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
- ...Vice President, Strategic Solutions & Delivery About the Company Innovative provider of cost containment technology & case management... ...responsibilities include serving as a thought leader in casualty operations, claims modernization, and AI-enabled business processes, as well as...Claims
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- ...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 of Preconstruction About the Company Nationally recognized commercial construction organization with diverse projects... ...insurance structures, SDI programs, surety/bonding, and construction claims environments. Leadership characteristics include a...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
- ...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
- ...the Role Sedgwick is seeking a seasoned and highly effective Vice President, IT Internal Audit to help lead and advance the Company’s... ...this or other roles. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating...ClaimsLocal areaRemote work
- ...a hospital setting. Ensures accurate and timely submission of claims, works to resolve outstanding balances, and communicates effectively... ..., or by contacting third-party payers or guarantors Review adjudicated claims from Medicare, Medicaid, and commercial carriers for...Claims
- ...such as co-pays and deductibles, and generating reports for all of these activities. Duties may also require follow-ups on denied claims, daily insurance claims, and posting payments made by patients to their account. Responsibilities You will have to solve collection...Claims
- ...Specialist to manage all aspects of medical AR collections for a physician medical group. This role will focus heavily on insurance claim denial follow-up, unpaid claims, payment recovery, billing issue resolution, and account management.Key ResponsibilitiesManage assigned...Claims
- ...across South Texas. As we expand our footprint with new hospitals and growing specialty services, we are seeking a visionary Vice President of Cardiovascular Services to lead one of our most critical and high-impact service lines. This is a rare opportunity to shape...
$19 per hour
...Reimbursement Specialist to join our healthcare team. The ideal candidate will be responsible for managing and processing medical claims, ensuring accurate reimbursement from insurance providers, and maintaining compliance with healthcare regulations. This role requires...ClaimsFull timeWork at office- ...adjusting experience is required for career-entry applicants. Are you interested in building a career as an Independent Insurance Claims Adjuster? With continued storm activity and catastrophic weather events across the country, experienced and properly trained adjusters...Claims
$60k - $90k
...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...ClaimsFor contractors- .../RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system... ...contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies....Claims
- POSITION SUMMARY/RESPONSIBILITIES Performs review, analysis, and adjudication of all claim types including coordination of benefits and DME claims. Performs analysis of provider appeals and documents outcome determination via correspondence. Acts as a provider liaison for...Claims
- ...established and growing law firm is seeking a skilled and dedicated attorney with significant experience in first-party homeowner property claims to join its dynamic team. The ideal candidate will bring a strong background in representing policyholders in disputes with...ClaimsFull timeRelocation package
$45k - $70k
...yearManage 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.Strong organizational...ClaimsWork at office- POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children’s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the...Claims
- ...is seeking a Chief Operating Officer (COO) with a strong background in self-funded healthcare operations, stop-loss programs, and claims management. The successful candidate will be responsible for a combination of strategic and tactical activities to support the company...ClaimsRemote work
- ...Vice President, Executive Search & Business Development About the Company Nationally recognized executive search firm Industry Staffing and Recruiting Type Privately Held Founded 1979 Employees 1-10 Categories Consulting & Professional...
- ...following areas:Wholesale OperationsShared Services OperationsConsumer Banking and Lending OperationsPayments OperationsFraud and Claims ManagementGlobal Operations Strategy and ExecutionBusiness CommunicationsGlobal Operations Data, Analytics, and ReportingEligible applicants...ClaimsRotational programFull timeWork experience placementSummer workInternshipSummer internshipWork at office
- ...Responsibilities: Supervise Insurance and Patient AR workflows, staffing, productivity, and performance. Oversee insurance follow-up, claims resolution, and escalated billing issues. Monitor quality through audits, reporting, and performance metrics. Ensure compliance...Claims
- ...experience in insurance defense and subrogation litigation, coupled with a strong background in commercial and construction defect claims. This individual serves as a trusted advisor to clients and claims professionals, provides strategic case assessments, and contributes...ClaimsFor contractorsFor subcontractorWork at officeRemote work3 days per week
- ...transmittal of complete packages to OPM Retirement Services for final adjudication. Leads benefit program learning initiatives, including... ...life events or changes in eligibility. Serves as a senior claim's administrator on behalf of the customer agency, providing...ClaimsFlexible hours
- ...Contracting staff for contracting issues or concerns; and will periodically assist the Claims staff with auditing and troubleshooting of provider data to ensure proper claims adjudication. The Provider Relations Representative knows and abides by all organizational and...Claims
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