Plan Testing Specialist: ACAS & Claims Validation Expert
CVS
CVS Health in New Jersey is seeking an Analyst, Plan Testing to support Commercial plan testing by interpreting client intent behind medical benefit designs and validating that intent through claims-based testing in ACAS. You will collaborate with stakeholders and guide testers on how to validate plan behavior. The role requires strong communication skills and expertise in ACAS, with a focus on accurate testing of new and revised plans before claim release. #J-18808-Ljbffr CVS Health
- ...problem‑solving while providing expert feedback that helps models produce... ...). Ensure Model Integrity: Test AI models for potential inaccuracies or biases, validating their reliability across use cases... ...habits and comfort validating claims using reputable sources when required...ClaimsHourly payFor contractorsRemote workFlexible hours
- CVS Health is seeking an Analyst, Plan Testing to support Commercial plan testing by interpreting client intent behind medical benefit designs and validating that intent through claims-based testing in ACAS. This role requires collaboration and strong communication, with...Claims
- Biology AI Subject-Matter Expert is a remote review track for evaluating... .... AuraOne uses scientific specialists to grade outputs the way a... ..., or experimental claims. Flag dimensional, methodological... ...Scientific reasoning Method validation Citation review Quantitative...ClaimsHourly payFor contractorsRemote work10 hours per week
- ...insurance and actuarial domain expert to work directly with a... ...are looking for a practicing specialist rather than a generalist. This... ...credential (FSA, ASA, FCAS, or ACAS) or an active state insurance... ..., enterprise risk management, claims adjudication, or underwriting....ClaimsFull timeContract workPart timeFreelanceLive inRelocationRelocation package
$116k - $194k
...Are you an experienced professional liability claims professional with a real passion for providing exceptional customer service? Do you embrace the challenge of handling complex claims while providing market leading customer service? If you are motivated by working in...ClaimsFull timeTemporary workWork at officeRemote workWorldwideFlexible hours- ...Logan Health is seeking a Medical Billing & Collections Specialist for a remote, full-time position. The specialist will ensure the accuracy of claim submissions and handle various billing responsibilities. The role requires 1+ year of experience in a medical setting,...ClaimsFull timeRemote work
- Ryan Specialty, LLC is seeking a Contract Loss Adjuster to play a critical role in our claims operations. The ideal candidate will conduct field inspections, evaluate crop damage, and ensure compliance with MPCI program guidelines. Responsibilities include collecting data...ClaimsContract work
- CorroHealth, Inc. is seeking an Insurance Specialist 3 for remote work within the US (Hawaii Time Zone). You will resolve complex LTC/SNF/ICF unpaid or denied claims, prepare submissions to Medicare/Medicaid/private insurers, and ensure UB-04 and RAI/MDS compliance. The...ClaimsRemote job
- ...take our RCM solutions — denials management, prior authorization, claims submissions, referral management, and more — from concept to... ...and adapt to local workflowsIterate rapidly with end users to validate that what we're building is what they actually want and needScale...ClaimsWork at officeLocal areaImmediate startRemote work
- Cover Genius seeks a Licensed Claims Adjuster to adjudicate regulated insurance claims within the Digital Commerce vertical. The role combines regulatory compliance with technical accuracy to strengthen financial risk controls across the claims function. Responsibilities...ClaimsRemote job
- ...Biller to manage the complete billing cycle, including Revenue Cycle Management (RCM) and Accounts Receivable (A/R). You will oversee claims submissions, investigations of denials, and ensure compliance with HIPAA. The ideal candidate will have proven experience in dental...Claims
$100k - $130k
A leading National Insurance Carrier is looking for a Senior Commercial Property Claims Examiner to join their remote team. In this role, you will manage complex claims, including litigated files up to $2M, collaborate with legal stakeholders, and ensure timely resolution...ClaimsRemote job- American International Group (AIG) is seeking a Senior Claims Examiner - International Casualty to manage bodily injury and property damage... ...to travel as needed. Based in NY area with eligibility for bonus under incentive plans. #J-18808-Ljbffr American International GroupClaims
