Vice President of Claims Adjudication
Confidential
Vice President of Claims Adjudication
About the Company
Premier cost-effective commercial insurance provider
Industry
Insurance
Type
Privately Held, VC-backed
Founded
2017
Employees
201-500
Funding
$200+ million
Categories
- Insurance
- Financial Services
- Insurance
- InsurTech
- Small and Medium Businesses
Specialties
- insurance
- insuretech
- workers' compensation
- and small business insurance
- small business insurance
- and commercial auto
About the Role
The Company is seeking a Vice President of Claims Adjudication to play a pivotal role in the design and execution of its claims strategy and programs. The successful candidate will be responsible for leading the claims adjudication function, with a focus on delivering optimal claim outcomes and exceptional customer experiences. This leadership role involves strategic planning, fostering relationships both internally and externally, and ensuring that the claims adjudication operations align with the broader claims strategy. The VP will also be accountable for the financial and performance aspects of the claims adjudication operation, driving continuous improvement, and leading innovation and technology initiatives to enhance the claims process. Applicants must have a minimum of 15 years' experience in workers' compensation claims, field claims operations, and claims adjudication, with at least 10 years in a people management role. The role requires an individual with a strong industry leadership track record, expert knowledge of managing disputed and litigated claims across multiple jurisdictions, and a data-driven approach to claims management. The ideal candidate will have a proven ability to contribute strategic insights, inspire and influence others, and foster a culture of open communication, continuous improvement, and innovation. Superior communication skills and the ability to represent the organization as a claims subject matter expert are essential. Experience in crisis communication and managing high-stakes stakeholder relationships is also a key requirement.
Hiring Manager Title
Chief Claims Officer
Functions
- Operations
- ...The Vice President, Complex Claims provides executive leadership for Fortegra's Complex Claims function, overseeing the handling, strategic direction, coverage analysis, litigation oversight, and resolution of the Company's highest-severity, major loss, and high-value...ClaimsTemporary workLocal area
- ...Vice President, Enterprise Quality & AutomationLocations: Atlanta, GA, Jacksonville, FL, Fort Worth, TXAbout the RoleAs Vice President of... ...business impact.Healthcare experience, particularly pharmacy claims and PBM; medical claims and health plan experience.What Sets You...ClaimsOngoing contract
- ...Senior Vice President, Liability Operational Strategy About the Company Renowned provider of workers’ compensation & risk management... ...liability ~ general liability ~ ancillary benefit management ~ claims management ~ provider network ~ pharmacy benefit...Claims
- ...Vice President of QA & Automation About the Company Large healthcare technology and services organization focused on enterprise quality... ...in healthcare technology, particularly in pharmacy, claims, or health-plan environments, and experience in applying automation...Claims
- ...Vice President of Engineering About the Company Respected security & investigations company specializing in risk mitigation & investigative... ...utilization management case management bill review claims management osint medical canvassing and ai About...ClaimsRemote work
- ...Vice President of Revenue Cycle About the Company Tech-enabled, multi-specialty medical practice delivering high-touch, data-driven... ...role includes evaluating and integrating modern technologies for claims processing, denial management, and payment analytics, while...Claims
- ...Vice President of Sales About the Company AI-enabled healthcare revenue cycle management company serving complex medical billing and claims recovery. Industry Hospital & Health Care Type Privately Held About the Role The Company is seeking a Vice...Claims
- ...Vice President, Business Development, Life Sciences About the Company AI-driven healthcare analytics platform Industry Hospital... ...heor biotechnology real world evidence lab data and claims data Business Classifications SAAS B2B Enterprise...Claims
- ...Vice President of General Liability Claims About the Company Fast-growing organization providing innovative claims solutions Industry Insurance Type Privately Held, VC-backed Founded 2022 Employees 501-1000 Funding $26-$50 million Categories...Claims
- ...Vice President of Gig Economy Claims About the Company Fast-growing organization providing innovative claims solutions Industry Insurance Type Privately Held, VC-backed Founded 2022 Employees 501-1000 Funding $26-$50 million Categories...ClaimsRemote work
- ...Senior Vice President, Benefits About the Company Global risk management firm helping clients navigate complex risks with creative solutions... ...specialty wholesale strategic risk analytics claims advocacy bermuda market access intermediaries group captives...Claims
- ...Vice President, Risk & Insurance About the Company Nationally recognized commercial construction organization with diverse portfolio... ...risk strategy, with a strong background in complex construction claims environments and a proven track record of managing...Claims
