Senior Claims Benefit 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 Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

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

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

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary : This Underwriting role is for Meritain Health, an independent subsidiary of Aetna and CVS, and one of the nation's largest employee benefits administrators. We have the resources of a national carrier coupled with the unique flexibility and devoted service of a third-party administrator (TPA). The Meritain Health underwriting department supports the attainment of organizational goals through the issuance of prospective and existing business quotations and proposals. Including administrative fee pricing, stop loss, RFP questionnaire responses, and plan consultation. This fully-remote position will have the opportunity to work on a diversified book of business including Mid-Market and our Captive/Alternate channels. Responsibilities Include: Provide guidance and consultation to our Sales and Client Management teams on pricing and stop loss strategies Prepares and issues quotations and other financial deliverables for prospective and existing business while meeting established departmental TAT goals. Prepares financial projections on prospects utilizing financial models in Excel and Salesforce. Marketing and placement of stop loss policies, negotiating terms based upon claims data, strategy, relationships. and cost avoidance/reduction efforts. Works with leaders from key functional areas to understand p

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

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

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

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 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

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 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+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. 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 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

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

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