• Senior Appeals Examiner

    CVS Health (Albany, NY)
    …experience. ** Preferred Qualifications** + 3 plus years of prior claim or health insurance experience. + Familiarity with medical terminology, self funding ... Qualifications** + 1 plus years knowledge of plan documents, claims research, letter writing. + 1 plus years working...letter writing. + 1 plus years working with appeals, claims , or compliance. (and/ or) + 1 plus years… more
    CVS Health (10/15/25)
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  • Specialist, Config Oversight (healthcare Medical…

    Molina Healthcare (Rochester, NY)
    …updates/changes within claims processing system . + Experience using claims processing system (QNXT). ** PREFERRED EDUCATION:** Bachelor's Degree or ... equivalent combination of education and experience ** PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working… more
    Molina Healthcare (09/24/25)
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  • Analyst, Configuration Oversight ( Claims…

    Molina Healthcare (Buffalo, NY)
    …combination of education and experience ** PREFERRED EXPERIENCE:** 3+ years of experience in claims as Adjuster or claims examiner in the healthcare field ... of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Comprehensive claims processing experience (QNXT) as Examiner or Adjuster +… more
    Molina Healthcare (09/17/25)
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  • Claims Team Leader - Liability

    Sedgwick (Albany, NY)
    …and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on ... projects for the office. + Provides technical/jurisdictional direction to examiner reports on claims adjudication. + Compiles...claim status; and provides written resumes of specific claims as requested by client. + Assures that direct… more
    Sedgwick (09/13/25)
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  • Complex Claims Advisor | Commercial GL…

    Sedgwick (Albany, NY)
    …FUNCTIONS and RESPONSIBILITIES** + Proactively and strategically manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional ... claims . Supervisory experience a plus. Specific jurisdictional expertise preferred . **Skills & Knowledge** + Subject matter expertise in worker's compensation… more
    Sedgwick (09/25/25)
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  • Claims Care Associate

    Lincoln Financial (Albany, NY)
    …environment. You will act as a liaison between the employee (member) and the claims examiner to provide a positive customer experience during their specific ... a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence...the day, answering questions and providing information regarding their claim through the utilization of multiple applications and platforms.… more
    Lincoln Financial (10/17/25)
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  • FEMA Disaster Management Accountant

    CDM Smith (Albany, NY)
    …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting, auditing, and investigative… more
    CDM Smith (08/01/25)
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  • Telephonic Case Manager

    Sedgwick (Albany, NY)
    …and support systems. + Effectively communicates and builds relationships with the claims ' examiner , client, injured worker, attorney and supervisor. + Identifies ... recovery. + Provides recommendations for alternate clinical resources to support claim resolution. + Maintains client's privacy and confidentiality, promotes client… more
    Sedgwick (09/19/25)
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  • Investigator, Special Investigative Unit - FLORIDA

    Molina Healthcare (Syracuse, NY)
    …Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation pertinent to investigations. + Detects ... the Medicaid and Medicare programs as well as Marketplace. + Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. +… more
    Molina Healthcare (09/22/25)
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  • Compliance Analyst II, Urmc and Affiliates

    University of Rochester (Rochester, NY)
    …OIC leadership to determine corrective action, such as formal self-disclosures or claim adjustments + Assists in responding to external audits and government ... integrated health system, an Academic Medical Center, or other comparable setting preferred . + **Certifications** + One of the following credentials is preferred… more
    University of Rochester (10/03/25)
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