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. Position Summary Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members. Aetna Better Health of Maryland is seeking an experience leader with vast operational knowledge of Medicaid for its state-wide managed Medicaid business in the role of Chief Operations Officer (COO). The COO role will be strategic and committed to developing colleagues as well as relentlessly pursuing change that is best for the organization and its customers. The COO role will collaborate with the CEO to develop the strategic vision of the Health Plan, policies & procedures, and operational objectives including leading RFP readiness efforts. The COO will oversee high level strategic and operational activities of various plan functional areas which include traditional service operations (Claims, Provider Services, Information Technology, Grievance & Appeals and Member Services) as well as Medical Management (Quality, Netw

Become a part of our caring community The Grievances and Appeals Representative 4 role in the Internal Review Team is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partners. Key Responsibilities: Manage Level 1 appeal cases , ensuring accuracy, completeness, and compliance with CMS requirements Review clinical documentation to support appeal determinations and escalation decisions Coordinate with clinical teams and internal partners to finalize appeal outcomes Investigate and resolve member and provider issues with a focus on timely resolution Maintain high productivity and quality standards in a production-driven environment Ensure strict adherence to confidentiality and compliance regulations Independently prioritize and manage multiple high-volume case assignments Proactively embraces change and supports smooth transitions in a dynamic work environment Use your skills to make an impact Required Qualifications: 1+ year of grievance & appeals and/or customer service experience Strong data entry skills Proficiency in Microsoft Office Applications Experience in a production-driven environment Experience prioritizing and delivering multiple assignments Strong commitment to confidentiality and high-quality results Preferred Qualifications: Associate's or Bachelor's degree 2–4 years of grievance and appeals experience Medical claims processing experience Previous inbound call center experience Experience wi

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

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

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 We're looking for a hands-on Operations Manager to own the operational and analytical supply side of our GPU fleet. Key focus areas: GPU fleet lifecycle, health, observability, utilization monitoring, and remediation across our neocloud and bare metal environments. We contract for a fixed amount of compute capacity. GPUs drift from healthy to unhealthy over time, and this role minimizes that downtime to keep the maximum number of GPUs healthy at any given moment. This is an operator role, not people management. You'll drive execution through clear processes, metrics, reporting, vendor coordination, and cross-functional alignment.. RESPONSIBILITIES Core Responsibilities: Drive suppliers to keep the maximum amount of the GPU fleet online and healthy. Maintain a live reconciliation of contracted vs. provisioned vs. healthy vs. utilized capacity, broken out by supplier and by cluster maximizing the number of healthy GPUs. Supplier-attributed fleet health accountability: own replacement SLAs, mean time to repair (MTTR), and RMA cycle times for every in-scope supplier. SLA monitoring, credit claims, and remedy enforcement: track SLA performance against contract terms, file and pursue credit claims, and drive remediation plans when suppliers fall short. Drive internal communications where suppliers need to perform maintenance to ensure all Baseten stakeholders are aware of activities that impact availability. Scope and

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

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

We believe that the way people interact with their finances will drastically improve in the next few years. We’re dedicated to empowering this transformation by building the tools and experiences that thousands of developers use to create their own products. Plaid powers the tools millions of people rely on to live a healthier financial life. We work with thousands of companies like Venmo, SoFi, several of the Fortune 500, and many of the largest banks to make it easy for people to connect their financial accounts to the apps and services they want to use. Plaid’s network covers 12,000 financial institutions across the US, Canada, UK and Europe. Founded in 2013, the company is headquartered in San Francisco with offices in New York, Washington D.C., London and Amsterdam. We are the first line of defense against fraud and abuse on the Plaid platform. Our mission is to ensure the safety and integrity of our platform for consumers and customers. As a Fraud and Abuse Operations Analyst , you will be responsible for responding to fraud and abuse events, investigating claims, and triaging incidents. We also partner with product and engineering teams to inform and improve fraud mitigation strategies. Responsibilities: Safeguard Plaid's Platform: Participate in the abuse on-call rotation, directly protecting our users and customers by responding to and resolving fraud and abuse events. Your timely actions will be instrumental in maintaining trust and security. Drive Investigations and Mitigate Risks: Investigate fraud and abuse claims from diverse sources, partnering with senior teammates on complex cases. Your findings will inform decisions and strategies, directly impacting Plaid's ability to prevent future incidents and minimize financial losses. Proactively perform threat modeling of abuse surfaces and continuously survey external fraud trends, adversary techniques, tooling, and emerging threat vectors Support Incident Response: Help triage and manage fraud and abuse ev

