Claim Health jobs

Health Representative - Rare Disease Malaysia - Kuala Lumpur posted: Posted 30+ Days Ago

Lead Full Stack Software Engineer, Claims San Francisco, CA | Lehi, UT | Plano, TX At Collective Health, we're transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. The Cost Containment team is developing efficient systems for prior authorizations and utilization management, ensuring members receive appropriate care cost-effectively. These systems will integrate with partner solutions to achieve provider payment integrity and accuracy for the healthcare service. We are leveraging proven technologies and business rules engines to create a highly configurable system. Collective Health is building modern health management systems, which enhance the claims engine, using cutting-edge technologies. What you'll do: - Design and develop scalable, secure, and configurable platform services for the Claims team. - Lead full-stack development and support of services across backend (Java/Spring Cloud), integration platforms (Kafka, Mulesoft), and frontend (React/Angular/GraphQL etc.). - Utilize working knowledge of AI-powered developer tools (e.g., Copilot, Cursor) and actively contribute to AI adoption in development and operational aspects. - Build and enrich APIs and data services to integrate with partners and our claims engine. - Collaborate with product managers, operations analysts, and data teams in building solutions that leverage Business Rules Management Systems (BRMS) like Drools, Camunda etc. - Actively work with the operations team to create efficient processes through automations to improve SLAs. - Understand architectural decisions and actively drive reusable patterns for cloud-native, AI-enabled backend systems. To be successful in this role, you'll need: - Experience:

Software Developer 3 BENGALURU, KARNATAKA, India About the Role At Oracle Health, we're transforming healthcare administration through Oracle Health Insurance (OHI), a cloud-native payer platform supporting enrollment, billing, benefits administration, provider payments, and claims adjudication. As Oracle expands Oracle Health Insurance capabilities globally, including support for U.S. Medicare, Medicaid, commercial insurance programs, and AI-enabled claims processing, we're investing in engineers who are passionate about building the next generation of healthcare payer solutions. As an IC3 Software Development Engineer, you will contribute to the design and development of scalable cloud services, healthcare business workflows, and AI-powered capabilities that improve operational efficiency for health plans and government programs.

Medical Representative Malaysia - Petaling Jaya posted: Posted 3 Days Ago

Manager, Front End Revenue Cycle Remote Virta Health is on a mission to reverse metabolic disease in one billion people. Current treatment approaches aren't working-over half of US adults have either type 2 diabetes or prediabetes, and obesity rates are at an all-time high. Virta is changing this by helping people reverse their metabolic condition through innovations in technology, personalized nutrition, and virtual care delivery reinvented from the ground up. We have raised over $350 million from top-tier investors, and partner with the largest health plans, employers, and government organizations to help their employees and members restore their health and take back their lives. Join us on our mission to reverse metabolic disease in one billion people. The Front End Revenue Cycle Manager is responsible for the accuracy, completeness, and timeliness of all upstream revenue cycle activities at Virta Health. This role owns the critical entry points of the revenue cycle - member eligibility, claims entry, and provider credentialing - which directly determine whether a billable claim can be submitted and collected. The Front End Manager ensures that every member who receives a Virta Health service has a verified, complete record in the billing system before a claim is generated, and that all providers and programs are credentialed and enrolled with payers in a timely manner. RESPONSIBILITIES Eligibility Management - Own the end-to-end member eligibility process - from receipt of client eligibility files through verification of active insurance coverage in Athena Health - Define and enforce client eligibility file completeness

VP, Patient Advocacy VP, Patient Advocacy

Health Care Claims Entry Level Analyst Remote Withum is a place where talent thrives - where who you are matters. It's a place of endless opportunities for growth. A place where entrepreneurial energy plus inclusive teamwork equals exponential results. Explore different industries. Learn new skills. Connect with our diverse teams of professionals to gain insight into the career you envision. Your Career Starts with You. Experience the Transformative Power of Withum Plus You - that's the Power in the Plus! Withum is a forward-thinking, technology-driven advisory and accounting firm that helps clients be in a position of strength in today's business landscape. Withum empowers clients with innovative tools and solutions to address their accounting, tax, and overall business management needs. We recruit the best and brightest people who are passionate about helping businesses grow and thrive. Job Summary The Healthcare Claims Analyst is responsible for analyzing and auditing healthcare claims (medical, pharmaceutical, dental, supplemental sickness, etc.), identifying trends, and providing actionable insights to improve operational efficiency and client outcomes under the supervision of the engagement lead. The analyst will also be responsible for understanding our clients benefit structures to analyze claim payments to ensure proper benefit administration. This role requires strong analytical skills, attention to detail, and the ability to communicate findings effectively to stakeholders. Remote role with potential to travel. Responsibilities - Perform audits and quality assurance processes related to claims processing. - Prepare working papers, which record and summarize data in accordance with professional standards. - Organize and

