Senior QA Lead - PBM Claims (Remote)
Infinite Computer Solutions
- Remote job
Infinite Computer Solutions is seeking a QA Manager to lead testing for PBM claims processing in a remote capacity. The role emphasizes hands-on testing, process discipline, and data-driven quality metrics within an Agile environment. Responsibilities include leading QA teams, developing test strategies, and collaborating with cross-functional stakeholders to ensure regulatory and business alignment. Medicaid PBM experience is preferred, with a strong focus on release readiness and quality #J-18808-Ljbffr Infinite Computer Solutions
$30 per hour
...Senior Program Manager We are seeking a Senior Program Manager to lead high-impact sub-programs within large-scale enterprise transformations. This role owns end... ...Background in change management Healthcare payer, PBM, or claims experience (nice to have) Experience in...Remote workSeniorClaimsWork at office- 100% remote, no travel 7+ years Every state is ok EXCEPT FOR Alaska, Hawaii... ...Pharmacy Benefit Management experience (PBM) **Must be able to convert to perm... ...Management and/or Clinical Programs. Claims Adjudication is always a plus. PBM is a must...Remote workSeniorClaimsPermanent employmentContract work
- Job-ID32690220Reference26-01740TypeContractGuidewire QA Lead - P&C InsuranceLocation: Remote Responsibilities Collaborate with client QA teams, developers... ...such as Client ALM, Jira, ADO, or Rally. Experience in claims creation, FNOLs, reserves, checks, and payment...Remote workClaims
$91.7k - $163.7k
...Connecting. Growing together.The Senior Underwriting Consultant will... ...enjoy the flexibility to work remotely from anywhere within the U.S.... ...detailed analysis of utilization, claims experience, and financial... ...a Pharmacy Benefits Manager (PBM) or in a consulting role supporting...Remote workSeniorClaimsMinimum wageFull timeWork experience placementWork at officeLocal area$81k - $138k
...Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a... ...with us. Job Posting Title Senior Underwriter - Remote Job Description The Senior... ...of which are very complex Performs claims re-pricing analyses for the most complex...Remote workSeniorClaimsWork experience placementLocal areaVisa sponsorshipWork visa- ...Emory University is a leading research university that... ...Description Senior Director, Financial Operations... ...Pharmacy Benefits Manager (PBM) invoice reconciliation... ...) reserve management, claims lag analysis, and... ...reserves the right to change remote work status with notice...Remote workSeniorClaimsContract workWork from homeFlexible hours
- ...development. Summary As a Senior Certified Pharmacy Technician... ...Pharmacy Benefits Management (PBM) Clinical and Technical Call... ...inquiries, including pharmacy claims, claim rejections, formulary questions... ...role This is a 100% remote position requiring a reliable...Remote workSeniorClaimsFull timeFlexible hoursShift workNight shiftAfternoon shift
$150k - $200k
...mission to empower people to lead healthier lives. Learn even... ...personifyhealth.com. Responsibilities Senior Counsel, Commercial... ...-loss, cost-containment and claims editing, care navigation, and... ...national carrier, provider network, PBM, stop-loss carrier, or a law...Remote workSeniorClaimsContract work$80k - $120k
...Senior Ophthalmology Revenue Cycle Manager Las Vegas, Nevada... ...report directly to the owners, and lead the billing team. What you'... ...and follow up on every unpaid claim until it's resolved. Work... ...time, on-site/hybrid/potential remote How to apply Compensation...Remote workSeniorClaimsFull time- ...HumanaPosted: Humana Inc. is seeking a Senior Medical Coding Outpatient Auditor to lead coding-focused audit activities,... ....The role involves researching claims anomalies, applying CPT/HCPCS guidelines... ...to improve audit strategies. Remote work with occasional travel is...Remote workSeniorClaims
- ...Managing high-severity, complex insurance claims, the full-time Senior Claims Consultant will focus on coverage analysis, policy interpretation,... ...Practices Liability and Professional Liability claims in a fully remote setting. Key Responsibilities Review and interpret EPL,...Remote workSeniorClaimsFull time
$76.22k - $81k
...Group (SSG) is seeking a talented Senior Database Administrator Location: Remote Department: Veterans Affairs (VA... ...transactions: ~ X.12 medical claims (837, 834, 835, 277, etc) ~270/27... ...Experience with healthcare payer/PBM systems, clearinghouses, or pharmacy...Remote workSeniorClaimsFull time$63.65k - $92.57k
...with one of the world’s leading integrated healthcare... ...and much more. The Senior Pharmacy Operations Specialist... ...quality. -Monitor PBM operational performance... ..., benefit, and claims configurations. -Support... ...position is eligible for remote work from approved U.S....Remote workSeniorClaimsFull timeWork at officeMonday to FridayFlexible hoursShift work- A leading forensic accounting firm is seeking a Senior Allocation Analyst to support their forensics team. This role involves building claim-level allocation models, performing quantitative analysis on... ...position offers a competitive salary, remote work flexibility, and a...Remote workSeniorClaims
$140k - $160k
