• Director , Initial Claims

    Humana (Madison, WI)
    …a part of our caring community and help us put health first** The Director , Initial Claims supports providers, members, and collection services in the processing ... adjudicating claims , along with researching and resolving claims inquiries. The Director , Initial Claims...oversight of and drives for continuous improvement in initial claims processing for all medical lines of… more
    Humana (08/09/25)
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  • Director , Data Scientist - P&C…

    USAA (Tampa, FL)
    …. Relocation assistance **is** available for this position. **Architect the Future of Claims with Scalable AI and Advanced Analytics-In Service of Those Who Serve** ... & Casualty is seeking a strategic and technically skilled Director of Data Science to lead innovation for the... of Data Science to lead innovation for the Claims organization. This high-impact role goes beyond analytics-your work… more
    USAA (08/04/25)
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  • Business Development Director - Casualty…

    Sedgwick (Fort Worth, TX)
    …fulfill those needs. **QUALIFICATIONS** + Ten (10) years of relationship building in the claims management or risk management area or equivalent combination ... Best Workplaces in Financial Services & Insurance Business Development Director - Casualty Claims (TX & OK)...**Experience:** Ten (10) years of relationship building in the claims management or risk management more
    Sedgwick (05/15/25)
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  • Director , Appeals & Grievances (Medicare…

    Molina Healthcare (Des Moines, IA)
    …including 2 years in a manager role. * Experience reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims , Surgery, ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management , and other business… more
    Molina Healthcare (07/18/25)
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  • Director Business Process Ownership…

    USAA (Plano, TX)
    …dedicated Director Business Process Ownership - Advanced Capabilities - Claims Optimization. This role is remote eligible, however, individuals residing within a ... and development of business rules, gathering of requirements, artifacts and process management . Guides team members in the ownership of assigned processed to… more
    USAA (08/09/25)
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  • Executive Director , Business and Data…

    USAA (Phoenix, AZ)
    …development and implementation of multiple Data and Analytics sub-functions for Claims that may include: Information Strategy and Architecture, Information ... Management , Information Governance, Information Delivery Analytics & Insights Delivery,...and vision of the assigned sub-functions for the CoSA Claims working with peers to set objectives across the… more
    USAA (08/08/25)
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  • Manager, Claims & Insurance

    American Water (Camden, NJ)
    …Manager, Insurance (or Director , Insurance), you will be responsible for overall claims management (including, uninsured claims ) at American Water. You ... and wastewater services to our communities. Effective, efficient, and intelligent insurance claims management , oversight, and forecasting are essential to this… more
    American Water (07/01/25)
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  • Workers' Compensation Claims Specialist

    Transdev (Lombard, IL)
    …little guidance and direction. + Demonstrated knowledge and experience in claim adjudication, medical management , and litigation management . + Ability to use ... watch an overview video athttps://youtu.be/ilO5cv0G4mQ About the Role: The Claims Specialist will assist the Director of...play a critical role in ensuring quality claim file management . This will be completed by working with internal… more
    Transdev (08/08/25)
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  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible ... Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for...and Analytics + Direct and relevant experience with HCFA/UB-04 claims management , coding rules and guidelines, and… more
    Commonwealth Care Alliance (05/28/25)
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  • Sr. Workers Comp Claims Specialist

    BJs Wholesale Club (Marlborough, MA)
    …defense counsel and TPA. + Identifies claim trends and provides recommendations to the Claims Manager and Director , Risk Management , and Insurance for ... ensure carrier/excess carrier reporting, determines compensability, scheduling of IME's, medical case management , surveillance, subrogation and litigation tasks… more
    BJs Wholesale Club (07/31/25)
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