- ...Vice President, Medical Affairs About the Company Industry-shaping mobile application empowering employees to improve heart health... ...Responsibilities include translating evidence into clear, defensible market claims and commercial materials, supporting customer and partner...Claims
- ...Vice President, Risk Management About the Company A leading farmer-owned agribusiness cooperative serving member-owners across a multistate... ...risk framework, insurance requirements, and all phases of the claims process. The VP will also be tasked with managing...ClaimsWork at office
- ...Vice President of Medical Economics About the Company Healthcare organization focused on medical cost analytics and value-based care... ...performance strategy. The role oversees analysis of healthcare claims, utilization, risk, and provider performance to identify opportunities...Claims
- ...Vice President of Product, Interoperability About the Company Globally-recognized payment integrity & transaction analytics company... ...subject matter expertise in payer/provider interoperability and claims processing operations is essential, with a strong preference for...ClaimsContract work
- ...Vice President of Sales About the Company Leading organization specializing in claims management solutions Industry Hospital & Health Care Type Privately Held, VC-backed Founded 2006 Employees 1001-5000 Categories ~ Health Care Specialties...ClaimsContract workWork at office
- ...Vice President, Law Firm Professional Services About the Company Leading provider of a legal management software solution Industry... ...immigration legal document management legal billing claims litigation and in-house legal Business Classifications...Claims
- ...Vice President of Commercial Strategy About the Company Innovative healthcare technology (HealthTech) company providing cloud-based... ...Insurance Specialties clinical and quality outcomes claims and payment integrity healthcare data insights predictive...Claims
- ...Associate Vice President of Revenue Cycle About the Company Leading hospice, palliative & home health care provider Industry Hospital... ...staff, and ensuring the timely and accurate submission of claims across various payers. The role also requires close...Claims
- ...Vice President & Associate General Counsel, Litigation About the Company Well-recognized operator of hospitals, nursing centers & other... ..., and court proceedings. The role also oversees liability claims, settlement recommendations, legal reserves, litigation reporting...Claims
$110k
...onboard to help drive growth. POSITION SUMMARY The Vice President of Recoveries provides strategic leadership and operational... ...operations for telecommunications and utility infrastructure damage claims, with a focus on maximizing financial recoveries from liable...ClaimsFull timeFor contractorsLive inRemote work- ...Fortegra is seeking an experienced Vice President, Complex Claims to lead the Complex Claims function in Jacksonville, FL. You will steer strategy, coverage analysis, and litigation oversight for the Company's highest-exposure claims while collaborating with senior leaders...Claims
- Overview Insurance Claims Specialist Work Style: Hybrid Location Requirement: UF Health Jacksonville FTE: Full-Time (1.0 FTE) Manages... ...Working knowledge of insurance policies, coverage, and claim adjudication processes Experience investigating, resolving, and following...ClaimsFull time
- ...Vice President of Human Resources Hampton Golf Jacksonville Florida Support Center Compensation: Competitive salary based on experience... ...with legal counsel insurers and leadership on employment claims litigation and EPLI matters. Oversee policy interpretation...ClaimsFull timeContract workFor subcontractorWork at officeLocal areaShift work
- ...Vice President of People About the Company AI-driven infrastructure for payers, providers & value-based care organizations Industry... ...consulting predictive modeling data management adjudication neutral-arbitrator value-based contract adjudication...Contract work
- ...Manage customer accounts and update information in the database.Assist customers with policy changes and inquiries.Process insurance claims and follow up with customers on claim status.Coordinate with underwriters to ensure timely policy issuance.QUALIFICATIONS: Strong...Claims
- ...-10, CPT, and HCPCS codes to diagnoses, procedures, and treatments. Ensure that coded data is correctly submitted for insurance claims, adhering to payer-specific guidelines and medical coding standards. Maintain strict adherence to healthcare regulations, including...ClaimsApprenticeshipWork at office
- ...licensed investigator looking for flexible hours while providing expert investigative services. We investigate all types of insurance claims including workers' compensation, suspected fraud, liability and aimed at mitigating expenses for our clients and delivering high-...ClaimsFlexible hours
- ...evaluating and proposing timely resolutions to general insurance claims such as General Liability, Workers Compensation, Auto Liability... ...for reserving, settlements and information needed from CSX to adjudicate the claim Assist insurance department with underwriting...ClaimsFor contractors
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