Claims Auditor in United States

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

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 Internal Auditor reporting to the Senior Manager, Technology Internal Audit, you’ll help GitLab assess risk and strengthen controls across a technology landscape that includes multi-cloud infrastructure, artificial intelligence and machine learning systems, and modern development practices. This USA-based role supports our Sarbanes-Oxley Act (SOX) program while partnering with Engineering, IT Operations, Security, and business teams to build controls that work in practice, not just on paper. You’ll execute technology audits, turn findings into practical improvements, and use data analytics, au

Airbnb was born in 2007 when two hosts welcomed three guests to their San Francisco home, and has since grown to over 5 million hosts who have welcomed over 2 billion guest arrivals in almost every country across the globe. Every day, hosts offer unique stays and experiences that make it possible for guests to connect with communities in a more authentic way. The Community You Will Join: The AirCover team is charged with ideating, building, launching, and managing the AirCover business inside of Airbnb. We have a huge responsibility to our community of Hosts and guests to be there when things don’t go exactly as planned with their reservations. We have a lot of work to do in the coming years and we are looking for someone who will help us manage all of the things that need to be done to deliver best-in-class services to our community. The Difference You Will Make: As a Complex Claims Manager in the Complex Claims, you will play a vital role in safeguarding the integrity of our Aircover platform by effectively identifying, investigating, and managing the risk and mitigation strategies in resolution of Complex and Large Loss claims. You'll manage partners to influence prioritization, drive accountability, deliver improvements, and scale changes on claims which impact Airbnb. You'll work with internal and external partners to influence prioritization, drive accountability, and deliver improvements. You will work closely with cross-functional teams to manage emerging risks / threats while enabling business growth in various markets. Philosophy will be to identify intelligence / risk gaps and work with other internal risk management teams (such as Trust team, and Safety team), third party adjusters, our partners, Platform Product Management, Global Crisis Management, Community support, Policy, Privacy Legal teams to strengthen Airbnb’s platform. You will be reporting at Monthly, Quarterly and Annual Business Reviews for your area. Yo

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: ·

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The growing DSNP business has created an opportunity for an individual with claims experience, who is familiar with the 837 standard claims format. This individual will own 837 file transmissions to the states, manage and act on state response files, ensuring that all transactions transmitted are complete and error free. Manage and complete error corrections to meet state requirements. Required Qualifications 1&#43; year of experience with encounter data, medical claims, or Medicare/Medicaid. 1&#43; year of experience using FTP and data transfer software. 1&#43; year of data management experience. Preferred Qualifications Experience with Microsoft Access Databases. Analytical skills with the ability to identify and resolve data discrepancies. Working knowledge of the 837 claims files. Education Bachelors degree or equivalent work experience Anticipated Weekly Hours 40 Time Type Full time Pay Range <p s

Airbnb was born in 2007 when two hosts welcomed three guests to their San Francisco home, and has since grown to over 5 million hosts who have welcomed over 2 billion guest arrivals in almost every country across the globe. Every day, hosts offer unique stays and experiences that make it possible for guests to connect with communities in a more authentic way. The Community You Will Join: The AirCover team is charged with managing and growing the AirCover business inside of Airbnb. We have a responsibility to our community of Hosts and guests to be there when things don’t go exactly as planned with their reservations. We have a lot of work to do in the coming years and we are looking for someone who will help us manage all of the things that need to be done to deliver best-in-class services to our community. The Difference You Will Make: As a Vendor Manager focused on operational vendor support, you will own the end-to-end management and performance of a portfolio of third-party partners that deliver critical operational services (e.g., third-party claims adjusting). Applying deep expertise in vendor management, SLA frameworks, and operational risk, you will exercise independent judgment across multiple sources of data to structure trade-off decisions, resolve complex and ambiguous problems, and hold vendors accountable to service, delivery, and cost outcomes for guests and hosts. You will operate with minimal oversight, act as a trusted advisor and resource to less experienced colleagues and internal stakeholders, and may lead vendor management projects or programs that shape how the broader function operates. A Typical Day: Own the day-to-day management and performance oversight of an assigned portfolio of vendors within established team strategy and governance. Lead daily/weekly performance forums, synthesizing multiple sources of operational and financial data to diagnose root causes, structure trade-off decisions, and drive action plannin

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Manager, Project Management is responsible for leading and overseeing Coordination of Benefits projects and operational initiatives that improve payment accuracy, reduce overpayments, enhance compliance, and drive process efficiency across the organization. This role manages a portfolio of complex, cross-functional projects and collaborates with stakeholders across Claims, Enrollment, Provider Services, Operations, Technology, Analytics, and Vendor Management to ensure successful delivery of strategic business objectives. The Senior Manager is accountable for defining project scope, objectives, timelines, resource requirements, and success measures while ensuring initiatives are delivered on time, within budget, and aligned with organizational goals. This role leverages data analytics and business intelligence to identify trends, assess risks, develop solutions, and implement process improvements that enhance operational performance and the provider and member experience. In addition to project leadership, the Senior Manager directly manages staff, providing day-to-day leadership, coaching, performance management, and professional development. Responsibilities include establishing team priorities, allocating resources, managing workload distribution, fostering collaboration, and creating a culture of accountability, innovation, and continuous improvement. The role