- ...compliance, and legal professionals to join our on-call AI Evaluation Specialists network. This remote, project-based role involves evaluating... ...candidates have real-world expertise in investment banking, FP&A, fixed income, claims auditing, forensic #J-18808-Ljbffr DoradoClaimsRemote jobFlexible hours
$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities...ClaimsRemote job$150 - $180 per hour
Expert Equities Research Reviewer [$150-$180/hr] Expert Equities Research Reviewers to evaluate AI-generated multi-source investment research... ...across key quality dimensions, including: Source reliability Claim confidence calibration Internal consistency Completeness of...Claims$60 per hour
...hourLocation:Remote Role Responsibilities Construct enterprise insurance scenarios for complex commercial underwriting, multi-stakeholder claims adjudication, and regulatory compliance review cycles at Fortune 500 carriers. Build insurance tasks across F500 underwriting,...ClaimsRemote jobSummer work- ...Description Job Description English Language Expert Job Type: Contractor Location:... ...and identify unsupported or inaccurate claims. Edit and revise AI-generated responses... ..., and contextual understanding. Test AI models across different use cases to identify...ClaimsRemote jobHourly payFor contractors
- Sompo is hiring a Claims Counsel, CML to manage U.S. CML Public Company claims, provide legal review and support to Underwriting, and analyze complex exposures. The role requires JD and 1-5 years in D&O claims handling with cross-functional collaboration. Based in multiple...Claims
- Sompo Holdings, Inc. seeks a Claims Counsel, CML to manage US Public Company claims within the CML team. The role provides legal review and underwriting support, delivering insight on complex claims and trends across D&O, fiduciary, and fidelity exposures. The position...Claims
- Yoh in New York is seeking a Senior Claims Counsel - Professional Liability to oversee examination, evaluation, and processing of complex claims estimates and paid values, ensuring policy terms are followed in line with the company philosophy. The role includes managing...Claims
- ...A leading pet insurance provider is seeking a Claims Adjuster in New York, NY. The role involves managing claims processing and evaluating veterinary medical records. Ideal candidates should have at least five years of veterinary experience and be capable of working independently...ClaimsRemote work
- ...consulting services to its clients, ensuring compliance with regulations. The role involves fielding customer inquiries, managing employee claims, and improving HR compliance systems by collaborating directly with Rippling's product and engineering teams. Candidates should...Claims
- Trucking Safety & Compliance Expert (Independent Contractor) Location: Remote / Nationwide Engagement Type: Independent Contractor (109... ...FMCSR) and trucking best practices to evaluate the merits of legal claims. You will act as a neutral third-party expert, providing...ClaimsHourly payPrice workFor contractorsRemote workFlexible hours
- ...States is seeking a Senior Total Loss Adjuster to manage total loss claims. This role requires at least 5 years of experience in total loss... ...package, including medical, dental, vision, PTO, and a 401k plan, within a collaborative and forward-thinking work environment. #J...Claims
- Jobgether is looking for a LTD Claims Consultant based in the United States. The role involves managing long-term disability claims, providing expert adjudication guidance, and driving improvements in claim decisions and efficiency. You will mentor colleagues, support...ClaimsRemote job
- Northeast Georgia Health System is seeking a Rev Cycle Specialist II to manage complex account follow-ups and claims resolutions. Candidates should have a minimum of 3 years of hospital billing experience and a High School Diploma or GED. The role demands understanding...Claims
$90k - $200k
...Kroll's Expert Services Kroll's Expert Services practice provides valuation, economic... ...the development and evaluation of damages claims and other financial calculations Organize... ...medical, dental, and vision plans. Time Off and Leave Policies: Generous...ClaimsTemporary work$140k - $160k
AXIS Capital is seeking a Senior Claims Specialist to support their expanding presence in North America's excess market. You will assess claims... ...processing efficiency. The ideal candidate is a recognized expert in claims management, adept at mentoring and fostering...Claims- ...work—the daily operations that keep medical practices, hospitals, and health plans running. You will own core workflows such as patient access, prior authorizations, revenue cycle, and claims processing. The ideal candidate has 3+ years in healthcare administration, hands...ClaimsWork at office
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