Claims Advocacy Jobs

This hybrid pharmacist role is based in North Carolina, combining four days of in-store retail operations with one day of remote centralized support. The position involves verifying prescriptions, compounding medications, and conducting drug therapy reviews while ensuring strict regulatory compliance. Key responsibilities include providing clinical services such as immunizations and patient consultations, managing inventory and financial workflows, and fostering professional development within the pharmacy team. The opportunity appeals to candidates seeking a blend of direct patient care and operational leadership within a large, established healthcare organization. The role offers a flexible work arrangement that balances community engagement with remote administrative duties, supporting a mission to build healthier futures through accessible healthcare services.

This hybrid pharmacist role is based in North Carolina, combining four days of on-site work at retail locations with one day of remote support for centralized services. The position involves verifying prescriptions, managing medication compounding, and providing clinical services such as immunizations and patient consultations. Key responsibilities include optimizing pharmacy workflows, managing inventory, and fostering relationships with local healthcare providers. The role appeals to professionals seeking a blend of direct patient care and operational leadership within a large, established healthcare organization. It offers the opportunity to work in diverse environments while contributing to community health initiatives and supporting team development.

The Accounting Officer Intermediate role supports the Direct Care and Treatment Financial Operations Team within the State of Minnesota. Key responsibilities include developing and verifying internal accounting procedures, maintaining accounts payable integrity, and providing leadwork direction to junior staff on payment and vendor activities. The position requires analyzing fiscal data to ensure proper controls and resolving discrepancies using systems like SWIFT and Excel. This opportunity appeals to candidates seeking to contribute to public service while improving the well-being of Minnesotans. The role offers a hybrid work arrangement with onsite presence required at least 50% of the time, alongside opportunities for professional development, training, and a commitment to equity and inclusion.

The Sous Chef role serves as a key member of the restaurant leadership team at Eddie Merlot's, responsible for directing safe and profitable kitchen operations. Key duties include managing daily food production for dining and events, leading and training kitchen staff to ensure high-quality standards, and monitoring food and labor costs to meet financial goals. The position appeals to culinary professionals seeking growth opportunities through cross-training and mentorship within a collaborative culture. The role requires active partnership with other locations and dining managers to enhance the guest experience while maintaining strict adherence to safety and sanitation regulations.

This full-time Property Adjuster role supports claims operations across multiple counties in New York, focusing on first and third-party property damage investigations. The position involves inspecting damaged structures, analyzing policy coverage, negotiating settlements, and preparing detailed documentation and cost estimates. Key responsibilities include maintaining accurate file reserves, adhering to state regulations, and managing a mobile caseload. The role offers a hybrid work arrangement with significant on-the-road travel, supported by a provided company vehicle and equipment. It appeals to candidates seeking a dynamic field position that values problem-solving skills, technical aptitude in construction, and the opportunity to resolve complex claims efficiently within a supportive team environment.

This field investigator role at Ethos Risk Services focuses on identifying fraudulent insurance claims through covert surveillance and evidence collection. The position involves reviewing case files, conducting stationary and mobile surveillance from a personal vehicle to capture video evidence, and drafting detailed, court-ready investigative reports. The role appeals to those seeking an independent career with opportunities for mentorship and professional growth within a leading industry firm. While the position requires early morning starts, weekend availability, and occasional travel, it offers the flexibility of working autonomously in the field. Candidates must possess a valid driver's license, a reliable vehicle, and relevant surveillance equipment or the willingness to obtain a private investigator license.

This full-time on-site role in Charlotte supports the Technical Department by managing warranty claims for key national accounts. The position involves reviewing and processing claim documentation, coordinating with engineers for validation, and ensuring timely reimbursement through accurate data entry and tracking. Key responsibilities include handling customer inquiries via phone and email, maintaining organized claim status records, and coordinating the logistics for tire inspections and shipments. The role appeals to candidates seeking a structured environment where strong organizational skills and problem-solving abilities are valued. It offers the opportunity to work closely with engineering and administrative teams while developing expertise in warranty policies and customer service operations within a collaborative office setting.

The Principal Data Analyst role serves as a trusted analytical partner to Long Term Care Claims Operations leadership at Genworth, focusing on translating complex data into strategic insights. Key responsibilities include designing scalable Power BI solutions, developing advanced SQL queries for forecasting and capacity planning, and ensuring data quality across enterprise systems. The position requires mentoring junior staff and presenting actionable narratives to senior executives. This opportunity appeals to candidates seeking a purpose-driven career within a compassionate culture that values diversity and community impact. The role offers a hybrid work arrangement in Richmond, Virginia, and supports professional growth through extensive training and upskilling resources.

