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Research and determine Reinsurance/Stoploss plan year, identify claim payments made by client versus the Stoploss carriers, and interpret complex plan language to ensure accurate handling of complex adjustments. Review, research, and adjust complex Reinsurance/Stoploss medical claims, splitting claims into multiple claim statuses; adjudicates high-dollar complex, sensitive, and/or specialized medical claims in accordance with claim processing guidelines.

HOUR

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.

CVS Health Corp

Reinsurance/Stoploss Medical Claims Adjustor

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This is an excellent opportunity for professionals with experience in healthcare claims processing, medical claims adjudication, data entry, and HIPAA-compliant environments. Collaborate with Business Configuration, Network Management, Provider Data, Appeals, Grievances, and other operational teams.

Sigma Systems

Claims Examiner Sr

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This individual will present relevant data, analysis and solutions related to feedback regarding identified processing trends, process improvement opportunities, general areas of concern found in routine review activity, claims processing turnaround times and quality benchmarks to the claims Executive Leadership Team. Functional: Ensure direct oversight of Claims Supervisors and claims support staff, claims processing workflows, queue management and daily transactional operations and completion and delivery of annual performance reviews.

YEAR

Avesis LLC

Manager of Claims

This individual will be responsible for onboarding new employees, delivering engaging training programs, identifying performance gaps, and providing ongoing coaching to ensure consistent processes and exceptional customer service. Excellent verbal and written communication skills, with the ability to work effectively with employees, leadership, and external customers.

GEE Group, Inc

Claims Trainer

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Produce clear, logically structured summaries outlining root causes, validation results, and historical trends to reduce repetitive requests. Review and validate incoming requests for mass claim adjustments (typically 50+ affected claims), ensuring completeness, accuracy, and alignment with internal guidelines.

Iconma LLC

Sr. Facets Mass Claims Adjustment Specialist

At the core of this role is deep, practical experience in claims management: overseeing the full claims lifecycle, driving financial recovery, managing carrier relationships, and building high-performing teams that consistently deliver results across both final mile and parcel claim types. Leverage AI-driven analytics and predictive modeling to forecast claim volumes, identify high-risk carriers or routes, optimize resource allocation, and proactively surface trends before they become financial liabilities.

Samsung Electronics America Inc

Claims Sr Manager

Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.

Guide Well

Claims Examiner I

Looking for individuals who are highly organized, detail-oriented and comfortable providing administrative support in a collaborative environment, including assisting a visually impaired team member with workflow coordination and document management. Serve as the Claims SharePoint Administrator by maintaining and updating site content such as on‑call schedules, contact lists, training materials, and other claims‑related resources.

Indotronix International Corporation

Claims Administrative Assistant

An employee must be willing and able to work their regularly assigned work schedule onsite, and in times of need, be able to work an extended schedule depending on company or departmental needs, project requirements, or customer demands. To perform the job successfully, an individual must be able to perform each essential duty satisfactorily and should demonstrate the following competencies to consistently perform the essential functions of this position.

Orion180 Insurance Services

Claims Manager

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Customer Interaction: Manage incoming calls, collect accident facts, investigate claim details, collect statements from involved parties, and assist in the process of getting our customers back on the road. You'll manage multiple steps impacting the claims life cycle, providing guidance, support, and solutions to policyholders during times of uncertainty.

GEICO GENERAL INSURANCE COMPANY

Claims Specialist

ADAPTED_NOW

Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.

In 1999, two historic Catholic charities became one, forming CHRISTUS Health and creating a unique purpose in the modern health care market - to take better care of people. To extend the healing ministry of Jesus Christ, the mission that the Sisters of Charity Health Care system and Incarnate Word Health system shared for more than a century, is now also the mission of CHRISTUS Health. Ranked among the top 10 Catholic health systems in the United States by size, the CHRISTUS Health system includes more than 40 hospitals and facilities in seven U.S. states, Chile and six states in Mexico, with assets of more than $4.6 billion. Whether seeking care in Alexandria Louisiana, or Coahuila, Mexico, patients discover that the healing spirit is alive at CHRISTUS Health.

CHRISTUS Health

Claims Examiner Senior - Health Plan Admin

NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com, @nttdatafed.com and @talent.nttdataservices.com email addresses. 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools.

NTT DATA Group Corp

Claims Examiner Remote

GuideWell Mutual Holding Corp

We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams.

Wisconsin Physicians Service Insurance Corp

Claims Examiner III - LPN

FULL_TIME

In this role, you'll work alongside dedicated professionals in a collaborative, high-energy environment where your expertise, problem-solving abilities, and commitment to customer service are recognized and valued. As an Auto Liability PD Claims Specialist, you will manage a portfolio of auto liability and property damage claims from initial investigation through final resolution.

Lonestar

Auto Liability PD Claims Specialist

Talent Acquisition

You will analyze coverage, evaluate liability and damages, negotiate settlements, and maintain accurate claim documentation while ensuring compliance with company procedures and state regulations. The ideal candidate is a detail-oriented professional who thrives in a fast-paced environment, exercises sound judgment, and is committed to delivering outstanding customer service.

Auto Bodily Injury Claims Specialist

Supervises and monitors the daily operations of claim processing of injured employees with catastrophic injuries in accordance with the Texas Workers' Compensation Act, rules of the Division of Workers' Compensation and internal procedures. Summary: Supervises claims personnel who administer compensation and medical benefits to injured employees with catastrophic injuries in accordance with the Texas Workers' Compensation Act, rules of the DWC, and internal procedures, as well as quality of their work.

Texas Mutual Insurance Co

Catastrophic Claims Supervisor

We align to a set of Values that are the core pillars that define our culture and help bring our brand purpose to life: We are stronger as one: We collaborate across the enterprise, scale what works and act decisively for our customers and partners. Work in a team environment, develop working relationships inside and outside the organization, share information and ideas with team members/management, and strive to achieve continuous improvement and increase efficiency.

Corebridge Financial Inc

Money Out Processor

PART_TIME

Conduct testing to ensure products perform according to user requirements and within established guidelines; if a product does not perform within specifications, report defects to EC Operations and the BOT teams identifying and recommending solutions, improvements, and updates. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.

CorVel Enterprise Claims, Inc.

Claims Quality Assurance

The Insurance Claims Coordinator supports the Risk Management Department through legal and risk management functions, by managing claims and lawsuits, and insurance applications. Manage claims and lawsuits, prepare case summary notebook, facilitate legal discovery and meetings between legal counsel and hospital staff.

Claims Processor Jobs in Texas

Reinsurance/Stoploss Medical Claims Adjustor CVS Health Corp

Claims Examiner Sr Sigma Systems

Manager of Claims Avesis LLC

Claims Trainer GEE Group, Inc

Sr. Facets Mass Claims Adjustment Specialist Iconma LLC

Claims Sr Manager Samsung Electronics America Inc

Claims Examiner I Guide Well

Claims Administrative Assistant Indotronix International Corporation

Claims Manager Orion180 Insurance Services

Claims Specialist GEICO GENERAL INSURANCE COMPANY

Claims Examiner Senior - Health Plan Admin CHRISTUS Health

Claims Examiner Remote NTT DATA Group Corp

Claims Examiner I GuideWell Mutual Holding Corp

Claims Examiner III - LPN Wisconsin Physicians Service Insurance Corp

Auto Liability PD Claims Specialist Lonestar

Auto Bodily Injury Claims Specialist Lonestar

Catastrophic Claims Supervisor Texas Mutual Insurance Co

Money Out Processor Corebridge Financial Inc

Claims Quality Assurance CorVel Enterprise Claims, Inc.

Insurance Claims Coordinator - Days Baptist Hospitals of Southeast Texas

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