Senior Medical Claims Specialist: Adjudication & Refunds
CVS
CVS Health is seeking a full-time medical claims processor in Pennsylvania to review and adjudicate complex claims across self-funded and fully insured plans, process refunds, and handle inquiries. The role emphasizes adherence to guidelines, cost containment, and accurate payments. Qualified candidates will have 2+ years of claim processing experience in a production setting, strong communication skills, and the ability to juggle multiple tasks efficiently. #J-18808-Ljbffr CVS Health
$10k
Great American Insurance Group seeks a Senior Medical Only Claims Representative to investigate, manage, and resolve workers' compensation medical-only claims across MN, IA, NE, SD, KS, and MO in a fully remote role. You will verify coverage, communicate with injured workers...SeniorRemote job$65k - $80k
Great American Insurance Group, a member of American Financial Group, is seeking a Senior Medical Only Claims Representative for a fully remote role primarily handling Texas, Arkansas, and Oklahoma workers’ compensation medical-only claims. This position requires independence...SeniorRemote jobFull time$100k
...to meet the unique coverage and claims-handling needs of businesses. The... ...Description Business Title(s): Senior Construction Defect Technical Claims Specialist Employment Type: Full-Time FLSA... .... This role will be adjudicating our most complex construction defect...SeniorFull timeLocal areaRemote work- ...Raintree Systems, Inc. in Chandler, AZ, is seeking an Accounts Receivable Specialist - Medical Claims for a fully remote role within designated U.S. states. You will handle billing, reimbursements, and claims follow-through for multispecialty medical services with HIPAA...SuggestedWork at officeRemote work
- ...and/or oversee commercial and financial lines Public and Private D&O, Financial Institutions E&O, EPL, Fiduciary and Crime/Fidelity claims. * Handle claims in accordance with Claim Handling Best Practices in all phases of the claim including through initial contact,...SeniorWork at office
$125k - $175k
A leading insurance company is looking for a Senior Claims Specialist to manage general liability claims, particularly in New York construction. You will conduct coverage analysis, negotiate resolutions, and collaborate with management and stakeholders to meet business...Senior- OdysseyRe in New York City is seeking a Senior Claims Specialist to lead coverage analysis, investigation, and resolution of complex general liability claims with emphasis on construction matters. You will collaborate with underwriting, actuarial, and management to drive...Senior
- Our client, a nationally recognized A+ rated insurance carrier, seeks a Sr. Construction Liability Claims Specialist to manage complex New York Labor Law and Construction Liability claims from inception to resolution. Responsibilities include investigating coverage, evaluating...SeniorRemote job
$69.39k - $84.81k
...actively seeking a talented Sr Long Term Disability Claims Specialist to join our growing Work Force Benefits Division. As a Senior Long Term Disability Claims Consultant you’ll... ..., including the ability to evaluate complex medical, vocational, and financial information...SeniorContract workWork experience placementFlexible hours- West Bend is seeking an experienced casualty claims professional to handle complex cases across construction defect, general liability, commercial transportation, and auto bodily injury lines. You will evaluate coverage and damages, negotiate settlements, and coordinate...Senior
- MetLife in the United States is seeking a Senior Life Claims Examiner to review FEGLI life claim submissions remotely from home. You will apply technical expertise to investigate pended claims, advocative in-depth knowledge of FEGLI procedures, and coordinate with internal...SeniorRemote jobWeekend work
$80k - $95k
A leading insurance staffing agency is seeking a Senior Commercial General Liability Claims Specialist. This remote role involves managing complex claims, requiring... ..., along with comprehensive benefits including medical, dental, and 401(k) matching. #J-18808-Ljbffr King's...SeniorRemote job- ...Global Customer Service and Operations (GCSO) team seeks a Senior LTD Claims Specialist to evaluate long term disability claims, deliver timely... ...across the United States. Responsibilities include reviewing medical and policy information, collaborating with clinicians and...Senior
- Elevate Patient Financial Solutions in the United States is seeking an experienced Senior Claim Specialist for a remote, full-time role. The position focuses on Medicaid eligibility, enrollment, and payment posting to support hospitals and physicians nationwide. You will...SeniorRemote jobFull time
$125k - $175k
