Health Claims Case Specialist — Adjudication
Sun Life
Sun Life is seeking a Case Specialist for Supplement Health Claims in the United States. The role involves independent claim review, eligibility determinations, and collaboration with employers and carriers to adjudicate benefits under applicable contracts and regulations. The incumbent will interpret policy language, manage data, and mentor new hires, with a focus on accuracy, efficiency, and customer service in a dynamic team environment. #J-18808-Ljbffr Sun Life
- Sun Life in the United States seeks a Case Specialist, Supplement Health Claims to manage initial liability claims for Critical Illness, Cancer, Hospital Indemnity and Accidental plans. You will review data, investigate with claimants and partners, and determine initial...Suggested
- Mass General Brigham Health Plan is seeking a detail-oriented claims processor to work remotely, performing claims adjudication and coding verification to ensure accurate payment and compliance with billing regulations. Ideal candidates will have 2-4 years in healthcare...SuggestedRemote jobFull time
- Mass General Brigham Health Plan is an exciting place to be within the healthcare industry... ...more. Job Description Summary Review claims to ensure accurate coding, appropriate... ...billing regulations and payer guidelines. Adjudicate claims to pay, deny, or pend as...SuggestedFull timeWork at officeRemote workMonday to FridayFlexible hours
$26 per hour
...We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Waltham, MA. This... ...Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy.... ...first call resolution to help health care providers and patients with their...SuggestedFull timeTemporary workWork experience placementRelocation packageFlexible hoursShift work$21.1 - $44.99 per hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At... ...underwriting exceptions/financial variances for their assigned cases to the appropriate level. Assists sales personnel in explaining...SuggestedHourly payFull timeTemporary workWork at officeLocal area- Acadia Insurance, Marlborough, MA, is seeking an experienced claims professional to investigate, evaluate, and resolve high exposure commercial liability claims. You will negotiate with insureds and third parties, coordinate with underwriting and loss control, and mentor...
$89.89k - $134.84k
Who We ArePoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan...Full timeWork from home$18 - $25 per hour
Pathways Healthcare is a leading home health and hospice provider, focused on patient-centered care. The main office is located in Westwood, MA, with a schedule Monday-Friday, 8:30 AM-5:00 PM. This full-time billing role offers an hourly rate of $18.00-$25.00. Join a mission...Hourly payFull timeWork at officeMonday to Friday$1,000 per month
...customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products,... ...Adjuster, you will investigate and evaluate homeowners property claims from start to finish. You will confirm the facts of loss, determine...Contract workFor contractorsWork at officeWork from homeVisa sponsorshipWork visaRelocation package$18 - $25 per hour
Pathways Healthcare, LLC in Westwood, MA is hiring for a full-time billing role focused on home health and hospice claims. You will audit, prepare, and follow up on documentation to ensure accurate and timely billing while supporting patient care. The position follows a...Hourly payFull timeMonday to Friday$100k - $165k
...property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of... ...financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we are...Local area$78k - $112k
...product roll out. Collaborating with underwriters, operations, claims, marketing and home office product management Consistently... ...property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of...Work at officeLocal areaHome office- ...flexibility of remote work for focused tasks and projects. The Claims Specialist works within a Claims Team, using the latest technology to... ...compensability/liability. Establishes action plan based on case facts, best practices, protocols, regulatory issues and available...Work experience placementWork at officeLocal areaRemote work
$69k - $98k
Senior Claim Representative Sharing Economy - Accident and Health (Hybrid) Our employees are at the heart of what we do: helping people, businesses and society prosper in good times and be resilient in bad times. When you join our team, you are bringing this purpose to...Full timeWork at officeFlexible hours$110k - $120k
...rated A+ (Superior) by A.M. Best, with an A+ claim paying ability rating by Standard & Poor’... ...direction, handles the most complex cases and those involving the most complex questions... ...discretionary bonus Benefits include: Health, dental, vision, dental, life, disability...Full time$78k - $106k
...leading medical and emotional and mental health benefits, dental, and vision insurance... ...office 5 days a week. Responsibilities The Claims Specialist under the supervision of the Director of... ...is necessary, such as medical case management, vocational rehabilitation counseling...Temporary workFor contractorsFor subcontractorWork at office- USI Insurance Services seeks an experienced adjuster to manage workers' compensation claims, including lost and non-lost time cases. You will apply in-depth knowledge of claims processes, communicate with clients, carriers, and claimants, and support negotiations and resolutions...
