244 claims analyst jobs found

Why would you join GM Protection as a Sr. Mechanical Claims Analyst?   Are you passionate about the automotive service industry and how vehicle service claims keep the world moving? Do you have experience both as a service department technician, advisor, or manager? Have you spent time applying your technical skills and operational knowledge with a vehicle service contract provider or administrator? Do you thrive on helping others perform at the top of their potential? GM Protection is looking for an analyst with these qualities to join our growing team and help drive claims performance at both the dealership and administrator levels. technologies to enhance learning experiences. Strategic thinking, creativity, leadership skills, excellent communication, and your ability to enhance dealership and administrator performance with data driven methods that align with our Strategic Priorities and Core Values will be essential to your success.   At GM Financial, our team members...

Claims Management Analyst Join us as a Claims Analyst to grow your experience in handling complex claims. Make your mark in Claims. Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.  How you will create an impact Analyzing the scope and extent of coverage of primary policies with deductibles. Clear and concise written and verbal communication with insureds, TPAs, brokers and underwriters. Make regular and appropriate contact with internal and external customers including leading national Fortune 500 companies. Give guidance to insureds and/or brokers to manage expectations. Effectively strategize and...

The Repricing Quality Assurance Analyst is responsible for reviewing, analyzing, and monitoring repricing audit data across multiple platforms to ensure accuracy, compliance, and efficiency. Works closely with internal teams to maintain contractual and organizational standards, enhance operational effectiveness, and improve client satisfaction. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify and resolve quality issues within repricing processes Develop and implement QA policies and procedures Monitor compliance with pricing guidelines and contractual requirements Investigate repricing discrepancies and apply corrective actions Prepare QA reports and documentation Collaborate with stakeholders to align quality objectives Provide training and guidance on repricing standards Conduct risk assessments to mitigate potential errors Maintain confidentiality of client data, PHI, and PII Additional duties as assigned...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

The Setup Team Lead is responsible for assisting and supporting the Setup Supervisor with ensuring the Setup Team meets protocol. This role will assist with supervisory functions when the Setup Supervisor is absent. The Setup Team Lead is responsible for ½ production. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Must maintain ½ production quota Organize and distribute claims according to established priority Provide guidance to analysts, aiding with resolution of problems or questions Process complex/problematic claims according to protocol Maintain production standards and production requirements Comply with standard protocol for processing problem claims Function as liaison between analysts and clients Professionally communicate with other offices and internal departments Train new team members Assist co-workers, supervisor and management in accomplishing production goals Maintain HIPAA compliance in all aspects of...

The Procurement Analyst plays a critical role in supporting Enhanced Bill Review Programs by securing essential medical documentation, including itemizations and medical records needed to process claims accurately and efficiently. This position involves proactive outreach to providers, managing inbound inquiries, and ensuring all documentation meets quality and compliance standards, including HIPAA regulations. The Procurement Analyst is detail-oriented, organized, and thrives in a fast-paced environment where meeting production goals and collaborating with team members are key to success. This is an onsite position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Spend approximately 80-85% of the shift making outbound calls to providers to obtain required information; may also send email or fax requests Respond to inbound calls regarding claim status and related inquiries Maintain accurate records of all communications between the company, providers, and...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within 60 mile radius of a USAA office will be expected to work on-site 4 days per week. We have multiple exciting opportunities available on our Modeling Factory and Insights & Development teams. As...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to work independently...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and analytical skills for...

As a Health and Benefits Senior Analyst  you will contribute to a wide variety of projects involving the design, financing and ongoing management of the full spectrum of health and benefit programs.  You will support the  project manager on select projects, interface with vendors and key clients internally and externally, create client deliverables, and ensure quality standards are met.  You will have the opportunity to significantly grow your health and benefits business acumen as well as your financial, project management and client relationship skills by working on cutting edge projects alongside leaders in the industry. The Role Materially contribute to core health and benefits projects supporting the design and management of group medical, dental, wellbeing, life, disability and absence management benefits for clients. Responsibilities include: Partnering with client service team leader to deliver superior project management Providing superior client service in response...

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits Utilize applicable tools and resources to complete internal audits and/or appeals Timely completion of internal audits and/or appeals Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings Additional duties as assigned   KNOWLEDGE & SKILLS: Ability to use clinical judgment and...

