• General Liability Claims Examiner…

    Sedgwick (Santa Fe, NM)
    …growth, and inclusion. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate ... Best Workplaces in Financial Services & Insurance General Liability Claims Examiner | Dedicated Client | Remote ... within designated authority. + Communicating claim activity and processing with the claimant and the client. + Reporting… more
    Sedgwick (08/14/25)
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  • Claims Adjudication Specialist - Healthcare…

    Cognizant (Santa Fe, NM)
    …* 1 year of Facets experience. * Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures. * Must ... Based on this role's business requirements, this is a remote position open to qualified applicants in the United...ET **Experience:** A minimum of 2 years of claim processing is required. **Travel:** None required **About the role:**… more
    Cognizant (08/15/25)
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  • Claims Representative - Workers…

    Sedgwick (Santa Fe, NM)
    …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Claims Representative - Workers Compensation ( Remote ) - Dedicated Account **PRIMARY ... PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving… more
    Sedgwick (08/21/25)
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  • Director, Appeals & Grievances (Medicare…

    Molina Healthcare (Rio Rancho, NM)
    …Contracted Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility ... and IPA. + 2 years supervisory/management experience with appeals/grievance and/or claims processing within a managed care setting. **Preferred Education**… more
    Molina Healthcare (07/18/25)
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  • Medical Claims Adjudication - remote

    Cognizant (Santa Fe, NM)
    …duties as assigned by management. **Qualifications:** + A minimum of 2 years' claims processing experience is required. + Knowledge of physician practice and ... + 1 year of Facets experience. + Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures. + Excellent… more
    Cognizant (08/01/25)
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  • Remote - Claims Adjuster…

    Reynolds & Reynolds (Albuquerque, NM)
    Position Description * This is a full-time, remote position working from 9:45am to 6:15pm CSTAmerican Guardian Warranty Services, Inc. (AGWS), an affiliate of ... Reynolds and Reynolds, is seeking Claims Adjuster - Automotive for our growing team. In...are not limited to:-\tAnswering inbound calls-\tProvide information about claim processing and explain the different levels of contract coverage… more
    Reynolds & Reynolds (07/03/25)
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  • Lead Analyst, Configuration Oversight - Payment…

    Molina Healthcare (NM)
    …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen.… more
    Molina Healthcare (07/24/25)
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  • French Speaking Desk Adjuster - Remote

    Sedgwick (Santa Fe, NM)
    …in Financial Services & Insurance French Speaking Desk Adjuster - Remote **_Bilingual/French Speaking Desk Adjuster_** **PRIMARY PURPOSE** **:** Handles losses and ... claims valued up to $15,000 for property and casualty...manages a case load using technology for efficient claim processing . **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Evaluates insurance policies,… more
    Sedgwick (06/29/25)
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  • Pricing Analyst - Remote

    Prime Therapeutics (Santa Fe, NM)
    …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare, and/or related field + Must be eligible to ... analysis of Prime's financial pricing programs, including data extraction, storage, manipulation, processing and analysis + Analyze claims data of varying… more
    Prime Therapeutics (08/13/25)
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  • Manager, Operations -System Operations…

    Molina Healthcare (Albuquerque, NM)
    …Provides leadership and direction to MMS Operational Units management staff (eg, Claims Processing , Provider Services, Provider Enrollment, Finance, Managed Care ... or equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high… more
    Molina Healthcare (07/31/25)
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