Head of Women’s Health

Medical Billing Specialist (ABA) Remote ABOUT US: Camber builds software to improve the quality and accessibility of healthcare. We streamline and replace manual work so clinicians can focus on what they do best: providing great care. For more details on our thesis, check out our write-up: What is Camber? https://camberhealth.notion.site/What-is-Camber-1a6c4e2fa5318049b6beef91b8ed7d1a?pvs=4 We've raised $50M in funding from phenomenal supporters at a16z, Craft Ventures, YCombinator, Manresa, and many others who are committed to improving the accessibility of care. For more information, take a look at: Announcing Camber https://www.camber.health/knowledge/launch ABOUT OUR CULTURE: Our mission to change behavioral health starts with us and how we operate. We don't want to just change behavioral health, we want to change the way startups operate. Here are a few tactical examples: 1) Improving accessibility and quality of healthcare is something we live and breathe. Everyone on Camber's team cares deeply about helping clinicians and patients. 2) We have to have a sense of humor. Healthcare is so broken, it's depressing if you don't laugh with us. WHAT YOU'LL DO: - Clean, review, and submit claims for behavioral health providers (specifically autism providers) - Track claim statuses and remittancesWork denials and follow up with unpaid claims proactively - Manage patient responsibility invoices (e.g., patient co-insurance, co-pays) - Evaluate insurance operations and identify efficiency improvements - Analyze EOBs and post manual payments WHAT WE'RE LOOKING FOR: - 2+ years experience with revenue cycle management and billing for commercial and Medicaid plans (especially in the autism space) with claim submission,

Communication Representative Banner Health Corp Mesa (525 W Brown Rd) posted: Posted 14 Days Ago

Senior Solutions Consultant - Health Remote This is a fully remote opportunity. Gradient AI: Gradient AI is revolutionizing Group Health and P&C insurance with AI-powered solutions that help insurers predict risk more accurately, improve profitability, and automate underwriting and claims. Our SaaS platform taps into one of the industry's largest data lakes-tens of millions of policies and claims-to deliver deep, actionable insights. Trusted by leading carriers, MGAs, TPAs, and self-insured employers, Gradient AI has grown rapidly since our founding in 2018. Backed by $56M in Series C funding, we're scaling fast-and it's an exciting time to join the team. About the Role: We are looking for a Senior Solutions Consultant to work with our sales and customer service team to drive effective implementations of our predictive analytics AI/ML solutions for underwriting and claims health clients. With a background in Health Insurance & Medical Stop Loss, this person will draw on deep domain experience to ensure we ask the right questions, use the best tools, articulate the best value propositions and provide the appropriate context; as well as to ensure the solutions we provide are on-point, value-add, and actionable. How you will make an impact: - Support the Health sales team by leading the creation, development, and ongoing maintenance of sales demo environments and presentation materials. - Arm the sales team with client success stories, KPI analyses, and reports that quantify client ROI - Participate on sales calls, providing demonstrations of our solutions and technical support for explanations of our products

Fleet Claims Specialist, Middle Mile Property Damage Nashville, Tennessee, USA At Amazon, we're working to be the most customer-centric company on earth. To get there, we need exceptionally talented, bright, and driven people. We are seeking a highly skilled and motivated candidate to file and manage claims related to accidents and damages involving Amazon's growing transportation fleet. The Fleet Claims Specialist will be focusing on filing, managing and resolving claims related to damaged ATS assets in addition to program and process improvement. This is an hourly position sitting in Nashville, TN. Responsibilities will include reviewing assigned claims, contacting the insured and other affected individuals, initiating documentation in the claim handling system, and resolving claims. An ideal candidate brings a background in fleet maintenance and automotive claims handling, with experience managing professional relationships with multiple stakeholders, holding responsible individuals accountable for asset damages and repair costs, and achieving organizational targets. This job will require exceptional communication, interpersonal, and negotiating skills with the ability to work independently. Benefits include health care (medical, dental, vision) coverage starting on day 1 as well as 401(k) with company match, holiday/overtime pay. Amazon offers a range of fully paid Maternity and Parental Leave options for parents prior to, and following, the birth or adoption of a child. Key job responsibilities - Interact with carriers and customers to obtain facts, explain claims processes, and provide high quality service to achieve a positive customer experience - Plan and conduct investigation to determine liability, bodily injury, and damages -

Communication Representative Banner Health Corp Mesa (525 W Brown Rd) posted: Posted 15 Days Ago

Medical Representative - Nutrition - Tay Ninh Vietnam - Ho Chi Minh City posted: Posted 4 Days Ago

Employee Health and Benefits Analyst Austin, Texas, United States of America Collect data from various sources to create reports that show health and benefits program cost projections. Work with client claims experience data to create reports showing budgeted vs. Develop bench...

