Senior Claims Lead — TRICARE & Managed Care
Providence
Providence’s Pacific Medical Centers USFHP team seeks a Lead Claims Specialist to adjudicate purchased services for enrolled capitated populations. You will resolve complex claims, manage advanced processing needs, and respond to customer inquiries with accuracy, leveraging TRICARE reimbursement rules for compliant, timely resolution. The role emphasizes leadership in a claims-focused environment within the Providence family of organizations, supporting patient-centered, whole-person care in the #J-18808-Ljbffr Providence
- ...Health & Services, is seeking a Lead Claims Specialist to adjudicate purchased... ...resolve complex claim situations, manage advanced processing needs, and apply TRICARE reimbursement knowledge to ensure... ...leadership in a dynamic managed care environment, with opportunities to...Claims
- ...Medical Centers in Renton, WA, is seeking a Lead Claims Specialist for the US Family Health... ..., assist customer requests, and apply TRICARE reimbursement knowledge to ensure compliant... .... The ideal candidate has extensive managed care/claims experience and a track record...Claims
- Are you a claims professional ready to step into a lead role where your expertise drives real results... ...claim situations, managing advanced processing needs... ...applying your expertise in TRICARE reimbursement to ensure compliant... ...-focused, whole-person care built on understanding,...Claims
- Providence is looking for a skilled claims adjudicator in Renton, WA. You will manage claims for our enrolled capitated population, providing excellent customer... ...situations. Our culture fosters patient-focused care, where your contributions are valued. Qualified candidates...SeniorClaims
- Providence Health Plan Group in Renton, WA is seeking a Claims Processor to adjudicate claims for its capitated population. You'll be responsible for complex claims adjustments and act as a primary resource in specific areas like EDI and Health Plan Repricing. Join us...SeniorClaims
- ...Centers in Renton, Washington is looking for an experienced claims adjudicator to manage and resolve complex claims. The ideal candidate will have a... ...Degree in a related field and at least 4 years of Managed Care operations experience. This role involves adjusting claims,...SeniorClaims
- ...who actively, genuinely care about our clients, each... ...and company. We LEAD with intelligence, hunger... .... Job Description The Senior Vice President (SVP) is... ...platform. This includes managing the financial performance... ...minimize and prevent E&O claims. Create and implement...SeniorClaimsFull timeWork at officeLocal areaFlexible hours
- ...Adjudicates all claims submitted by outside purchased services for PMC's enrolled capitated... ...problem claim situations. Assists in managing the workflow of assigned Line of Business... ...culture of patient‑focused, whole‑person care built on understanding, commitment, and mutual...SeniorClaims
- Pacific Medical Centers is seeking a Lead Claims Specialist to oversee adjudication of purchased... .... You will resolve complex claim issues, manage advanced processing, and respond to... ...equivalent experience, 4 years in managed care operations with 3+ years in claims processing...Claims
- Argo Group in the United States is seeking a Senior Construction Technical Claims Specialist Team Lead to adjudicate complex construction defect claims from any listed Argo offices or remotely, excluding certain states. The role combines technical claims analysis, leadership...SeniorClaimsRemote job
- ...seeks an Executive Director to join our Senior Leadership team at Aljoya Thornton Place,... ...24-hour leadership, guiding operations, care quality, staff relations, and financial objectives... ...long-term care, with a track record in managing complex operations, driving census growth...SeniorFull time
$160k - $225k
...seeking a Capture & Proposal Lead to build the pursuit strategies... ...contracts, compliance, and program management to develop differentiated win... ...library of reusable content, claims, evidence, graphics, and past... ...paid time off for you to take care of yourself so we all succeed....ClaimsPermanent employmentContract workFor contractorsFlexible hours- Argo Group seeks a Senior Environmental Claims Adjuster to adjudicate commercial environmental claims, primarily complex storage tank claims, in a 100% in-office role. You will work with a manager in New York City and support other offices with on-site presence as needed...SeniorClaimsRemote jobWork at office
- ...Senior Vice President, Platform Leader About the... ...commercial insurance risk management property & casualty... ...President (SVP) to lead the maintenance and growth... ...for operations and E&O claims prevention. The ideal... ...the company's values of care, collaboration,...SeniorClaims
$99k - $124k