For over 20 years, Smartsheet has empowered teams to manage work seamlessly and scale solutions smarter. Now, in our most ambitious chapter yet, we are uniting human teams with AI agents. By orchestrating the work agents do best, automating manual tasks and uncovering insights at scale, we create the space for people to focus on what truly matters: judgment, creativity, and big thinking. That is magic at work, and it’s what we show up for every day. Smartsheet targets industries where workflow specificity is essential. As a Principal Product Marketing Manager, Vertical Industries, you will lead the strategic development of industry-specific value narratives, use case positioning, and sales-ready content for priority vertical, Manufacturing. In this role, you will own the GTM narrative, ensuring positioning is grounded in quantified, defensible value claims. This role requires deep industry curiosity, methodological discipline, and the ability to drive multiple complex workstreams in parallel to maintain Smartsheet’s competitive edge. This full-time position reports to the Sr. Director, Customer Value and can be located in our Bellevue, WA office, or you may work remotely from anywhere in the US where Smartsheet is a registered employer. What You Will Own: Value Strategy Execution — Vertical Industries Lead the team's execution of the Smartsheet Value Strategy process for priority verticals. Define positioning scope, including target segments, industry-specific buyer roles, KPIs, and competitor sets. Validate buyer value levers and map them to Smartsheet's capabilities to demonstrate differentiated, quantified benefits. Build vertical Value Impact Models and define the problem Smartsheet owns within each industry. Develop cross-functional Adoption Plans and validate position hypotheses through direct buyer sessions. ICP & CAPDB for Vertical Segments: Own ICP definition and target account prioritization for each priority vertical. Ensure each vertical ICP sp

For over 20 years, Smartsheet has empowered teams to manage work seamlessly and scale solutions smarter. Now, in our most ambitious chapter yet, we are uniting human teams with AI agents. By orchestrating the work agents do best, automating manual tasks and uncovering insights at scale, we create the space for people to focus on what truly matters: judgment, creativity, and big thinking. That is magic at work, and it’s what we show up for every day. Smartsheet's horizontal use cases — spanning Enterprise PMO, Operations & Process Management, IT PPM, Service Delivery, and Governance, Risk & Compliance — represent the company's largest ARR expansion opportunity. Most enterprise accounts enter through a single buying center. The horizontal pod's job is to unlock the adjacent functional buyers in those same accounts, and to build the positioning that makes Smartsheet the obvious choice for each. As a Product Marketing Manager II on the Horizontal Use Cases pod, you will help support the value strategy, positioning, and sales-ready content for a defined set of horizontal use cases. You will partner with the Sr. Manager, Product Marketing and contribute to the development of differentiated, quantified value propositions that help Smartsheet win against category competitors and drive multi-function adoption within the enterprise installed base. This full-time position reports to the Manager, Product Marketing and can be located in our Bellevue, WA office, or you may work remotely from anywhere in the US where Smartsheet is a registered employer. What You Will Own: Assisting with Value Strategy: Support the execution and maintenance of the differentiated value strategy for each use case Value Impact Model: Assist in the development of quantified Value Impact Models for assigned use cases — helping translate Smartsheet's capabilities into specific productivity and efficiency claims for ROI conversations. Buyer Validation & Market Testing: Support buyer inte

At Snowflake, we are powering the era of the agentic enterprise. To usher in this new era, we seek AI-native thinkers across every function who are energized by the opportunity to reinvent how they work. You don’t just use tools; you possess an innate curiosity, treating AI as a high-trust collaborator that is core to how you solve problems and accelerate your impact. We look for low-ego individuals who thrive in dynamic and fast-moving environments and move with an experimental mindset — who rapidly test emerging capabilities to discover simpler, more powerful ways to deliver results. At Snowflake, your role isn't just to execute a function, but to help redefine the future of how work gets done. Snowflake product marketers develop and execute go-to-market strategies for the most strategic areas of the business. We are looking for a highly technical, driven, and self-motivated Product Marketing Engineer to lead competitive benchmarking for Snowflake’s Analytics portfolio. This role will own the end-to-end benchmarking process, from defining the testing strategy and designing the benchmarking architecture to executing workloads, validating results, and communicating the outcomes. You will partner closely with Product Management and Engineering to evaluate Snowflake products against competitive offerings using rigorous, repeatable, and defensible methodologies. You will translate technical benchmark results into meaningful customer outcomes and compelling market-facing narratives. Your work will appear across Snowflake blogs, partner publications, technical papers, presentations, demos, and videos. You will also closely monitor competitive products, technical claims, and published benchmarks, helping Snowflake respond quickly, credibly, and strategically. The role will support Snowflake’s broader Analytics portfolio, including Interactive Analytics for real-time use cases, Business Intelligence, Semantic Views, Ontologies, context for AI-powered applications, and core

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 Supervisor of Service Operations will maintain oversight of a team of claim processors and all claim related functions for Medicaid Claim Operations. We are seeking a highly motivated individual who will establish a clear vision aligned with company values and team goals. The claim Supervisor works with staff to align daily processing activities to successfully meet Health Plan metrics. Responsibilities will include: Managing a team of claim processors and overseeing daily operations for assigned health plan to achieve state required metrics. Manage employee performance and development. Identifies risks and barriers and collaborates with business partners to improve processes. Coaches and mentors team members, assisting with complex questions and customer interactions. Acts as liaison between staff and other areas, communicating workflow results, ideas, and solutions. Completes various business reports, including tracking, trending and results. Works with the Medicaid leadership team to allocate resources to meet volume and performance standards. Builds a cohesive team through collaboration, inclusion, and diverse thinking. Ability to work in a fast-paced production environment. Required Qualific

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 Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data. Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors. Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid