5 claims consultant jobs found in Remote

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Pricing Manager will be responsible for managing pricing and underwriting processes in support of business development efforts.  They will have a thorough understanding of PBM pricing intricacies, financial modeling, and data analysis.  The ideal candidate will have experience in development and execution of PBM competitive bidding, guarantee setting, rebate projections, ad-hoc analysis, and narrating pricing related...

Foundation Risk Partners , one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Stop Loss Insurance Administrative Support Assistant t o their team at Arbor Benefit Group .  Job Summary: The Stop Loss Insurance Administrative Support Assistant plays a critical role in supporting the Medical Underwriting, Claims, and Policy Issuance teams. This position ensures the efficient intake, tracking, and management of key documents—enabling timely underwriting decisions and effective high-dollar claim reviews. This role serves as a central hub for incoming reporting, including Group Claim Experience reports, medical documentation, underwriting materials, and licensing records received through company mailboxes. The ideal candidate is highly organized, detail-oriented, and thrives in a fast-paced, document-driven environment. Key Responsibilities Manage the intake, organization, and tracking of client reporting documents...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Vice President, Client Management provides executive leadership for AffirmedRx’s Client Management organization, responsible for defining and executing the strategic vision, operating model, and performance strategy for client relationship management across the book of business. Reporting to the SVP, Operations, this role leads the Client Management function in delivering best-in-class client experience, driving client...

To provide ultimate claim service for insurance claim matters presented by clients of Risk Strategies Inc., and affiliates, in accordance with objectives and procedures outlined by management. Your Impact Receive loss reports from Healthcare Clients and confirm that the claims are filed under the appropriate policy(ies) Research policy terms and stipulations to determine coverage applicability and advocate for maximum recovery. Strong understanding of all lines of insurance policies, coverage, and relevant regulations. Educate and address questions from Clients regarding claim reporting requirements Advocate for the client, maintaining an active diary, transmittal of documentation, follow up calls, and emails to the client and carrier Oversee the claims at the carriers to ensure timely investigation, liability determination, litigation and fair resolutions.  Evaluate complex, high-exposure claims and interpret policy wording. Ability to work with demanding stakeholders,...

The Reinsurance division at Risk Strategies is part of the National Healthcare Practice, providing consultative risk management and evaluation services across a full range of individual and group medical and supplemental health products for both private and public-sector clients.   Our team is driven by a passion for client service, emphasizing prompt, courteous support and long-term relationship building. We value clear, consistent communication and have assembled a team of professionals who combine strong technical expertise with exceptional interpersonal skills. Risk Strategies fosters a collaborative, family-oriented culture where teamwork and client satisfaction are paramount.   Primary Responsibilities and Duties:   Client & Program Review and Support (Primary) Develop proformas and evaluate business plans and new product opportunities for clients/prospects Support carrier/reinsurer discussions to secure rating and...