- USI Insurance Services in Needham, MA is seeking an experienced claims adjuster for workers' compensation claims. You will adjust lost time and non-lost time claims, communicate with clients and carriers, and review and authorize related expenses. You will influence outcomes...
$59.9k - $98.2k
Zurich is looking for an accomplished Workers Compensation Claims Specialist II to serve our Northeast region. This position offers a hybrid... ...coverage. Work to have a timely resolution to claims by developing case strategy and case evaluation, and escalating issues as...Full timeTemporary workFor contractorsApprenticeshipWork at officeLocal areaRemote workVisa sponsorship$83k - $157k
Schedule: Full-Time Salary Range: USD $83000.00 - $157000.00 Job Category: Claims Description Looking for an amazing new claims opportunity? Senior Complex Construction Claims Specialist - Complex CGL & Construction Liability (Litigated, $500K+) Overview...Full timeWork at officeLocal areaImmediate startRemote workHome office$49.01k
...nurse, nutritional counseling, and mental health resources Tuition assistance programs... ...once trained. Job Responsibilities Claim Service Specialists act as advocates for our customers.... ...and fairly. They thoroughly check claim case facts, determine coverage, liability,...Full timeWork experience placementRemote workFlexible hours- DentaQuest is building a better future for oral health in the United States. The incumbent will perform statistical and trend analyses of corporate accounts to monitor profitability and drive pricing decisions. This role supports the underwriting department by providing...
$72k - $141k
...direction, and within broad authority limits, to manage commercial claims with high complexity and exposure for a specific line of... ...on oversight/watch lists, and preparing and presenting succinct case summaries to senior management.Maintains subject matter expertise...Full timeWork experience placementWork at officeLocal areaFlexible hoursShift work$101.18k - $119.78k
...meet the unique coverage and claims‑handling needs of businesses.... ...York City and is focused on adjudicating first and third party commercial... ...tasks to ensure that cases move to the best financial outcome... ...comprehensive benefits program‑including health, dental, vision, 401(k) with...Full timeLocal areaRemote work- This Opportunity WSP is currently initiating a search for a Early Career Human Health Risk Assessor for our Chelmsford, Massachusetts office. Be involved in projects with our Earth & Environment Team and be a part of a growing organization that meets our client’s objectives...Work at office
- A leading environmental consulting firm in Chelmsford, Massachusetts is seeking an Early Career Human Health Risk Assessor to join their team. The role involves conducting risk assessments for various environmental projects and requires a Bachelor's degree in a relevant...
- Early Career Human Health Risk Assessor - Chelmsford, Massachusetts, USA. WSP is seeking a motivated candidate to join our Earth & Environment Team, executing multimedia risk assessments (air, water, soil, biota) across government and commercial projects. Responsibilities...
- A leading environmental consulting firm is seeking an Early Career Human Health Risk Assessor in Chelmsford, Massachusetts. The role involves conducting multimedia risk assessments and using Microsoft Excel for data analysis and calculations. Candidates should have a Bachelor...
$37.66 - $44.33 per hour
...meet the unique coverage and claims-handling needs of businesses.... ...Rockwood (PA). This role will adjudicate indemnity workers'... ...and complete tasks to ensure cases move toward the best financial... ...benefits program, including health, dental, vision, 401(k) with...Hourly payTemporary workRemote work- ...experienced Automotive Warranty Administrator to join our team in the Norwood area. The role focuses on accurate processing of warranty claims, verifying coverage, and reconciling receivables with manufacturers, while collaborating with service staff and suppliers. We value...
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