Health Claims Case Specialist - Adjudication & Investigations
Stryker Orthopaedics
Sun Life in the United States seeks a Case Specialist, Supplement Health Claims to manage initial liability claims for Critical Illness, Cancer, Hospital Indemnity and Accidental plans. You will review data, investigate with claimants and partners, and determine initial liability with independence and accuracy. You will work with clinical staff, interpret policy language, and communicate benefits payable while maintaining timely, compliant processing. #J-18808-Ljbffr Stryker Corporation
- Sun Life is seeking a Case Specialist for Supplement Health Claims in the United States. The role involves independent claim review, eligibility determinations... ..., and collaboration with employers and carriers to adjudicate benefits under applicable contracts and regulations....Suggested
- Mass General Brigham Health Plan is seeking a detail-oriented claims processor to work remotely, performing claims adjudication and coding verification to ensure accurate payment and compliance with billing regulations. Ideal candidates will have 2-4 years in healthcare...SuggestedRemote jobFull time
- Mass General Brigham Health Plan is an exciting place to be within the healthcare industry... ...more. Job Description Summary Review claims to ensure accurate coding, appropriate... ...billing regulations and payer guidelines. Adjudicate claims to pay, deny, or pend as...SuggestedFull timeWork at officeRemote workMonday to FridayFlexible hours
$26 per hour
...We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Waltham, MA. This... ...Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy.... ...first call resolution to help health care providers and patients with their...SuggestedFull timeTemporary workWork experience placementRelocation packageFlexible hoursShift work- Acadia Insurance, Marlborough, MA, is seeking an experienced claims professional to investigate, evaluate, and resolve high exposure commercial liability claims. You will negotiate with insureds and third parties, coordinate with underwriting and loss control, and mentor...Suggested
$1,000 per month
...evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche... ...Description As a Field Property Adjuster, you will investigate and evaluate homeowners property claims from start to finish. You will confirm the facts of...Contract workFor contractorsWork at officeWork from homeVisa sponsorshipWork visaRelocation package- ...for focused tasks and projects. The Claims Specialist works within a Claims Team, using the... ...to moderately complex claims from the investigation of the claim through resolution. This... ...liability. Establishes action plan based on case facts, best practices, protocols,...Work experience placementWork at officeLocal areaRemote work
$69k - $98k
Senior Claim Representative Sharing Economy - Accident and Health (Hybrid) Our employees are at the heart of what we do: helping people, businesses and society... ..., determines and completes appropriate level of investigation to make determination of coverage, assess...Full timeWork at officeFlexible hours$110k - $120k
...Superior) by A.M. Best, with an A+ claim paying ability rating by... ...URL: Responsibilities Investigate, evaluate and resolve assigned... ...direction, handles the most complex cases and those involving the most... ...bonus Benefits include: Health, dental, vision, dental, life...Full time$78k - $106k
...medical and emotional and mental health benefits, dental, and vision... ...week. Responsibilities The Claims Specialist under the supervision of the... ...responsible for proactively investigating, managing, and resolving... ...necessary, such as medical case management, vocational rehabilitation...Temporary workFor contractorsFor subcontractorWork at office$21.1 - $44.99 per hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At... ...underwriting exceptions/financial variances for their assigned cases to the appropriate level. Assists sales personnel in explaining...Hourly payFull timeTemporary workWork at officeLocal area$89.89k - $134.84k
Who We ArePoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan...Full timeWork from home$49.01k
...nutritional counseling, and mental health resources Tuition... ...trained. Job Responsibilities Claim Service Specialists act as advocates for our... ...loss, inspect the damage, and investigate all documentation to ensure... ...thoroughly check claim case facts, determine coverage,...Full timeWork experience placementRemote workFlexible hours$18 - $25 per hour
Pathways Healthcare is a leading home health and hospice provider, focused on patient-centered care. The main office is located in Westwood, MA, with a schedule Monday-Friday, 8:30 AM-5:00 PM. This full-time billing role offers an hourly rate of $18.00-$25.00. Join a mission...Hourly payFull timeWork at officeMonday to Friday$83k - $157k