This is an opportunity to join Ascot Group - one of the world’s preeminent specialty risk underwriting organizations.   Designed as a modern-era company operating through an ecosystem of interconnected global operating platforms, we’re bound by a common mission and purpose: One Ascot. Our greatest strength is a talented team who flourish in a collaborative, inclusive, and entrepreneurial culture, steeped in underwriting excellence, integrity, and a passion to find a better way, The Ascot Way.   The Ascot Way guides our people and our organization. Our underwriting platforms collaborate to find creative ways to deploy our capital in a true cross-product and cross-platform approach. These platforms work as one, deploying our capital creatively through our unique Fusion Model: Client Centric, Risk Centric, Technology Centric.   Built to be resilient, Ascot maximizes client financial security while delivering bespoke products and world class service — both pre- and post-claims....

As a Health and Benefits Senior Analyst, you will contribute to a wide variety of projects involving the design, financing and ongoing management of the full spectrum of health and benefit programs.   You will support the  project manager on select projects, interface with vendors and key clients internally and externally, create client deliverables, and ensure quality standards are met.  You will have the opportunity to significantly grow your health and benefits business acumen as well as your financial, project management and client relationship skills by working on cutting edge projects alongside leaders in the industry. Responsibilities: Materially contribute to core health and benefits projects supporting the design and management of group medical, dental, wellbeing, life, disability and absence management benefits for clients. Responsibilities include: Partnering with client service team leader to deliver superior project management Providing...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We have multiple exciting opportunities available on our Pricing, Indications , and Reserving teams.  As a dedicated Actuarial Analyst I , you will be a near-credentialed analyst responsible for independently applying complex technical and actuarial methodologies as well as requiring expert knowledge in one actuarial practice area (pricing, reserving, modeling, catastrophe risk, claims analytics, product management, etc.) to complete unstructured projects. This role is remote eligible in the continental U.S....

What part will you play? If you’re looking for a place where you can make a meaningful difference, you’ve found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you’ll find your fit amongst our global community of optimists and problem-solvers. We’re always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! What part will you play? If you’re looking for a place where you can make a meaningful difference, you’ve found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you’ll find your fit amongst our global community of optimists and problem-solvers. We’re always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! The Senior Client Service...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity We have multiple exciting opportunities available on our Pricing, Indications , and Reserving teams.  As a dedicated Actuarial Analyst I , you will be a near-credentialed analyst responsible for independently applying complex technical and actuarial methodologies as well as requiring expert knowledge in one actuarial practice area (pricing, reserving, modeling, catastrophe risk, claims analytics, product management, etc.) to complete unstructured projects. We offer a flexible work environment that requires an...

This position is for our subsidiary: Claim Assist Technologies, LLC To know more, visit us at http://www.claimassist.com Job Title : Business Analyst Location : San Antonio, Texas (On-site) Job Type : Full-Time Industry : Insurance Technology / Software Development Salary Range: $75,000 – $90,000 Position Overview: We are seeking an experienced Business Analyst to join our on-site team in San Antonio. This role is critical in bridging the gap between our end users and offshore development team. The ideal candidate will have a strong understanding of software systems, exceptional communication skills, and the ability to handle support-related interactions directly with users. Key Responsibilities: · Gather and analyze business requirements to translate into functional specifications for system enhancements and fixes · Act as a liaison between stakeholders and offshore development teams to ensure clarity and alignment on technical solutions · Create user...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Performance Assurance Analyst PRIMARY PURPOSE :  Performs comprehensive reviews on personal and commercial lines claims of varying degree of severity (up to approximately $300,000) to ensure the highest quality of work product is delivered to our clients; confirm our adjuster’s claim files comply with specific client handling guidelines and company standards; and identifies trends in non-compliance to recommend training opportunities that exist.  ESSENTIAL...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider contact information, and client information for accuracy to ensure proper delivery of requests. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate with respective leadership on any issues or problems identified Maintain production standards, production requirements, and quality of work Assist coworkers, supervisor, or management to accomplish product goals; report potential issues in a proactive manner Timely forward misdirected requests to the correct recipient Ensure strict confidentiality of all medical records, PHI, and PII Outbound calling may be needed Additional duties as assigned KNOWLEDGE & SKILLS: Ability to work independently...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60 mile radius of a USAA office will be expected to work on-site 4 days per week. The Climate Risk and Exposure Analytics team is situated in the Actuarial group within USAA’s P&C business. The...