Claims Correspondence Analyst Marlborough, MA, US Company Details Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley's success is our nimble approach to risk - our ability to quickly understand, think through, and devise a plan that addresses each client's challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation , is one of the largest and best managed property/casualty insurers in the United States. #LI-AV1 #LI-Hybrid The Company is an equal employment opportunity employer. Responsibilities The Claims Correspondence Analyst will serve as a first point of contact for inquiries related to claims. This role is responsible for handling Explanation of Reimbursement (EOR) requests, claim status inquiries, general claim-related questions, and prescreening information received for initial claim file setups. The ideal candidate will have strong communication skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. This position will be based in one of our offices: Hamilton Square, NJ Marlborough, MA We offer hybrid work schedule with 4 days in the office; and 1 day

Medical Representative - Nutrition - Binh Duong Vietnam - Bien Hoa posted: Posted 3 Days Ago

Health Representative - IM (GP) Malaysia - Johor posted: Posted 30+ Days Ago

Claims Processor Des Moines, Iowa About Carrot: Carrot is the leading global fertility and family care platform, built on intelligent care orchestration: the right clinical guidance, at the right moment, in the context of each member's life. More than a thousand multinational employers, health plans, and health systems trust Carrot to support millions of members across 195 countries - from pre-pregnancy through menopause and major life moments in between. Carrot's comprehensive clinical program delivers industry-leading cost savings for plan sponsors and award-winning experiences and improved outcomes for millions of people worldwide. Carrot is widely regarded as a defining force in healthcare innovation as a recipient of several top-tier awards, including Fast Company's 'Most Innovative Companies' and CNBC's '100 Barrier Breaking Startups'. The company is regularly cited by leading global outlets - including The Economist, Bloomberg, The Wall Street Journal, NPR, ABC News, and Harvard Business Review - as a leading voice on digital health, the future of work, and family health. Learn more at get-carrot.com . The Role: You'll report to our Manager, Payments and support Carrot's existing members and internal business partners to ensure the best possible experience. In this role, you will be responsible for adjudicating member out-of-pocket expenses, supporting eligibility checks, tracking the life cycle of claims, and reviewing member transactions incurred using the Carrot Card. You will collaborate and cross functionally work with other teams in the organization to ensure that payment for applicable care is quickly and accurately facilitated. This role will respond timely to

Health Representative (Central) Malaysia - Kuala Lumpur posted: Posted 30+ Days Ago

IHCRA France, Paris posted: Posted Yesterday

Customer Solutions & Claims Supervisor Country United States At Nestlé Health Science, we believe that nutrition, science, and wellness must merge, not collide. Here, we embrace the intrinsic connections of these three pillars, harnessing their collective strength to empower healthier lives. Our broad product portfolio includes renowned brands like Garden of Life®, Nature's Bounty®, Vital Proteins®, Orgain®, Nuun®, BOOST®, Carnation Breakfast Essentials®, Peptamen®, Compleat Organic Blends®, and more. We also have extensive pharmaceutical expertise, offering innovative medicines that aim to prevent, manage, and treat gastrointestinal and metabolic-related diseases. At Nestlé Health Science, we bring our best for better lives. Our people are challenged to bring fresh, diverse views and make bold moves to empower healthier lives through nutrition. We know brilliant ideas can come from anyone, anywhere. Here we embrace the entrepreneurial spirit and collaborate with teams that champion focused and forward thinking. We are committed to fostering professional growth and celebrating the achievements of our people along the way. We offer dynamic career paths, robust development, opportunities to learn from talented colleagues around the globe, and benefits that support physical, financial, and emotional wellbeing. Join us to innovate for impact and reimagine the future of health and nutrition for patients and consumers. POSITION SUMMARY: The Customer Solutions & Claims Supervisor leads the execution of Order-to-Cash (O2C) operations, overseei

Client Accounting Specialist (Meritain Health) Work At Home, Albany, New York,United States Embrace the role of a Client Accounting Specialist and play a key role in financial operations at CVS Health. Utilize your expertise in Excel, financial analysis, and reconciliation to support revenue and claim processes. Grow your career in a collaborative environment focused on quality, compliance, and operational excellence. Apply now to make an impact!

Acute Patient Access Services Representative Wyoming Medical Center Central (1233 E Second St) posted: Posted 30+ Days Ago