Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Senior Medical Claims & Adjudication Specialist

CVS Health

CVS Health in the United States is seeking a claims processor to adjudicate complex medical claims across self-funded, fully insured, and RX programs. The role handles refunds, refunds checks, and may respond to customer inquiries while applying medical necessity guidelines to determine coverage. The position requires approximately 2+ years of experience in medical claim processing, working in a production setting, and strong communication skills. #J-18808-Ljbffr CVS Health

Vacancy posted 18 hours ago
Similar jobs that could be interesting for youBased on the Senior Medical Claims & Adjudication Specialist in Clayton, NM vacancy
  • $90k - $115k

    Remote Liability Claims Examiner | General Liability Exp. Required By joining Sedgwick,...  ...Apply your knowledge and experience to adjudicate complex customer claims in the context of...  ...comprehensive benefits offering including medical, dental vision, 401K on day one. As... 
    Medical
    Remote job
    Local area
    Flexible hours

    Sedgwick

    Clayton, NM
    1 day ago
  • Otsuka America Pharmaceutical, Inc. seeks a Medical Science Liaison (Sr Manager) to lead clinical and scientific engagement in CNS. You will work with ecosystem teams to tailor regional medical strategies, engage KIs, LPLs, providers, and patient groups, and translate evidence... 
    Senior
    Medical

    Otsuka Pharmaceutical Co., Ltd

    Clayton, NM
    3 days ago
  • Takeda is seeking a Senior Medical Science Liaison in the US who will be a field-based, external facing member of the medical unit. You will analyze, interpret and disseminate scientific data to KOLs and HCPs, translate insights, and connect customers to Takeda to advance... 
    Senior
    Medical
    Remote job

    Takeda

    Clayton, NM
    1 day ago
  • The Senior Medical Science Liaison is a field-based, external customer-facing member of the US therapeutic area medical unit team, responsible for analyzing, interpreting and disseminating scientific data, acquiring and translating customer insights, fostering external... 
    Senior
    Medical
    Minimum wage
    Full time
    Local area
    Night shift

    Takeda

    Clayton, NM
    1 day ago
  • We are seeking a Senior Electrical Engineer to join our team in a fully remote capacity. This position is aligned with our Oak Ridge,...  ...Depending on your employment status, AtkinsRéalis benefits may include medical, dental, vision, company-paid life and short- and long-term... 
    Senior
    Medical
    Remote job
    Temporary work
    Work at office
    Flexible hours

    AtkinsRéalis

    Clayton, NM
    1 day ago
  •  ...patients first — developing innovative medical technologies that improve the lives of 7...  .... This is more than a sales role. As a Senior Territory Manager for Coronary, you will...  ...Strategic Accounts, Sales Leadership, clinical specialists, and inventory analysts—to drive access,... 
    Senior
    Medical
    Contract work
    Temporary work
    H1b
    Local area
    Remote work
    Flexible hours
    Shift work
    Night shift

    Medtronic plc

    Clayton, NM
    1 day ago
  • $15 per hour

    Summary The Wikimedia Foundation is looking for a Senior Software Engineer, iOS to join the App Growth team within the Core Experiences...  ..., religion, color, national origin, sex, pregnancy or related medical conditions, parental status, sexual orientation, gender... 
    Senior
    Medical
    Permanent employment
    Full time
    Contract work
    For contractors
    Currently hiring
    Local area
    Remote work

    Wikimedia Foundation

    Clayton, NM
    3 days ago
  •  ...required by government contract. Additional Benefits & Requirements Travel Requirements Relocation Provided Incentive Bonus Plans ~ Medical, Dental, Vision benefits ~10 Paid Holidays ~ Employee Stock Purchase Plan ~ All qualified applicants will receive consideration for... 
    Senior
    Medical
    Remote job
    Contract work
    Local area
    Relocation

    Motorola Solutions

    Clayton, NM
    1 day ago
  • $120k - $130k

     ...ANM is seeking a Senior Client Success Manager to join our exceptional team. Who We Are: ANM is a leading IT solutions provider helping...  ...: ANM offers a comprehensive benefits package including: Medical, Dental and Vision Insurance Life Insurance; Short-Term and Long... 
    Senior
    Medical
    Temporary work
    Work experience placement
    Local area
    Flexible hours

