales teams to accelerate growth and market penetration. Ensure achievement of commercial objectives, portfolio profitability, and Annual Operating Plan (AOP) targets. Oversee product validation and testing activities to ensure quality, performance, and customer satisfaction. You're the right fit if: You’ve acquired 10&#43; years of experience in an international business environment in the field of product management, marketing, or related commercial/strategic role in medical devices or health technology. Exposure to Regulatory frameworks (FDA, EU MDR) and Reimbursement considerations You have a Bachelor's/ master’s degree in business

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Inspects and provides accurate claim information to support savings optimization for claims. Responds to customers on benefit inquiries. Maintains customer service standards. Administers policies and procedures for medical cost management. Coordinates support functions for claim adjudication. Required Qualifications Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers. Follows area protocols, standards, and policies to provide effective and timely support. Reviews provider billing practices to identify trends and cost savings opportunities. Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors. Tests automated code review programs. Takes direction to execute techniques, processes, and responsibilities Preferred Qualifications Working knowledge of problem solving and decision making skills 5&#43; years work experience Education High school diploma or equivalent required. Anticipated Weekly Hours 40 </p

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Analyst, Network Operations is a key role within the Network Operations function. The role is responsible for business operations managing Aetna’s provider network, which accounts for >$30Bn in annual medical claims spend. Business operations includes, but is not limited to, facilitating new provider applications, managing provider inquiries and assistance requests, and ensuring provider data and demographic information is maintained current. The role is a senior individual contributor position. The role will have a broad span of influence over responsible areas, and it will command the need to make accurate decisions on processes and directions for work, interactions with appropriate local market colleagues. The Senior Analyst’s ability to identify, evaluate and act on trends impacting market objectives and demonstrate independent judgement, discretion and authority will be critical for success. The ideal candidate will use their professional and technical experience, extensive Aetna systems knowledge, and internal cross-functional relationships to successfully complete their responsibilities (notably with common, non-standard provider requests and/or situations). The Senior Analyst will use advanced interpersonal skills to interact cross-functionally with multiple business areas to ensure timely completion of work and be r esponsible for achievin

Become a part of our caring community The Counsel provides a full range of legal advice and services. The Counsel work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Counsel typically a Legal generalist or provides counsel in a combination of disciplines. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact Responsibilities: Be a part of the legal team -- use your legal expertise to drive healthcare strategy. Humana is seeking legal counsel who will support Humana and its management by: Providing legal advice and support for Humana’s Medicare Advantage lines of business; Advising on Medicare Advantage rules and regulations and related health care fraud and abuse laws, including the Anti-kickback statute and False Claims Act; Drafting contract provisions to address regulatory concerns; and Collaborating and consulting with leaders throughout the company in order to ensure full compliance with applicable laws and regulations, and protection against external risk. Required Qualifications: Juris Doctorate, with licensing in at least one state At least 3 years of experience in health law at a law firm or in-house health care organization Experience in Medicare, Medicaid, or similar regulatory work Strong legal research, analytical, and writing/oral communication skills Experience negotiating contracts </l

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Leads and manages the QA team by setting strategic objectives and ensuring the implementation of effective quality assurance processes. Collaborates with cross-functional teams to define testing requirements, develop test plans, and ensure timely and thorough testing of software products. Analyzes testing metrics, provides reports to stakeholders, and drives continuous improvement in QA practices to deliver high-quality and reliable software solutions. Required Qualifications 5-7 years work experience in a claims or claims audit position. Adept at execution and delivery (planning, delivering, and supporting) skills Adept at business intelligence Adept at problem solving and decision making skills Adept at collaboration and teamwork Adept at growth mindset (agility and developing yourself and others) skills Preferred Qualifications 5&#43;years of quality management, audit, compliance or operational quality experience Adept at growth mindset (agility and developing yourself and others) skills Demonstrated experience using quality metrics, KPIs, dashboards, and business intelligence tools to identify trends and present recommendations to senior leadership Experience leading root-cause analysis, corrective and preventive action (CAPA), risk mitigation, and co

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. What you will do: Client Support Perform and support plan changes. Perform ID card facilitation. Complete any necessary reporting (scheduled, ad-hoc). Conduct inbound phone calls. Complete any assigned invoices. Perform any assigned group terminations. Complete documentation requests. Serve as a presence throughout the implementation process. Facilitate and participate in external-facing meetings. Member Support Perform overrides as needed. Oversee prior authorization and accessibility processes. Conduct inbound phone calls. Oversee resolution of claims issues. Perform manual eligibility adds and terminations. Service warranties as assigned. Required Qualifications 5&#43; years of experience in a pharmacy, PBM ( Pharmacy Benefit Management ), and/or insurance setting. Ability to travel up to 25% of time within the continental United States. Preferred Qualifications </

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