Claims Specialist in United States

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. Job Profile Summary Leads automation and AI transformation strategy across the Payment Integrity, Revenue Integrity, and Grievances and Appeals COEs. Builds and manages a team to ideate, prioritize, and oversee delivery of automation and agentic AI initiatives that improve claims accuracy, recovery, and appeals outcomes. Partners with COE and business leadership to align automation roadmaps to enterprise priorities, governance standards, and measurable business impact. Job Description A Brief Overview Leads a team to drive automation and AI-enabled transformation across Payment Integrity, Revenue Integrity, and Grievances and Appeals. Sets strategic direction for how automation and intelligent workflow opportunities are identified and scaled across these COEs, and ensures successful, on-time delivery through strong program oversight. Balances delivery accountability with team development, ensuring the group operates as a cohesive practice rather than three disconnected initiatives. What you will do Leads and develops a team, setting priorities, allocating capacity across COEs, and holding the team accountable to delivery and quality standards. Sets the automation transformation strategy for Payment Integrity, Revenue Integrity, and Grievances and Appeals in partnership with COE leadership. <

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. Job Description Summary The Application Developer is responsible for designing, building, and maintaining automation solutions that support claims processing workflows within the Rocket Automation platform. This role partners closely with business, governance, and operations teams to translate defined requirements into scalable, reliable automation capabilities. The Developer serves as a technical expert, ensuring solutions are built to enterprise standards and operate efficiently in production, while supporting continuous improvement of automation performance and stability. Key Responsibilities Design, develop, and enhance automation solutions based on clearly defined business requirements and processing rules Translate functional requirements into technical logic, ensuring accuracy and scalability of automation workflows Perform unit testing, system testing, and validation of automation solutions prior to deployment Support production deployments, including release readiness, implementation, and post-production monitoring Troubleshoot and resolve defects, errors, and performance issues in production automation processes Maintain and enhance existing automation solutions to improve efficiency, accuracy, and throughput Monitor automation performance and system health, identifying opportunities for optimization and i

Be at the forefront of innovation with NVIDIA! Our CUDA Libraries & Frameworks Product Marketing Manager role offers an outstanding opportunity to build the future of accelerated computing. This is your chance to join an elite team in Santa Clara, where your contributions will have a lasting impact on technology and society! We are looking for a technical, AI-first CUDA Product Marketing Manager. This is a hands-on PMM role for someone who uses AI coding agents and automation as part of daily execution, not as an occasional productivity aid. Come help craft the story for CUDA, core NVIDIA acceleration libraries like cuDNN, NCCL, NIXL, and AI frameworks like PyTorch, JAX, vLLM, and SGLang. What you'll be doing: Own positioning and messaging for CUDA as a developer platform, including the CUDA programming model, compilers, and core libraries. Make technical capabilities clear, credible, and useful for developers and technical decision-makers. Translate technical features for core libraries such as cuDNN, NCCL, CUTLASS, and TensorRT-LLM into data-driven developer narratives, release messages, proof points, ecosystem informed claims, and field-ready assets. Describe how NVIDIA speeds up AI frameworks and runtimes such as PyTorch, JAX, vLLM, and SGLang, linking low-level platform features to benefits for developers. Use AI coding agents daily to build PMM operating systems: competitive-intelligence agents, automated research pipelines, content auditing, reporting, and partner mapping. Turn documentation, performance benchmarks, GitHub issues, customer signals, and roadmap updates, into messaging assets. Lead go-to-market execution for CUDA launches and core library releases. What we need to see: Bachelor's degree in Computer Science or relevant field (or equivalent experience).

Senior Manager, Logistics Security Description - At HP, we create technology that helps people and businesses bring their ideas to life. Our global supply chain plays a vital role in that mission, moving high-value products safely and reliably to customers around the world. We are looking for a collaborative and solutions-oriented Senior Manager, Logistics Security to help protect our logistics network, strengthen transportation risk programs, and lead efforts that reduce loss, improve carrier performance, and support a secure customer experience. Core responsibilities Own logistics security strategy for HP's transportation network. Manage loss, theft, damage, shortage and mis-delivery incidents across carriers, warehouses and distribution partners. Lead transportation claims management, including investigation, documentation, recovery and settlement. Manage relationships with major LSPs, carriers, freight forwarders and 3PLs. Investigate high-value shipment incidents and identify root causes. Develop controls to prevent cargo theft, fraud, unauthorized access and product diversion. Establish security standards for transportation lanes, warehouses and high-risk locations. Track claims and losses using KPIs such as: Claim $ / shipment Loss rate Damage rate Theft incidents Recovery % Claim cycle time Carrier performance Partner with Supply Chain, Logistics, Finance, Legal, Compliance, Security and Insurance teams. Lead corrective/preventive actions with logistics service providers. Review carrier contracts and ensure appropriate liability and insurance coverage. Establish escalation processes for major incidents. Conduct risk assessments of logistics providers and distribution locations. Use dat

Replit is the agentic software creation platform that enables anyone to build applications using natural language. With millions of users worldwide, Replit is democratizing software development by removing traditional barriers to application creation. Role Summary Replit is the agentic software creation platform that enables anyone to build applications using natural language. With millions of users worldwide, Replit is democratizing software development by removing traditional barriers to application creation. As a Disputes and Chargeback Program Manager at Replit, you’ll be part of our Trust and Safety Operations team, who owns customer-facing workflows that handle sensitive and policy-driven interactions across the Support organization. This includes areas such as privacy requests, DMCA and intellectual property claims, law enforcement requests, and abuse appeals. You'll own Replit's disputes and chargeback function end-to-end: from the individual case in front of you to the policies, playbooks, and automation that let it hold up as we scale to millions of users. This role combines strategic ownership with hands-on execution: you'll determine dispute and chargeback strategy, and build the systems that make those decisions repeatable at scale, working closely with Engineering, Legal and Finance. In this role you will… Own the full dispute lifecycle: investigate incoming chargebacks and disputes, decide whether and how to represent, gather evidence, and respond within network deadlines. Design and maintain the policies, decision trees, and SOPs that govern how disputes and chargebacks are handled. Define the key metrics, health targets, and goals for the disputes program and track performance against them, reporting to leadership. Monitor chargeback rates and dispute trends to identify the underlying drivers of volume, and partner with Engineering and Finance to address root causes. Partner with Engineering and Support Operations to automate manual parts of the wor