The Ops Sup Lead Analyst is a senior-level operations professional responsible for managing transaction exception processing, including payment network claims, adjustments, disputes, settlement exceptions, and reconciliation activities for internal Citi business partners. The role is accountable for ensuring the accurate and timely resolution of operational exceptions, maintaining a strong control environment, and overseeing third-party vendors that support these functions. This individual serves as the primary liaison between Operations, Business, Technology, Risk & Control partners, payment networks, and external vendors to ensure operational issues are resolved effectively, controls are maintained, and processes continue to evolve to support business growth and regulatory expectations. The successful candidate will act as a subject matter expert in payment network operations, transaction routing, settlements, reconciliations, and exception management. Responsibilities Lead the end-to-end management and resolution of transaction exceptions, including payment network claims, adjustments, disputes, settlement discrepancies, and other operational exceptions. Oversee settlement and reconciliation processes to ensure the timely identification, investigation, and resolution of breaks, variances, and outstanding items. Monitor operational performance and service level adherence, ensuring all activities are completed accurately, timely, and in compliance with applicable policies and procedures. Serve as the primary operational liaison with internal Citi business partners, Technology, Risk & Control, Compliance, Finance, payment networks, and third-party vendors. Manage vendor relationships supporting claims, adjustments, settlement, and reconciliation functions, including performance monitoring, issue escalation, service delivery oversight, and process improvements. Act as the b

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: We are seeking a compassionate, customer-obsessed Customer Service Representative to care for our customers. Our customers include members of our benefit plans, employers that offer benefits, and doctors, hospitals, and other healthcare providers. In this role, you will create connections with our customers by helping with their benefits and claims to improve their health and well-being. You will be responsible for educating customers about their benefits and claims while resolving issues and directing them to helpful resources. This position requires adaptability and empathy, as you will be handling a variety of inquiries and ensuring customer satisfaction through kind and respectful interactions. As the face of our company, you will care for our customers by researching issues, documenting outcomes, resolving inquiries and delivering a high level of customer satisfaction. Your ability to listen and respond to customer needs is crucial in inspiring trust and loyalty. Key Responsibilities: Actively listen and be an advocate for customers, understand their needs and provide guidance and support Resolve customer inquiries and issues efficiently while documenting all interactions. Educate customers about available resources and assist them in navigating their options. Anticipate customer needs and provi

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 Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

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 Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

Become a part of our caring community The Market Finance Lead is a key member of the Gulf South Region’s finance team responsible for connecting market financial performance with operational effectiveness. This role will partner closely with Corporate Finance, Network Performance, Network Contracting, and regional Health Services teams. This individual will manage a team covering a diverse set of responsibilities around Medicare Advantage financial business operations with a heavy focus on value-based providers. This role reports to the Market Finance Director. This role analyzes financial results, claims experience, utilization trends, contract performance, membership, and provider performance data to identify opportunities, influence business decisions, and support market growth and operational improvement. The Market Finance Lead will partner closely with regional leadership, actuarial, corporate finance, clinical, risk adjustment, market operations, network performance, network contracting, sales/MarketPoint, and value-based care providers. This individual will translate complex financial and operational data into meaningful insights, recommendations, and action plans that improve performance across the market. As the Market Finance Lead, you will: Manage a team to review value-based providers’ financial performance, membership, cost and utilization trends, contractual results, and opportunities for improvement. Lead the financial portion of provider engagement prep sessions prior to joint operating committee meetings to advise the Network Performance team on contract performance and opportunities for improvement. Lead analysis and reporting related to value-based provider and contract performance, including financial results, utilization, claims experience, membership, and operational trends. Leverage data analytics, business ins

Become a part of our caring community The Actuarial Analyst 2, Analytics/Forecasting supports value-based initiatives within the HealthCare Economics team, partnering across actuarial, finance, analytics, and business teams to develop actionable financial insights and forecasting solutions. This role will play a key part in the design and development of a holistic modeling solution, building new methodologies and frameworks from the ground up to support performance measurement, financial reconciliation, and strategic decision-making across multiple value-based care programs. You work assignments are varied and frequently require interpretation of complex business issues, independent judgment, and the ability to recommend and execute appropriate courses of action with limited guidance. The Actuarial Analyst 2, Analytics/Forecasting will be responsible for analyzing and forecasting claims and revenue trends, developing innovative forecasting methodologies, and translating complex business requirements into scalable analytical solutions. This individual must be able to independently evaluate data, identify gaps, propose holistic approaches, and develop end-to-end solutions that integrate financial, operational, and claims-based insights. Responsibilities include designing forecasting methodologies, establishing reporting metrics, validating model results, and supporting the evolution of value-based care analytics. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Use your skills to make an impact Required Qualifications Bachelor's Degree Successful completion of

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. A Brief Overview Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp