UNKNOWN

FEED

Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues.

Molina Healthcare Inc

Senior Examiner, Claims (Remote)-Must reside in Florida

Provides support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. At least 1 year of experience in a clerical role in a claims, and/or customer service setting - preferably in managed care, or equivalent combination of relevant education and experience.

Examiner, Claims (Remote)

Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act of 1934 (title 25, USC Section 472) Native American Indian Preference shall apply to this position pursuant to the Indian Self-Determination and Education Assistance Act (24 U.S.C. 450, et seq.), 25 CFR 271.44 and other relevant laws (title 25, #LI-Remote. Must demonstrate excellent verbal communication skills, including the ability to confidently conduct outbound calls to obtain additional information, clarify details, and resolve issues.

HCSC

Claims Recovery Examiner

We are seeking experienced professionals to join our Workers' Compensation team in two key roles: Senior Claim Examiner and Lead Claim Examiner. Both positions play a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service.

Amtrust Financial Services Inc

Senior Claim Examiner II

Both positions play a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service. Reviewing and analyzing medical bills to confirm charges and treatment are workers' comp injury-related and in accordance with the treatment plan.

Senior Claim Examiner I

FULL_TIME

Overview: The Workers' Compensation Examiner Lead is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers. Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.

AmTrust Financial Services, Inc.

Lead Claim Examiner I

[AW]-iCims

Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations . Your ability to effectively interact with insureds, claimants, and their legal representatives will be essential in driving timely settlements while adhering to AmTrust’s mission, vision, and values.

HOUR

Senior Claim Examiner I, CA

Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors. At least 2 years of experience in claims, and/or customer service experience in a clerical role - preferably in a managed care setting, or equivalent combination of relevant education and experience.

Senior Examiner, Claims(Florida)

Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

TRISTAR Insurance Group, Inc

Claims Assistant - Workers compensation

OTHER

Operating with minimal supervision, this role requires strong analytical judgment, regulatory knowledge, and a commitment to delivering timely, accurate, and compliant claim outcomes. This organization is a professional risk management and claims administration firm committed to delivering responsive, compliant, and high-quality claims services.

TEEMA Group

Workers’ Compensation Claims III

WorkWolf

Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. Skills: Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.

Looking for a great job? Join eTeam. We’re looking for talented staffing professionals to join our staff. We also provide contract assignments and full-time jobs at Fortune 2000 Companies. We’ve been named one of the best companies to work for by Staffing Industry Analysts and New Jersey Business.

eTeam Inc.

Claims Adjuster - Workers Compensation (Hourly)

jobdiva

The position requires strong analytical judgment, excellent communication skills, and consistent collaboration with clients, claimants, vendors, legal counsel, and internal teams. This role handles highly complex claims and plays a critical part in ensuring compliance with state regulations, timely investigations, accurate reserving, and effective claim resolution.

Claims – Workers’ Compensation

Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the "Commission"). As an employee of MTA NYC Transit, you may be required to complete an annual financial disclosure statement with the state of New York, if your position earns more than $101,379 (this is subject to change) per year or if the position is designated as a policy maker.

YEAR

Metro is unique among the nation’s transportation agencies. We serve as transportation planner and coordinator, designer, builder, and operator for the country’s largest, most populous county. More than 10 million people – nearly one-fourth of California’s residents – live, work and play within our 1,433-square-mile service area.

Metropolitan Transportation Authority

Claims Fraud Investigator

ea_via_bold

Identify and recommend systems and process modifications necessary to improve the efficiency and effectiveness of the Assignment processes. Cash Claims Processor duties: Process transactions, apply cash, member bills, resubmit invoices, write-offs, etc.

Global Channel Management

Customer Service Rep

By combining global corporate cards and banking with intuitive spend management, bill pay, and travel software, Brex enables founders and finance teams to accelerate operations, gain real-time visibility, and control spend effortlessly. Data Mining: Use SQL and Python to mine large-scale data, and apply LLM-based tools to detect and automate the identification of fraudulent patterns across credit, deposit, and card payment rails.

Brex Inc.