Senior Claims Specialist Date: Jan 7, 2026 Company: Odyssey Headquartered in New York City with offices throughout the U.S. and in Vancouver, Canada, Hudson is a market-leading specialty insurer that offers a wide range of property and casualty insurance products to...SeniorWorldwide- AF Group seeks a Claim Representative II to handle moderately difficult workers' compensation claims. You will verify coverage, determine... .... Responsibilities include establishing reserves, managing medical bills, facilitating return-to-work, and negotiating settlements...Senior
- Raintree Systems, Inc. is seeking an experienced Accounts Receivable Specialist - Medical Claims for a fully remote U.S. role within designated states. The position focuses on accurate billing and timely reimbursement for multispecialty medical services, requiring strong...Remote job
- Knowtion Health is seeking a Revenue Recovery Specialist to resolve motor vehicle and health insurance claims from hospital providers. This remote role requires a dedicated home workspace and the ability to multi-task and communicate professionally with payers and attorneys...Remote job
- Abbott is seeking a Senior Specialist Medical Affairs to support Cardiac Rhythm Management and Electrophysiology. This fully remote role requires travel across the Northeastern United States and Europe. The position focuses on establishing relationships with fellowship...SeniorRemote job
$32k - $42k
Position : Senior Healthcare Claims Processor Location : Remote, Eastern Standard Time (EST) based... ...procedures for claims intake, review, adjudication, pend and reject handling, adjustments... ...certification. 3-5+ years of medical coding knowledge preferred, including...SeniorContract workRemote work- Description If you’re looking for a claims role where you can make a real impact—not just manage a desk—this is it. Our Construction... ...the work is challenging, fast-moving, and meaningful. The Senior Claims Specialist works within a Claims Team navigating some of the most...SeniorContract workFor contractorsFor subcontractorWork at officeLocal areaRemote work
- Bristol Myers Squibb is seeking a Territory Account Specialist (TAS) to drive demand for medicines in a field-based role across the Little Rock, AR region. You will engage Health Care Providers with scientific dialogue and ensure alignment with label and CE^3 tools. Responsibilities...Senior
- Virtual Vocations Inc. is seeking a full-time Senior Medical Coding Specialist to review and assign diagnostic and procedural codes for outpatient encounters while working remotely, ensuring compliance and providing training to staff. The role requires 4 years of medical...SeniorRemote jobFull time
- ...America) Please review the following job description: The Senior Claims Specialist is responsible for investigating, evaluating, and resolving... ...and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-...SeniorFull timeTemporary workWork at officeShift workDay shift
- Senior Claim Specialist Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) CRC... ...and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-...SeniorRemote jobFull timeTemporary workWork at officeShift workDay shift
$16.5 - $27 per hour
A healthcare services company in Staten Island, NY is seeking a Senior Service Representative/Courier. The role involves the pickup, transport, and delivery of medical specimens, ensuring excellent service to clients. Candidates must have 3+ years of courier experience...SeniorHourly pay$140k - $170k
...Type: Permanent Build a brilliant future with Hiscox Our Senior Complex Claims Specialist - Allied Healthcare is an individual contributor role, responsible... ...to, mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies,...SeniorPermanent employmentTemporary workWork at office$56.16k - $99.36k
...and resources. For more information, visit emblemhealth.com . Senior Claims Overpayment & Recovery Analyst Proactively assess and monitor... ...balance opportunities. Perform research and analysis of refund root causes and initiate corrective action plans for issue resolution...SeniorContract workWork experience placementH1bVisa sponsorship$58k - $69k
...what we do, one conversation at a time. The Opportunity The Senior LTD Claim Specialist is responsible for independently evaluating and managing... ...process, benefits and plan provisions and to gather essential medical, occupational and financial information. Manage the...SeniorTemporary workLocal areaWorldwide- CRC Group seeks a Senior Claim Specialist in the United States to manage a portfolio of moderately complex property and casualty claims from intake to resolution. You will conduct investigations, review policy coverage, analyze facts, and negotiate settlements within authority...Senior
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