...$83000.00 - $157000.00 Job Category: Claims Description Looking for an amazing... ...opportunity? Senior Complex Construction Claims Specialist - Complex CGL & Construction Liability... ...and liability strategy, directing investigations and experts, coordinating litigation...Full timeWork at officeLocal areaImmediate startRemote workHome office$72k - $141k
...authority limits, to manage commercial claims with high complexity and exposure for a... ...protocols to verify policy coverage, conduct investigations, develop and employ resolution... ..., and preparing and presenting succinct case summaries to senior management.Maintains...Full timeWork experience placementWork at officeLocal areaShift work$101.18k - $119.78k
...the unique coverage and claims‑handling needs of... ...City and is focused on adjudicating first and third party... ...own coverage letters. Investigating claims promptly and thoroughly... ...tasks to ensure that cases move to the best... ...benefits program‑including health, dental, vision, 401(k...Full timeLocal areaRemote work$18 - $25 per hour
Pathways Healthcare, LLC in Westwood, MA is hiring for a full-time billing role focused on home health and hospice claims. You will audit, prepare, and follow up on documentation to ensure accurate and timely billing while supporting patient care. The position follows a...Hourly payFull timeMonday to Friday$100k - $165k
...property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of... ...financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we are...Local area$78k - $112k
...product roll out. Collaborating with underwriters, operations, claims, marketing and home office product management Consistently... ...property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of...Work at officeLocal areaHome office$37.66 - $44.33 per hour
...the unique coverage and claims-handling needs of... ...(PA). This role will adjudicate indemnity workers' compensation... ...and developments. Investigate claims promptly and... ...complete tasks to ensure cases move toward the best... ...benefits program, including health, dental, vision, 401(k...Hourly payTemporary workRemote work- ...Claims And Program Representative As a Claims and Program Representative, you will... ...evaluates its validity and acceptability. Adjudicate claims for benefits and makes... ...award payment of benefits. Conduct investigations, including sensitive and difficult interviews...Work at officeLocal area
- Auto-Owners Insurance in Arlington, MA is seeking a motivated individual to join our claims team. The role handles claims under close supervision from investigation through resolution, with initial in-person training and potential flexible work‑from‑home arrangements based...Work from homeFlexible hours
$80k
Sedgwick in Boston, Massachusetts, is looking for a claims management professional to analyze and process complex auto and commercial... ...line auto policies. Responsibilities include coordinating investigations, managing vendors, and ensuring proper documentation. The role...$150k
...workers’ compensation, along with claim services, providing expertise... ...currently seeking a Claims Specialist. This individual would be... ...responsible for reviewing, processing, investigating, evaluating, negotiating and... ...bonus. Benefits: Health, Dental, Vision, Life, Disability...Full time- ...looking to make a meaningful impact on public health and the environment? Join the MWRA team!... ...and implements the construction claims management programs for all MWRA engineering... ...requested. Participates in review and investigation of potential design errors and omissions...Contract workFor contractorsWork at officeRemote workMonday to Friday
- Staples, Inc. in Framingham, MA is seeking a Claims Associate to triage incidents, support investigations, and resolve workers’ compensation claims while collaborating with risk and legal teams. You’ll safeguard data, handle daily admin tasks, and serve as the main contact...
$62k - $68k
Arbella 56 Group is seeking a Claims Specialist in Wakefield, Massachusetts. This role involves investigating and resolving total loss claims for vehicles while ensuring excellent customer service and careful management of payouts. Ideal candidates will have at least 18...- ...CNA Insurance in Boston, MA seeks an individual contributor to manage commercial claims of low to moderate complexity. Under supervision, you will investigate, verify coverage, reserve appropriately and communicate with insureds and partners to ensure quality service....
- USI Insurance Services in Needham, MA is seeking an experienced claims adjuster for workers' compensation claims. You will adjust lost time and non-lost time claims, communicate with clients and carriers, and review and authorize related expenses. You will influence outcomes...
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