Fraud Strategy Associate

ADAPTED_NOW

Performs several services including, but not limited to, studying and evaluating internal controls, reviewing operating practices to promote increased efficiency and economy, conducting audits in accordance with audit plans approved by the Governing Board annually, carrying out certain investigative duties and responsibilities, and perform the applicable duties of state agency inspectors general as provided in s. Five or more years of progressively responsible experience as an inspector general; managing programs for prevention, examination, detection, elimination of fraud, waste, abuse, mismanagement, malfeasance, or misconduct in government or other organizations; administration and management of complex audits and investigations; electronic data processing auditor, or any combination thereof.

Our mission: To safeguard and restore South Florida's water resources and ecosystems, protect our communities from flooding, and meet the region's water needs while connecting with the public and stakeholders. 
The South Florida Water Management District is a regional governmental agency that manages the water resources in the southern half of the state, covering 16 counties from Orlando to the Florida Keys and serving a population of 9 million residents. It is the oldest and largest of the state's five water management districts. Created in 1949, the agency is responsible for managing and protecting water resources of South Florida by balancing and improving flood control, water supply, water quality and natural systems.
A key initiative is restoration of the Everglades – the largest environmental restoration project in the nation's history. The District is also working to improve the Kissimmee River and its floodplain, Lake Okeechobee and South Florida's coastal estuaries.

South Florida Water Management District

Inspector General

The Citys liberal fringe benefits for full-time employment include sick leave, holiday and vacation pay, the Public Employees Retirement System, medical, dental and vision insurance, credit union, deferred compensation, tuition reimbursement, Dependent Care Assistance Plan and priority enrollment consideration at Hill & Dale Family Learning Center, Marine Park Child Development Center, and Santa Monica Early Childhood Lab School. If fewer than three qualified City employees pass the examination, the appointing authority, in accordance with the Citys civil service rules and regulations, can decline to use a promotional list, in which case a promotional list will not be established for this position.

City of Santa Monica

SCADA Systems Analyst

These investigations may include participation in telephone calls or meetings with providers, members, clients, legal, compliance, and other investigative areas and requires adherence to state and federal compliance policies, reimbursement policies, and contract compliance. Develop and deliver case presentations to leadership, clients, and compliance (case theories, evidence summaries, overpayment methodology, recommended outcomes.

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

UnitedHealth Group Inc.

SIU Lead Investigator

The Fraud Investigator plays a critical role in protecting the financial assets, operational integrity, and reputation of Nymbus clients by leading advanced investigations into complex and high-impact fraud cases across multiple payment channels and products. We expect team members to engage in our global community, proactively build relationships, participate actively in team and company conversations, seek opportunities to collaborate, and take shared ownership of creating a connected and inclusive remote community including showing up on camera.

Nymbus, Inc.

Fraud Investigator

Responsibilities: MV Transportation is seeking an experienced  Safety and Training Manager for proposed business that will be a hands - on manager helping implement programs and procedures in compliance with State and Federal regulations and corporate and client policies and be accountable for the leadership of OSHA/CDL at the division level. Ensures a consistent safety culture throughout the locations that incorporates operations, safety, and maintenance departments and emphasizes the team approach and individual responsibility of all employees to achieve common goals.

Claims Examiner Jobs in the United States

Senior Examiner, Claims (Remote)-Must reside in Florida Molina Healthcare Inc

Examiner, Claims (Remote) Molina Healthcare Inc

Claims Recovery Examiner HCSC

Senior Claim Examiner II Amtrust Financial Services Inc

Senior Claim Examiner I Amtrust Financial Services Inc

Lead Claim Examiner I AmTrust Financial Services, Inc.

Senior Claim Examiner I, CA AmTrust Financial Services, Inc.

Senior Examiner, Claims(Florida) Molina Healthcare Inc

Claims Assistant - Workers compensation TRISTAR Insurance Group, Inc

Workers’ Compensation Claims III TEEMA Group

Claims Adjuster - Workers Compensation (Hourly) eTeam Inc.

Claims – Workers’ Compensation TEEMA Group

Claims Fraud Investigator Metropolitan Transportation Authority

Customer Service Rep Global Channel Management

Fraud Strategy Associate Brex Inc.

Inspector General South Florida Water Management District

SCADA Systems Analyst City of Santa Monica

SIU Lead Investigator UnitedHealth Group Inc.

Fraud Investigator Nymbus, Inc.

Training and Safety Manager MV Transportation

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