...Pharmacy Benefit Management (PBM) quality assurance and testing... ...improvement. Your role in our mission Lead the strategy, planning,... ...and PBM platforms, including claims adjudication (NCPDP D.0/F6),... ...you should expect in this role Remote opportunity to work anywhere...Remote workSeniorClaimsFull timeFlexible hours- ...Position: Sr Claims Examiner- Workers Compensation (CA) Location: 100% Remote Duration: 04+ months contract with strong possibility of extension Shift Timing: Mon- Fri: 8 AM- 5 PM PST (40 hrs/week) JOB ID- 37563378 The examiner can work remotely, The adjuster...Remote workSeniorClaimsContract workShift work
$139.6k - $200k
...the industry's first Unified Claims Processing architecture, seamlessly... ...of Americans and proudly leading the next generation of care. To... ...that enable collaboration in a remote environment. ~ Ability to... ...PreviousPharmacy Benefits Manager (PBM) experience. AWS +...Remote workSeniorClaimsWork at officeLocal areaFlexible hours- ...based insurance defense Firm, looking for a Senior Insurance Defense Attorney to join their... ...defense experience. This role is remote. Requirements: ~8+ years of insurance... ...of insurance defense cases, from initial claim evaluation to final resolution. Conduct...Remote workSeniorClaimsFlexible hours
$160k - $225k
...Labor Law and general liability defense matters. This is a mostly remote role with a stable caseload and direct client exposure.... ...resolution Defend owners, general contractors and subcontractors in claims under Labor Law §§ 200, 240(1) and 241(6) Draft pleadings, discovery...Remote workSeniorClaimsFull timeFor contractorsFor subcontractor- ...CSAA Insurance Group (CSAA IG) is hiring a Sr. Litigation Specialist for a remote role across the United States. You will manage complex auto/home claims, direct defense counsel, and shape settlement strategy, while controlling costs and indemnity exposure. Travel as...Remote workSeniorClaims
$163k - $190k
...Associate Director, PBM Clinical Services (PharmD) - Hybrid (... ...Hybrid: 3 days in office / 2 days remote in New York, NY! Benefits... .... ~ Demonstrated experience leading projects, mentoring others, or... ...complex clinical and claims data into actionable recommendations...Remote workClaimsFull timeWork at officeLocal areaImmediate startMonday to Friday- ...Processing corrected claims in QNXT, the temporary Senior Claims Analyst will review original claims for adjustments and ensure accurate documentation while working remotely. Key responsibilities Process corrected claims in QNXT according to established policies and...Remote workSeniorClaimsTemporary work
- ...Frontline Insurance is seeking a Senior Litigation Specialist/Corporate Rep to support litigation and claim management remotely across the US. You will analyze lawsuits, negotiate settlements, and partner with Legal and Claims teams to protect company interests. The role...Remote workSeniorClaims
- ...in establishing a Fraud Rapid Response Center, the remote Senior Healthcare Fraud Investigator will lead case development by reviewing analytics-generated leads... ...of healthcare fraud laws, including the False Claims Act and Anti-Kickback Statute Experience in developing...Remote workSeniorClaims
$120k - $130k
...Talent Solutions is partnering with a leading insurance organization that is... ...several professionals to its liability claims team and seeking Claims Counsel / Senior Liability Claims Adjusters to... .... Key Details ~100% Remote (U.S.) ~ Competitive Compensation...Remote workSeniorClaimsPermanent employmentFull time- ...Senior Commercial Litigation Attorney Location: New York, NY / Queens, NY Schedule: Hybrid – 4 days in office / 1 day remote Employment Type: Full-Time Position Overview Our client... ...Handle breach of fiduciary duty claims, contract disputes, and other commercial...Remote workSeniorClaimsFull timeContract workWork at officeImmediate start
- ...Davies Talent Solutions is partnering with a leading insurance organization that is adding several professionals to its liability claims team and seeking a Liability Adjuster /... ...experience to manage complex EPL claims in a fully remote, temp-to-hire role. This is an...Remote workSeniorClaimsHourly payFull timeTemporary workMonday to Friday
$129.3k - $172.3k
...decision maker rather than just an advisor? Want better work-life balance? Ready for a change with an in-house opportunity?The Senior Claims Counsel position with First American Title Insurance Company provides an excellent opportunity for counsel to engage in complex...Remote workSeniorClaimsFull time- Lumicera is seeking an Analyst, Contract Operations to join its team. This data-driven role focuses on PBM and managed care contracting, translating complex claims data into actionable insights for client contracts. You will support discount programs and deliverables across...Remote jobClaimsContract work
$87.92k
...Advance Your Career as a Senior Civil Litigation Plaintiff Attorney... ...cases. This position is non-remote and offers an opportunity for... ...-time What You Will Do: Lead civil litigation matters from... ...class actions, and related civil claims. Prepare cases for...Remote workSeniorClaimsFull timeWork at officeImmediate start
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