The Inside Property Adjuster role within the Property Damage Department involves handling property claims telephonically with independent judgment. Key responsibilities include investigating claims, interviewing policyholders and witnesses, inspecting damage, preparing estimates, and determining coverage and payment amounts. The position offers a hybrid work arrangement based in the Lexington, KY office and provides opportunities for professional growth through industry training and a supportive culture. The role is appealing due to the company's commitment to employee well-being, including comprehensive health benefits, a traditional pension plan, and a collaborative environment within a Fortune 500 organization.

The Shop Foreman role oversees daily operations within a heavy construction equipment service department. Key responsibilities include managing work orders and invoices, performing basic diagnostics and repairs on machinery, and maintaining inventory and safety standards. The position also involves assisting with technician training, conducting safety meetings, and supporting performance reviews. This opportunity appeals to candidates seeking a leadership position that combines technical expertise with administrative duties in a team-oriented environment. The role requires a flexible schedule with occasional evenings and weekends, and involves working on-site at the branch facility.

This full-time remote Patient Accounting Representative role supports the Physician Billing Operations team within the Revenue Cycle department. The position focuses on monitoring insurance claims, resolving denials and appeals, and managing payment discrepancies to ensure accurate adjudication. Key responsibilities include analyzing Explanation of Benefits, applying coding concepts, and utilizing healthcare operating systems to follow up on unpaid or underpaid claims. The role appeals to candidates seeking a position that values independent self-management and offers flexibility, with occasional requirements for office work or travel. It provides an opportunity to work in a fast-paced environment where strong organizational and problem-solving skills are essential for maintaining efficient revenue cycles.

This full-time Private Investigator role with DigiStream Investigations focuses on gathering evidence for cases involving potentially fraudulent worker's compensation claims within the Fresno, CA region. Key responsibilities include conducting covert surveillance, following subjects, capturing video evidence, and drafting detailed reports. The position offers significant appeal through its dynamic nature, providing a company vehicle, paid travel time, and comprehensive benefits including health insurance and a 401(k) match. The role emphasizes professional growth with a structured promotion track and hands-on training, serving as a strong foundation for careers in law enforcement or security. The work arrangement involves high autonomy with a company vehicle kept at the investigator's residence, requiring flexibility to work long days, weekends, and occasional overnight travel.

This senior Data Architect role focuses on designing and maintaining enterprise-scale data architectures specifically for Medicaid claims, eligibility, and care management within the healthcare sector. The position involves establishing data ingestion frameworks, defining governance standards to ensure HIPAA and CMS compliance, and leading cloud-based modernization efforts using platforms like Snowflake or Azure. Key responsibilities include translating complex regulatory requirements into scalable technical solutions, mentoring data engineering teams, and ensuring data quality across high-volume pipelines. The role is appealing for its opportunity to shape critical healthcare infrastructure while working in a fully remote environment with a collaborative culture that values professional growth and technical leadership.

The Technical Business Analyst role supports two Scrum teams within the Product Department at Avalon Healthcare Solutions, acting as a bridge between the Product Owner and technical IT teams for a healthcare claims rules engine. Key responsibilities include documenting functional and technical requirements as user stories, establishing best practices for detailed documentation such as data flows and wireframes, and collaborating with stakeholders to define product features. The position requires expertise in SQL, data modeling, and Agile methodologies within the healthcare IT sector. This opportunity appeals to candidates interested in shaping a new market while improving clinical outcomes and healthcare affordability. The role offers remote work flexibility with quarterly travel required to the Tampa, Florida corporate office.

This Insurance Agent role within the Commercial Lines department focuses on servicing policyholders and evaluating coverage needs for businesses. Key responsibilities include performing frontline underwriting for new applications and renewals, binding coverage according to guidelines, and assisting with claims processing and policy inquiries. The position involves building client relationships, coordinating with lenders, and maintaining accurate account records. The role offers a hybrid work arrangement allowing up to three days of remote work after initial in-person training. It is appealing due to the company's structured training program, mentorship opportunities, and a collaborative culture that supports long-term career growth in a top-rated insurance carrier.

The Program Integrity Clinical Reviewer II role supports CareSource's investigative and audit teams by evaluating medical records for documentation accuracy, coding compliance, and potential fraud. Key responsibilities include conducting claim reviews against clinical standards, presenting findings to medical directors, developing training materials, and collaborating with cross-functional departments to improve policies. This position is appealing for professionals seeking to leverage their clinical background and coding expertise in a collaborative environment that values continuous learning and professional development. The role requires a current RN license and coding certification, with a preference for readmission and fraud investigation experience. The position operates within a general office setting.

This full-time Payment Integrity and Refund Specialist role supports KabaFusion's home infusion operations by ensuring accurate and compliant billing across government and commercial payers. Key responsibilities include analyzing payer correspondence, resolving claims issues, processing patient and payer refunds, and escalating reimbursement trends to management. The position requires strong attention to detail, knowledge of medical coding, and the ability to manage a daily volume of 30 to 35 claims. The role appeals to candidates seeking a supportive culture that celebrates diversity and offers immediate benefits, including a 401k match and professional development opportunities. While specific work arrangements are not detailed, the position emphasizes productivity and minimal supervision within a rapidly growing industry leader.