...Lead Actuarial Analyst, MA Risk AdjustmentSeattle,... ...coordinating thoughtful care, and supporting people... ...and recommendations to senior leadership, illustrating... ...intellectual curiosity.Able to manage a high volume of... ..., MAO-004 and medical claims data.3+ actuarial exams...ClaimsWork at officeRemote workWork from homeFlexible hours- ...department workflow of the Claims Adjudicators and Claims... ...Monitors Medicare and TRICARE coding and payment... ...compliance with standards. Manages revisions to the code... ...-focused, whole-person care built on understanding,... ...Supervisory capacity, including Lead role; or six months...ClaimsMinimum wageContract workShift workNight shift
$58k - $78k
...Agency Manager at Cesar Ramos - State Farm Agent At Cesar Ramos - State Farm Agent, we're here to... ...pride in serving our community with integrity, care, and real support. Whether we're helping someone navigate a claim or personalize a plan, we believe in doing meaningful...ClaimsFor contractorsWork at office- Privia Health seeks a Sr. Population Health Operations Manager to advance operational value-based care strategies nationwide. You will lead cross-functional initiatives, optimize systems and workflows, and supervise a team of Operational Consultants to drive practice success...SeniorRelocation
- Gritter Francona is seeking a Program Implementation SME to provide senior-level expertise to support the ERCM Pilot focused on improving suicide prevention-related care coordination for Veterans at elevated risk. The role spans the full pilot lifecycle, from design through...SeniorFor contractors
- Lane Construction is one of America's leading construction companies, specializing in large... .... Description Coordinates and manages design firms as required, analyzes design... ...Developing Capabilities Quantity Management Claims Influencing and Communicating Design Coordination...SeniorClaimsContract workFor subcontractorWork at office
- ...an Inventory Control professional to join Enterprise Inventory Management Operations (EIMO). This role supports supply chain services across... ...reliable, people-centered operations that improve patient care. The position requires a Bachelor's Degree in Inventory Management...Senior
- ...Group in Renton, WA, is seeking an experienced professional to manage the Network Plan and ensure compliance with URAC and DoD standards... .... The ideal candidate will have a strong background in managed care operations, extensive experience in contract negotiations, and a...SeniorContract work
- U.S. Department of Veterans Affairs in Seattle seeks a Supervisory Chaplain to lead the chaplaincy program, supervise staff, and ensure full integration of religious and spiritual care into patient services. Requirements include a Master of Divinity or equivalent, ecclesiastical...Senior
$58k - $78k
...pride in serving our community with integrity, care, and real support. Whether we’re helping someone navigate a claim or personalize a plan, we believe in doing meaningful... ...in with us. We are seeking a motivated Agency Manager to provide leadership within the office and...ClaimsFull timeWork at office- Coordinated Care Agency, a dba of the Archdiocesan Housing Authority, seeks a Program Manager to lead Resident Services and oversee program budgets. The role emphasizes Housing First, Harm Reduction, and trauma-informed care for formerly homeless adults with mental health...Senior
- Ignite Human Capital in the United States is seeking a seasoned Case Manager to lead complex litigation matters under attorney supervision. This role serves as the central coordinator among attorneys, clients, outside counsel, paralegals, and vendors, blending advanced...SeniorLocal area
$117.5k - $222.99k
...the future. Company Overview: Leading with our core values of... ...solutions for healthcare cost and care management.MedInsight is a subsidiary of... ...Milliman MedInsight is seeking a Senior Product Strategy Manager to... ...operations, healthcare data, claims analytics, and health plan...SeniorClaimsFull timeWork experience placementRemote workFlexible hours$137.94k
...Contracts (Construction) Senior... ...lean into our mission: We Care. We Collaborate. We Deliver... ...is looking for a Senior Manager to join our Capital Projects... ...delays, change orders, and claims. You are passionate about... ...client value. You enjoy leading teams, developing talent...SeniorClaimsFull timeContract workTemporary workFor contractorsFor subcontractorLocal areaRemote workFlexible hours- ...& Company is hiring a Sr. Property Adjuster to resolve serious property losses, investigate claims, negotiate settlements, and present evidence when required. You will manage complex files under limited supervision, maintain high production levels, and sometimes work...SeniorClaims
$117.5k - $222.99k
...Milliman delivers market-leading services and solutions... ...financing, risk management and regulatory compliance... ...for healthcare cost and care management. MedInsight... ...MedInsight is seeking a Senior Product Strategy Manager... ...organizations, healthcare claims, clinical and pharmacy...SeniorClaimsHourly payFull timeTemporary workWork experience placementWork at officeRemote workWorldwideFlexible hours
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