    Advanced Network Management

    Clayton, NM
    2 days ago
  • Mosai is seeking a Senior Clinical Informaticist to serve as the clinical conscience of its AI initiatives for home-based care. You will own the clinical ground truth used to train models and ensure safe, high‑quality outputs for nurses, therapists, and hospice teams.... 
    Senior
    Work from home

    Mosai

    Clayton, NM
    1 day ago
  • CVS Health is seeking an experienced Senior Manager to negotiate, execute, and analyze complex provider contracts, focusing on hospitals, physician groups, and local systems. You will drive value-based arrangements and collaborate with cross-functional teams to optimize... 
    Senior
    Local area

    CVS Health

    Clayton, NM
    1 day ago
  • Roadrunner Venture Studios is seeking a Head of Hardware Engineering for a portfolio company focused on rainfall enhancement technology. You will own system architecture across mechanical, thermal, combustion, and controls, guiding prototypes through production-scale manufacturing...
    Senior
    Remote job

    Roadrunner Venture Studio

    Clayton, NM
    3 days ago
  • CVS Health is seeking a Senior Analyst, PPO Network Discount Optimization to strengthen Aetna Dental's provider networks across the United States. You will analyze provider reimbursement arrangements, guide fee schedule negotiations, and shape discount strategies to improve... 
    Senior
    Remote job

    CVS Health

    Clayton, NM
    3 days ago
  • Mobilitas, created by CSAA Insurance Group, is hiring a Senior Commercial Actuarial Pricing Manager (Auto). You will lead actuarial analysts, coach teams, and guide pricing strategies for commercial auto risks. This remote role supports cross‑functional collaboration and... 
    Senior
    Remote job

    CSAA Insurance Group

    Clayton, NM
    1 day ago
  • The Wikimedia Foundation is seeking a Senior Software Engineer, iOS to join the App Growth team within the Core Experiences engineering group on a 3-month full-time contract. This fully remote role requires four hours daily between 14:00 UTC and 21:00 UTC to coordinate... 
    Senior
    Remote job
    Full time
    Contract work

    Wikimedia Foundation

    Clayton, NM
    3 days ago
  • AtkinsRéalis is seeking a Senior Electrical Engineer to join our team in a fully remote capacity. This position aligns with our Oak Ridge, TN office and involves leading electrical system design for nuclear and commercial projects. You will mentor junior staff, ensure... 
    Senior
    Remote job
    Work at office

    AtkinsRéalis

    Clayton, NM
    1 day ago
  • $120k - $139.5k

     ...next steps. Our partner is looking for a Senior Service Designer based in the United...  ...data scientists, researchers, and other specialists to define problems, align priorities, develop...  ...assume. Comprehensive Healthcare: Medical, dental, and vision insurance. Retirement... 
    Senior
    Contract work
    Temporary work
    Remote work
    Flexible hours

    Jobgether

    Clayton, NM
    3 days ago
  •  ...Group is hiring for a Casualty Evaluator (Remote) to manage owner/adjuster responsibilities, handling 1st and 3rd party auto liability claims with exposure under $50,000 across multiple states, including licensed and statutory states. The role supports the claims... 
    Remote work
    Flexible hours

    CSAA Insurance Group

    Clayton, NM
    6 hours ago
  • CSAA Insurance Group is seeking an Associate Auto Claims Advisor for a remote role. You will handle non-injury auto claims, verify coverages, conduct liability investigations, and keep members informed about claim status. Training is paid and remote, with Pacific Time... 
    Remote job
    Flexible hours

    CSAA Insurance Group

    Clayton, NM
    1 day ago
  • $25.32 - $28.13 per hour

    Auto Claims Adjuster- Remote Requisition Number: R8051 Locations: Alabama - Home Teleworkers, Arizona - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Colorado - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Iowa... 
    Remote job
    Hourly pay
    Currently hiring
    Work from home
    Monday to Friday
    Flexible hours
    Shift work
    Afternoon shift

    CSAA Insurance Group

    Clayton, NM
    1 day ago
  • $25 - $30 per hour

     ...The AR Follow-Up Specialist is responsible for timely and accurate follow...  ...proactive payer outreach, claim status monitoring, denial...  ...Compensation claims to ensure prompt adjudication Conduct direct outreach to...  ...claims for timely filing, medical necessity, eligibility... 
    Medical
    Hourly pay
    For contractors
    Work at office
    Remote work
    Monday to Friday

    Integrated Pain Management Medical Group, Inc.