This experienced desk-based Property Adjuster role at USAA focuses on investigating, evaluating, and settling low to moderate complexity property insurance claims for the military community. Key responsibilities include analyzing coverage, negotiating equitable settlements, utilizing estimating technology like Xactimate, and collaborating with vendors and internal teams to resolve claims efficiently. The position offers a hybrid work arrangement requiring three days in the office within select locations, providing a stable environment with opportunities for professional growth through comprehensive training and career path planning. The role is appealing due to its mission-driven culture centered on integrity and service, along with access to best-in-class benefits including retirement plans and wellness programs.

This full-time remote Medical Case Manager role supports federal workers with occupational injuries and illnesses within Sedgwick Government Solutions. The position involves developing comprehensive case management plans, coordinating acute and chronic treatment phases, and serving as the primary communication link between patients, providers, and agencies. Key responsibilities include tracking patient improvement goals in a database and implementing services to minimize disability outcomes. The role appeals to nurses seeking a meaningful career where caring for others is central to the mission, offering the flexibility of a home-based office while collaborating with a supportive nationwide team. Success in this position requires an active nursing license, relevant workers' compensation experience, and the ability to obtain a federal security clearance.

This full-time Project Manager role oversees restoration and reconstruction projects within Homeowners Association communities. The position manages the full project lifecycle from initial assessment to completion, including water, fire, mold, and storm damage repairs. Key responsibilities involve developing project scopes and budgets, coordinating subcontractors and vendors, conducting site inspections for safety and quality, and serving as the primary liaison for HOA boards, property managers, and insurance adjusters. The role requires a blend of office planning and frequent field visits to active construction sites. It is appealing for candidates seeking a dynamic environment that values strong leadership, professional client relationships, and the opportunity to manage complex multi-unit residential projects with a focus on timely delivery and high-quality workmanship.

This 1099 field adjuster role is based in the Des Moines, Iowa area, focusing on residential and commercial property claims for CCMS & Associates. The position requires at least one year of first-party adjusting experience and involves conducting on-site property inspections, investigating claims through interviews and official reports, and preparing detailed loss statements and reserve recommendations using estimating software like Xactimate. The role appeals to professionals seeking flexible independent work arrangements within an innovative team that handles complex property and casualty cases. Success in this position relies on strong time management, communication skills, and a valid driver's license to travel to various claim sites.

This entry-level medical role within the BlueCross BlueShield of South Carolina family focuses on conducting medical reviews and managing utilization for inpatient, outpatient, and facility services. The position involves evaluating medical claims, determining coverage based on clinical guidelines, and documenting decisions for appeals. Key responsibilities include performing authorization processes, assessing medical necessity, and providing education to members and providers. The role offers a stable career path with a company rooted in the community for over seven decades, featuring a supportive culture that values diversity and professional growth. While the position begins with six months of onsite training in Myrtle Beach, it transitions to a remote work arrangement thereafter, providing long-term flexibility for qualified candidates.

This part-time Special Investigations Unit role focuses on detecting and combating insurance fraud across auto, property, and liability lines. The position involves conducting in-person and recorded interviews, collecting evidence at accident scenes, and preparing detailed investigative reports for clients. Candidates collaborate with law enforcement to support regulatory compliance and criminal prosecutions. The role appeals to experienced professionals seeking a hybrid work arrangement that combines remote flexibility with local travel. The team offers a collaborative culture, comprehensive training, and essential support including equipment, mileage reimbursement, and professional licensing fees.

This full-time Billing Clerk role within the Fiscal department supports the Billing and Coding Supervisor in a clinic setting located in Alpine. Key responsibilities include verifying patient charges and insurance eligibility, processing medical claims, correcting rejections, and managing patient payment plans and statements. The position requires strong attention to detail regarding medical coding and excellent communication skills for interacting with patients and payers. The role offers a collaborative team environment focused on accurate reimbursement and patient service, with a standard Monday through Friday schedule and occasional flexibility for operational needs.

This full-time Account Manager role at Resolute Management, Inc. supports the handling of complex environmental, asbestos, and latent insurance claims within a Berkshire Hathaway affiliate. The position involves analyzing loss notices, coordinating defense strategies with counsel and stakeholders, and managing case resolution including mediations and settlement valuations. Key responsibilities also include establishing appropriate claim reserves, processing payments, and collaborating with reinsurance and legal departments. The role appeals to candidates seeking a supportive culture that combines the stability of a large corporation with a friendly, small-team atmosphere. While the position is based in Boston with additional offices in Chicago, Philadelphia, and Stamford, it requires occasional travel. The opportunity offers professional growth in a specialized claims environment with a preference for those holding a law degree or relevant industry experience.