Senior Claim Benefit Specialist Jobs

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. An overview of this role As a Senior Benefits Analyst on GitLab's Total Rewards team, you'll help design, administer, and improve our global benefits programs. You'll combine hands-on benefits operations with program assessment, vendor and broker partnerships, and cross-functional collaboration to make our offerings market-aligned, compliant, and easy for team members to navigate and use. You'll work across multiple countries and employment models, including professional employer organization (PEO), employer of record (EOR), and GitLab legal entity arrangements, while navigating local requirements and vendor processes. You'll ser

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

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

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 : This Underwriting role is for Meritain Health, an independent subsidiary of Aetna and CVS, and one of the nation's largest employee benefits administrators. We have the resources of a national carrier coupled with the unique flexibility and devoted service of a third-party administrator (TPA). The Meritain Health underwriting department supports the attainment of organizational goals through the issuance of prospective and existing business quotations and proposals. Including administrative fee pricing, stop loss, RFP questionnaire responses, and plan consultation. This fully-remote position will have the opportunity to work on a diversified book of business including Mid-Market and our Captive/Alternate channels. Responsibilities Include: Provide guidance and consultation to our Sales and Client Management teams on pricing and stop loss strategies Prepares and issues quotations and other financial deliverables for prospective and existing business while meeting established departmental TAT goals. Prepares financial projections on prospects utilizing financial models in Excel and Salesforce. Marketing and placement of stop loss policies, negotiating terms based upon claims data, strategy, relationships. and cost avoidance/reduction efforts. Works with leaders from key functional areas to understand 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 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

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

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

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. Senior Frontend Engineer An overview of this role As a Senior Frontend Engineer, you'll solve high-scope frontend problems and influence your team's technical and product direction. You'll ship moderately sized features with minimal guidance, improve quality and performance, mentor other engineers, and help establish standards for a high-scale web environment. You'll partner across product, design, backend, and frontend to make sound trade-offs, communicate clearly, and improve how the team delivers software. This is an opportunity to shape product experiences and frontend architecture for a global platform while helping define h

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. An overview of this role As a Senior Contracts Manager, Commercial (EMEA), you’ll help keep GitLab’s commercial contracting moving by managing a varied pipeline of customer agreements, from established contracting work to more involved and complex negotiations. You’ll work closely with sales and internal teams to keep deals on track while protecting GitLab’s interests. You’ll be part of the team that helps GitLab do business every day, bringing pace, precision, and good judgment to a broad range of commercial legal work. In this hands-on role, you’ll keep the day-to-day contracting work moving while also contributing to various s

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. An overview of this role As a Senior Security Engineer on GitLab's Security Incident Response Team (SIRT), you will be on the frontline of protecting both GitLab.com and GitLab the company from security threats. You will lead high-impact incidents and investigations, drive continuous improvements in defense, detection and response capabilities, and help scale security operations through automation and intelligent workflows. Operating within a 24/7 global environment (follow the sun model), you will own incidents end-to-end - from detection and triage through containment, eradication, and recovery - while partnering cross-function

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. An overview of this role As a Customer Success Engineer, you'll expand your impact by partnering with customers in GitLab's group across APJ to help them get measurable value from GitLab through hands-on technical guidance and proactive enablement. You'll serve as a trusted technical advisor, partnering with customers over Zoom and email to improve adoption, unblock implementations, and apply DevSecOps best practices across the software delivery lifecycle. Working closely with Account Executives and Renewals Managers, you'll align technical recommendations to customer goals and help support renewals and expansion by demonstrating

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. About the Team GitLab's APJ Ecosystem team builds and scales the partner (channel, alliance, and hyperscaler) motion across the region. ASEAN is a strategic market for GitLab, and this hire is central to strengthening our partner ecosystem there — deepening a smaller number of high-value partnerships rather than spreading thin across many transactional ones. About the Role Based in Singapore, our Ecosystem Sales Manager (ESM)- ASEAN, is a senior, market-facing role responsible for building and scaling GitLab's partner business in ASEAN countries across the full breadth of the ecosystem: hyperscalers, large ASEAN-centric system in