About the role: Datadog is building a product-led Competitive Intelligence function to help inform product strategy, roadmap prioritization, positioning, and competitive readiness. As the Head of Competitive Intelligence you will build and lead the CompIntel function across priority competitors and adjacent market opportunities. You will translate competitor product evolution, technical capabilities, launches, pricing value, customer sentiment, analyst narratives, and ecosystem shifts into actionable insights for Product, GTM, Sales Engineering, Customer Success, Technical Advocacy, and leadership. In this highly technical, hands-on leadership role, you should understand how observability products are implemented, where workflows differ, what technical claims are credible, and how product gaps translate into customer impact. What You'll Do: Own the recurring competitive radar for Datadog’s priority competitor set, including taxonomy, source standards, evidence quality, and update cadence. Produce competitive deep dives, feature-gap analyses, early-warning briefs, and opportunity assessments tied to specific product domains and leadership questions. Translate CompIntel findings into roadmap recommendations, product differentiation hypotheses, and Product-facing decision guidance. Build and maintain a central CompIntel repository with competitor profiles, source notes, comparison frameworks, evidence logs, and decision-ready briefs. Convert validated findings into GTM-ready handoffs for battlecards, objection handling, strategic deal narratives, and field enablement. Synthesize signals from Product, Engineering, Sales Engineering, Customer Success, field teams, technical communities, Advocacy programs, win/loss, customer feedback, analyst research, public competitor materials, and CABs. Partner with Product Management to frame competitive questions, identify decision criteria, and connect findings to roadmap and prioritization discussions. Partner with Tec

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 Community Support org handles tens of millions of interactions yearly, engaging with Airbnb customers by phone, messaging, chat, or social media channels. The group handles hundreds of issues across categories including Cancellations, Account Issues, Refunds, Payments, Reservations, Extenuating Circumstances, Booking & Listing issues, Safety & Claims. The organization is globally distributed with offices in San Francisco, Dublin, Montreal, Seattle, Singapore, Manila, Gurgaon and an extensive partner network serving all regions. The Difference You Will Make: We are looking for a seasoned Forecasting and Demand Planning Analyst on our Community Support (CS) team. This individual is responsible for demand forecasting and long-term planning across multi-channel contact center operations for our Global Operations team. This role ensures the organization has the right resources, at the right time, with the right skills to meet service level objectives while optimizing cost and productivity. The role combines planning, advanced analytics and business partnership to drive scalable, data-driven workforce decisions in a complex, fast-changing environment. A Typical Day: Demand Forecasting & Statistical Modeling Own short-term, mid-term, and long-term demand forecasting across all Global Operations teams and channels (phone, messaging, email, back-office etc.). Design, develop, and maintain statistically robust demand forecasting models using time series and machine learning techniques (e.g., exponential smoothing, ARIMA, regression-based models etc.). Perform trend

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 Community Support org handles tens of millions of interactions yearly, engaging with Airbnb customers by phone, messaging, chat, or social media channels. The group handles hundreds of issues across categories including Cancellations, Account Issues, Refunds, Payments, Reservations, Extenuating Circumstances, Booking & Listing issues, Safety & Claims. The organization is globally distributed with offices in San Francisco, Dublin, Montreal, Seattle, Singapore, Manila, Gurgaon and an extensive partner network serving all regions. The Difference You Will Make: In this role you will own the strategic design and continuous evolution of risk frameworks, the risk registry, and executive risk narratives for Community Support — translating investigative findings, AI/ML model outputs, operational signals, and emerging threats into decisions and actions that protect Airbnb. A defining element of this role is your close partnership with the Insider Threat program. Together, you will form a complementary unit: you will ensure that investigative outcomes are contextualized within the broader risk ecosystem — informing risk appetite decisions, shaping detection strategy, and driving remediation accountability. You will co-own escalation frameworks, jointly challenge detection model effectiveness, and ensure that the feedback loop between investigations, risk governance, and AI-driven detection is robust and continuously improving. Beyond analysis and governance design, you will serve as the program manager for systemic root cause resolution — ensuring that when investigations, incident

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 has a powerful purpose – “Bringing our heart to every moment of your health.” To enable this purpose, we have several initiatives, existing and new, that are re-inventing pharmacy and enabling better health outcomes. In the Merchandising Organization, we support our company’s purpose and our Pharmacy and Consumer Wellness vision to be America’s most trusted health, wellness, and pharmacy care partner, delivering differentiated omnichannel experiences and meeting consumers where they are. As the Associate Manager of Category Promo & Coupon Planning & Execution, you will use your interpersonal skills to build strong relationships with partners to influence and execute strategies that positively impact the company. As an Associate Manager you will partner with your leader to execute and report on the promotional strategies for our divisional merchandising teams, partnering closely with other leaders in Category Promo & Coupon Planning & Execution and Promotion Optimization. You will impact our business in the following ways: Support your leader in participating in the building and execution of category-level bi-weekly promotional plans deliver on event criteria, themes/claims, or strategically pre-defined category promo KPIs, as established based on the impact promotion has