    Clayton, NM
    1 day ago
  • $46.99k - $122.4k

     ...community at a time. Position Summary The Senior Analyst, PPO Network Discount...  ...objectives. The Senior Analyst leverages claims, reimbursement, and market data to assess...  .... The benefits for this position include medical, dental, and vision coverage, paid time off... 
    Senior
    Hourly pay
    Full time
    Contract work
    Temporary work
    Local area
    Remote work

    CVS Health

    Clayton, NM
    3 days ago
  • $35k - $150k

     ...We do not sell insurance and we do not work for insurance companies. We advocate on behalf of homeowners throughout the insurance claims process. No experience necessary. WE PROVIDE TRAINING !! Work can be done from home using video-conferencing software Must be able... 
    Full time
    Part time
    For contractors
    Live in
    Remote work
    Work from home
    Flexible hours

    National Claims Assistance Inc

    Clayton, NM
    4 days ago
  • $67.9k - $165.95k

     ...Dallas-Fort Worth area or Oklahoma The Senior Manager negotiates, executes, conducts high...  ...resolve complex escalations related to claims, contract interpretation, and provider data...  .... The benefits for this position include medical, dental, and vision coverage, paid time... 
    Senior
    Hourly pay
    Full time
    Contract work
    Temporary work
    Work experience placement
    Local area

    CVS Health

    Clayton, NM
    1 day ago
  • Med-Trans Corporation seeks a Helicopter Pilot to perform safe, efficient air medical transport for critically ill and injured patients. In this Emergency Services role, you will conduct preflight planning, complete safe takeoffs and landings in diverse conditions, and... 
    Medical

    Med-Trans Corporation

    Clayton, NM
    2 days ago
  • $148.48k - $185.6k

    Position Information: Job Title: Senior Manager - Regional Organic Growth Location: Arizona, Denver, CO, Portland, OR, Salt Lake City, UT, Reno, NV, Las Vegas, NV or Albuquerque, NM Salary Range: $148,480 - $185,600 Schedule: Remote Job Summary The location of this... 
    Senior
    Work at office
    Local area
    Remote work

    Iberdrola

    Clayton, NM
    1 day ago
  •  ...patient care technician provides direct care to patients, assisting with daily activities, monitoring vital signs, and supporting the medical team to ensure patient comfort and well-being. Highlights : Complete in as short as a few weeks to a few months Online and... 
    Medical

    Dreambound

    Clayton, NM
    2 days ago
  • $182 per hour

     ...working experience as a Dentist Ability to build rapport with patients Compassionate and caring demeanor Familiarity with medical terminology A valid and current CPR card (American Heart Association) Must have up to date credentials in the state of NM... 
    Medical
    Work experience placement
    Monday to Friday
    Shift work
    Day shift

    HAN Staff

    Clayton, NM
    4 days ago
  •  ...healthcare industry? Use Dreambound to find a Medical Billing and Coding program that will...  ...What does a Medical Billing and Coding Specialist do? A medical billing and coding specialist processes and codes healthcare claims to ensure accurate billing and insurance... 
    Medical

    Dreambound Inc.

    Clayton, NM
    3 days ago
  •  ...services, requiring licensure and 3+ years of clinical experience, with EMR proficiency and CST work hours. Responsibilities include medical necessity reviews, applying guidelines, coordinating with care teams, crisis triage, and discharge planning. #J-18808-Ljbffr CVS... 
    Medical
    Remote job

    CVS Health

    Clayton, NM
    3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Senior Medical Claims & Adjudication Specialist. Be the first to apply!