Lead Claims Auditor Jobs

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

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 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

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

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

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: 53989

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

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 As the Senior Lead Coordinator you will be responsible for implementing and maintaining comprehensive billing review processes. You will identify and quantify trends/issues and effectively communicate/report them to the appropriate members of the management team and payer business partners along with the potential impact. You will assist leadership in building and maintaining a high performing highly engaged team. In this role you will also provide excellent mentorship and support to your colleagues as well as design and implement training classes. The key responsibilities of the Medical Revenue Cycle Senior Lead Coordinator are: Review and analyze patient profiles, benefits, and prior authorizations to identify potential issues affecting clean claims. Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing. Monitor claims submissions and follow up on pending claims to expedite resolution and payment. Identify trends in claims denials and develop strategies for improvement. Conduct training sessions for staff on best practices for claims submissions and compliance. Maintain up-to-date knowledge of insurance policies, regulations, and healthcare trends that impact claims

Front Line Manager - Insurance - P&C Claims Ready to turn bold ideas into real-world impact? At Genpact, we don’t just adapt to change, we lead it. AI and digital innovation are transforming the way businesses work, and we’re at the forefront of it. Genpact’s AI Gigafactory , our industry-first accelerator, exemplifies how we scale advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. Whether tackling complex challenges through large-scale models or agentic AI , our breakthrough solutions tackle companies’ most complex challenges. If you thrive in a fast-moving, innovation-driven environment, love building and deploying cutting-edge AI solutions, and want to push the boundaries of what’s possible, this is your moment. Genpact (NYSE: G) is an agentic and advanced technology solutions company. We leverage process intelligence and artificial intelligence to deliver measurable outcomes. With a strong partner ecosystem and decades of client trust, we provide innovative solutions that transform how businesses run. Powered by a team with an active learning mindset and client centricity at its core, we deliver lasting value for the world’s leading enterprises. Get to know us at genpact.com and on LinkedIn , YouTube , X , and Facebook . Job Description Responsibilities: ·

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 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

Who We Are Nuro believes self-driving vehicles are the most immediate and profound opportunity for AI to drive positive change in the physical world. Safer streets, more time for what matters, and easier access to the world around us, that’s why we’re building a universal autonomy platform: self-driving for all roads and all rides. Founded in 2016, Nuro is a physical AI company developing Level 4 autonomous driving technology for a wide range of vehicles, use cases, and markets. Powered by the Nuro Driver™, our universal autonomy platform enables the global mobility ecosystem to deploy autonomy at scale, from robotaxis and logistics fleets to personal vehicles. With years of real-world deployment experience and a flexible, partner-led business model, Nuro is working toward a future where millions of autonomous vehicles powered by our technology help make everyday life safer, easier, and more connected. Nuro has raised over $2B in capital from Uber, NVIDIA, Google, Softbank, Fidelity, T. Rowe Price, and other leading investors. About the Role As the Autonomous Driving System Safety Lead on the Systems Engineering team, you will own and author safety claims in the forward-facing ADS safety case for onboard and offboard software, a large fraction of which is AI components. You will work closely with the autonomy software, data platform, operations, and legal teams to coordinate system requirements, AI architecture, and evidence in support of these claims. You will be responsible for ensuring that the cross-functional team creates a safety case for onboard and offboard software that is comprehensive and that potential gaps are identified and mitigated. About the Work Manage safety claims by understanding the ADS design, interfaces, and technical capabilities of the system and by working closely with Autonomy Robotics and Software Infrastructure leads. Generate atomic claims through claim decomposition, delegating to the cross-functional teams where appropriate and

About the Team The Product Marketing team shapes how OpenAI brings its research, models, and products to market. We work across Research, Product, Engineering, Sales, Communications, and Marketing to translate technical advances into clear customer value, compelling market narratives, and go-to-market strategies that drive meaningful adoption. About the Role We’re looking for a senior product marketing leader to shape how OpenAI’s models and research are understood and adopted around the world. You’ll work directly with frontier research teams to understand emerging capabilities and translate them into compelling product strategies, market narratives, and customer experiences. Your scope will span frontier models, specialized models for cybersecurity and life sciences, multimodal capabilities, and the API portfolio that makes these systems accessible to developers and businesses. You’ll build and lead the team responsible for helping customers understand what our models can do, how they’re evolving, and how to deploy them responsibly. In this role, you will: Define the product marketing strategy for OpenAI’s models, research advances, and API portfolio. Embed with Research, Product, and Engineering to understand model capabilities, evaluations, limitations, and technical tradeoffs. Shape how OpenAI explains advances in AI to developers, business leaders, and the broader market. Lead positioning, launches, demonstrations, and adoption strategies across frontier, specialized, and multimodal models. Help customers navigate model selection, API access, privacy, security, and responsible deployment. Bring customer and market insights into research and product decisions. Partner with Sales, Solutions, Partnerships, and regional teams to develop customer narratives, use cases, and enablement. Work with Communications, Safety, Policy, and Legal to ensure technical claims are accurate and grounded. Build and lead a high-performing product marketing team and define success ac

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