Vice President of Claims Adjudication
Confidential
Vice President of Claims Adjudication
About the Company
Premier cost-effective commercial insurance provider
Industry
Insurance
Type
Privately Held, VC-backed
Founded
2017
Employees
201-500
Funding
$200+ million
Categories
- Insurance
- Financial Services
- Insurance
- InsurTech
- Small and Medium Businesses
Specialties
- insurance
- insuretech
- workers' compensation
- and small business insurance
- small business insurance
- and commercial auto
About the Role
The Company is seeking a Vice President of Claims Adjudication to play a pivotal role in the design and execution of its claims strategy and programs. The successful candidate will be responsible for leading the claims adjudication function, with a focus on delivering optimal claim outcomes and exceptional customer experiences. This leadership role involves strategic planning, fostering relationships both internally and externally, and ensuring that the claims adjudication operations align with the broader claims strategy. The VP will also be accountable for the financial and performance aspects of the claims adjudication operation, driving continuous improvement, and leading innovation and technology initiatives to enhance the claims process. Applicants must have a minimum of 15 years' experience in workers' compensation claims, field claims operations, and claims adjudication, with at least 10 years in a people management role. The role requires an individual with a strong industry leadership track record, expert knowledge of managing disputed and litigated claims across multiple jurisdictions, and a data-driven approach to claims management. The ideal candidate will have a proven ability to contribute strategic insights, inspire and influence others, and foster a culture of open communication, continuous improvement, and innovation. Superior communication skills and the ability to represent the organization as a claims subject matter expert are essential. Experience in crisis communication and managing high-stakes stakeholder relationships is also a key requirement.
Hiring Manager Title
Chief Claims Officer
Functions
- Operations
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Tata Consultancy Services is seeking a Claims Manager to handle Absence case management and adjudication of claims. You will analyze claims, review medical information, and determine benefits due according to US regulations. The ideal candidate will have over 1 year of...Claims- ...Vice President, Health Economics About the Company Acclaimed provider of employer-based health services Industry Health, Wellness... ...of a function dedicated to translating clinical and claims data into actionable insights. The successful candidate will be...Claims
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- ...decisions and maintains a visible external presence with agents, brokers, and industry stakeholders. Partners closely with actuarial, claims, product, distribution, and technology teams to ensure the specialty portfolio is well-positioned, well-priced, and well-run.Key...ClaimsTemporary workLocal area
$259.78k - $397.28k
...Senior Vice President, Facilities OperationsThe Senior Vice President, Facilities Operations will be responsible for leading multiple facilities... ...government, or against any individuals who assist or participate in the investigation of any complaint or discrimination claim....ClaimsTemporary workWork experience placementLocal areaFlexible hours- ...manner: Greet patients, visitors and others upon entry Process prescriptions by performing data entry, adjudication of insurance claims, filling and providing medications to patients at pick-up Support the clinical staff with obtaining information for...ClaimsFull timeTraineeshipWork at officeMonday to Friday
$48k - $55k
Overview To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments. Responsibilities To...ClaimsTemporary work- A leading training provider for insurance claims adjusters is seeking Licensed Claims Adjusters to join their thriving team in Westerville, Ohio. This role offers the flexibility to assist in disaster recovery while making a significant impact on people's lives. Whether...ClaimsFlexible hours
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- ...is seeking a Chief Operating Officer (COO) with a strong background in self-funded healthcare operations, stop-loss programs, and claims management. The successful candidate will be responsible for a combination of strategic and tactical activities to support the company...ClaimsRemote work
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- ...representatives on an ongoing basis Train and coach reps on door-to-door sales, roof inspections, and how to navigate the insurance claims process Identify and address retention risks early; build loyalty through recognition, development, and clear career paths...ClaimsContract work
- ...Receivable Specialist to manage medical billing processes and ensure timely reimbursement. You will follow up on unpaid and partially paid claims, analyze denials to identify root causes, and correct and resubmit claims or prepare appeals as needed. You will proactively work...Claims
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$18 - $24 per hour
...schedule appointments, and manage recalls Verify dental insurance benefits and eligibility Submit and follow up on insurance claims and pre-authorizations Explain treatment estimates and patient financial responsibilities Post payments, manage accounts receivable...ClaimsWork at office$185k - $250k
...requirementsVerifies the accuracy of project financial forecast, notice provisions, and billings to meet contract requirements and resolve potential claims and deviationsEnsures team creates a project-specific quality plan aligned with the owner contract and contract documentsEnsures a...ClaimsContract workFor contractorsFor subcontractorWork at officeLocal area- Ohio State University Physicians in Columbus is seeking a Revenue Cycle Representative to handle insurance billing, claims processing, and denials management, contributing to accurate reimbursement and a smooth revenue cycle. The role requires a high school diploma with...Claims
- ...Hancock Claims Consultants specialize in Ladder Assist and Property Inspection Services, collaborating directly with numerous insurance agencies for efficient claims management. At Hancock, we are at the forefront of claims resolution services, offering nationwide coverage...ClaimsPermanent employmentFor contractors
$185k - $309.5k
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...requirementsVerifies the accuracy of project financial forecast, notice provisions, and billings to meet contract requirements potential claims; escalates to leadership of unresolved deviationsEnsures team creates a project-specific quality plan aligned with the owner...ClaimsContract workFor contractorsFor subcontractorWork at officeLocal area
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