Lead Claims Auditor 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 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&#43; years of experience in healthcare analytics, Payment Integrity, Fraud, Waste & Error (FWE), Special Investigations, or related healthcare operations. 5&#43; years of experience leading analytical projects or providing technical leadership within a healthcare environment. Demonstrated experience working with healthcare claims platforms including ACAS, QNXT, HRP, or comparable systems. Experience using SAS, SQL, Python, R, or other analytical and statistical programming languages. Experience performing advanced data analysis, opportunity identification, trend analy

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

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

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As the Senior Lead Coordinator you will be responsible for implementing and maintaining comprehensive billing review processes. You will identify and quantify trends/issues and effectively communicate/report them to the appropriate members of the management team and payer business partners along with the potential impact. You will assist leadership in building and maintaining a high performing highly engaged team. In this role you will also provide excellent mentorship and support to your colleagues as well as design and implement training classes. The key responsibilities of the Medical Revenue Cycle Senior Lead Coordinator are: Review and analyze patient profiles, benefits, and prior authorizations to identify potential issues affecting clean claims. Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing. Monitor claims submissions and follow up on pending claims to expedite resolution and payment. Identify trends in claims denials and develop strategies for improvement. Conduct training sessions for staff on best practices for claims submissions and compliance. Maintain up-to-date knowledge of insurance policies, regulations, and healthcare trends that impact claims

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

About the Team OpenAI’s mission is to ensure that artificial general intelligence benefits all of humanity. Our Communications team supports that mission by explaining our technology, our values, and how we safely build powerful AI. We help business leaders see what AI can make possible for their organizations, show how customers use OpenAI’s products, and explain how AI is changing the way people work. About the Role We are looking for a senior product communications leader to own OpenAI’s B2B product story across business, trade, and nontraditional media. You will lead B2B communications for major product and platform moments, translate technical capabilities into clear business value, and build a sustained editorial program grounded in customer proof. Your work will help business leaders understand the problems our products solve and the outcomes they can enable using frontier intelligence. This is an exceptionally fast-paced, hands-on role that spans every altitude of communications. You will move from setting strategic positioning and shaping executive narratives to writing launch materials, developing media pitches, and delivering the details that make a story land. Working closely with Product, Research, Marketing, Sales, and our central Product Communications team, you will identify buyer needs, substantiate our claims, and carry a clear, consistent B2B story into the market. This role reports to the Head of Business Communications. In this role, you will: Set the positioning for OpenAI’s business products, connecting new capabilities to customer needs, the work they enable, and the evidence behind our claims. Lead business storytelling for priority launches across Codex, ChatGPT Work, API and developer capabilities, agents, and other enterprise products, in partnership with central Product Communications and product owners. Build a sustained editorial program between launches, using customer stories, explainers, and executive perspectives to show how our pr

ABOUT BASETEN Baseten powers mission-critical inference for the world's most dynamic AI companies, like Cursor, Notion, OpenEvidence, Abridge, Clay, Gamma, and Writer. By uniting applied AI research, flexible infrastructure, and seamless developer tooling, we enable companies operating at the frontier of AI to bring cutting-edge models into production. We're growing quickly and recently raised our $1.5B Series F , led by Altimeter Capital, Conviction Partners, and Spark Capital. Join us and help build the platform engineers turn to ship AI products. THE ROLE This role owns Baseten's relationships and market intelligence across hyperscalers and strategic neoclouds, including NVIDIA cloud partners. This is a technical and commercial role in equal measure: you'll evaluate capacity from the GPU to the data center, negotiate cost and terms with suppliers, and stay close enough to the market to develop and defend a real point of view on where it's heading. Given current market conditions, Baseten needs a much stronger pulse on this part of the market so we can track pricing, stay close to the right relationships, and move fast the moment more capacity is needed. This is a senior, experienced hire who will also help pair with and develop 1-2 junior to mid-level teammates covering the same space. WHAT YOU'LL DO Build and maintain deep relationships across hyperscalers and strategic neoclouds (including NVIDIA cloud partners), working each organization from top to bottom rather than a single point of contact Maintain a consistent, "top of mind" presence with key accounts so Baseten is positioned to move quickly when capacity needs arise Evaluate capacity from the GPU to the data center — hardware generation, rack and node configuration, interconnect, power density, and cooling — so you know what a configuration will actually deliver, not just what the spec sheet claims Live in compute pricing daily: track rates by GPU generation, region, and contract term to keep Baseten inf

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

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

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

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

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