medical claims manager

Shaw Industries

<div>
 <strong>
  Job Title
  <br/>
  <br/>
 </strong>
 Claims Manager
 <br/>
 <br/>
 <strong>
  Position Overview
  <br/>
  <br/>
 </strong>
 To develop the skills and decision-making capacities necessary to manage the claims process for a claims manager&rsquo;s area and to be able to ensure cost effective and timely resolution of customer claims within established authority level. The Claims Manager Trainee must develop the knowledge and skills needed to advance to a Claims Manager I position within a designated time. In all actions and communications, the Claim Manager Trainee must demonstrate impeccable ethical standards, while focusing on the Customer Experience.
 <br/>
 <br/>
 <strong>
  Essential Duties
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Complete the training and development necessary to manage and conduct the investigation, research, negotiation, communication, and resolution activities for claims within assigned authority level. On-the-job training requiring continuous discretionary judgment and decision making has company profit/loss impact.
  </li>
  <li>
   Develop the knowledge to ensure that all claims within the assigned area are coded to reflect the proper claims type for disposition, reporting and root cause and analysis.
  </li>
  <li>
   Develop and maintain an elevated level of professional business communication (both verbal and written) to internal Shaw customers/departments and customers (both dealer and end user) during the investigation and decision process. The trainee may have to communicate information to internal and external customers that may be viewed as unfavorable, thus the information should be delivered with professional tact and empathy. Our goal is to maintain our customers&rsquo; loyalty to our products and services.
  </li>
  <li>
   Develop and demonstrate a level of sound business judgment during the investigation, the disposition, and the pre/post communication of the claim's decision.
  </li>
  <li>
   Develop the ability to assess each claim individually, with consideration of the dealer/end user&rsquo;s concern, warranty coverage and all other pertinent business factors that are at stake. Develop negotiation skills to negotiate claims and provide resolutions that satisfy our dealers/end users while creating the most favorable fiscal impact to our company.
  </li>
  <li>
   Develop an understanding of the proper selection, assignment, requirements, and performance of 3rd party independent inspectors, installers, or other service providers that we use in claims investigation and resolution.
  </li>
  <li>
   Become proficient in the initiation of claims, return authorizations, credit memos, and all other information process, documentation, and maintain the claim file/record, in compliance with claims procedures and corporate records retention policies.
  </li>
  <li>
   Develop and maintain in-depth knowledge of claims experience for dealers within assigned area. The trainee must develop an understanding of customers with high claims rates through consistent business analysis. Report specific trends and/or customer abuse of the claims process to internal Shaw departments. Must also participate with internal Shaw departments in developing strategic action plans to address high claims rates.
  </li>
  <li>
   Develop the ability to direct activity and follow up that moves the claim resolution process along with an optimal level of velocity without sacrificing thoroughness in the investigation and assessment.
  </li>
  <li>
   Be willing to travel for claims assessment, training, and to testify if deposed in reference to a claim.
  </li>
  <li>
   Participate in special projects, committees, and provide claims handling assistance and support for teammates, as required.
  </li>
  <li>
   Develop basic knowledge of credit, accounts payable, and accounts receivable policies and procedures.
  </li>
  <li>
   Develop and maintain knowledge of claims policies and procedures with expertise in product specification and construction, warranty information, manufacturing processes, installation techniques/requirements, maintenance, and repair.
  </li>
  <li>
   Be fully engaged in PX (Performance Experience) for accelerated growth and results of goals.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Knowledge, Skills, And Abilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Bachelor's Degree preferred or High School/GED. Previous claims experience is a plus.
  </li>
  <li>
   Must be able to effectively analyze job-related information.
  </li>
  <li>
   Must effectively demonstrate problem solving, negotiation and organization skills.
  </li>
  <li>
   Must be self-motivated and detail oriented.
  </li>
  <li>
   Must be able to manage multiple tasks simultaneously (work queues, etc.) within compressed time limits.
  </li>
  <li>
   Must be able to provide elevated levels of service and consistently demonstrate value in every aspect of the customer&rsquo;s experience.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Competencies
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage Work
  </li>
  <li>
   Communication/Collaboration
  </li>
  <li>
   Solve Problems
  </li>
  <li>
   Build Customer Satisfaction
  </li>
  <li>
   Adapt and Change
  </li>
  <li>
   Learn and Apply
   <br/>
   <br/>
  </li>
 </ul>
 THIS JOB DESCRIPTION IS NOT INTENDED TO INCLUDE ALL DETAILS OF THE WORK FUNCTIONS INHERENT IN THIS POSITION. ESSENTIAL DUTIES OF ANY POSITION MAY CHANGE WITHOUT PRIOR NOTICE DUE TO DIRECTIONS OR BUSINESS CONDITIONS. THE INFORMATION LISTED HERE IS DESIGNED TO HELP CANDIDATES QUALIFY THEMSELVES FOR NEW POSITIONS AND IMPROVE IN CURRENT POSITIONS. NO ONE IS GUARANTEED A PROMOTION OR POSITION BASED ON THE INFORMATION IN THIS DOCUMENT. ULTIMATELY, THE MANAGER FOR THE POSITION MUST DETERMINE WHO IS MOST QUALIFIED.
 <br/>
 <br/>
 <strong>
  Work Shift
  <br/>
  <br/>
 </strong>
 8 Hr non-rotating shift, Hrs fall to in punch day, Observed Calendar, shift starts AM
 <br/>
 <br/>
 Shaw Industries is an equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities.
</div>


Claims Manager

<div><div>Job Title</div>
Claims Manager<div></div><div>
Position Overview</div><div>
To develop the skills and decision-making capacities necessary to manage the claims process for a claims manager&rsquo;s area and to be able to ensure cost effective and timely resolution of customer claims within established authority level. The Claims Manager Trainee must develop the knowledge and skills needed to advance to a Claims Manager I position within a designated time. In all actions and communications, the Claim Manager Trainee must demonstrate impeccable ethical standards, while focusing on the Customer Experience.</div><div></div><div>
Essential Duties:</div><ul><li><div>
Complete the training and development necessary to manage and conduct the investigation, research, negotiation, communication, and resolution activities for claims within assigned authority level. On-the-job training requiring continuous discretionary judgment and decision making has company profit/loss impact.</div></li><li><div>
Develop the knowledge to ensure that all claims within the assigned area are coded to reflect the proper claims type for disposition, reporting and root cause and analysis.</div></li><li><div>
Develop and maintain an elevated level of professional business communication (both verbal and written) to internal Shaw customers/departments and customers (both dealer and end user) during the investigation and decision process. The trainee may have to communicate information to internal and external customers that may be viewed as unfavorable, thus the information should be delivered with professional tact and empathy. Our goal is to maintain our customers&rsquo; loyalty to our products and services.</div></li><li><div>
Develop and demonstrate a level of sound business judgment during the investigation, the disposition, and the pre/post communication of the claim's decision.</div></li><li><div>
Develop the ability to assess each claim individually, with consideration of the dealer/end user&rsquo;s concern, warranty coverage and all other pertinent business factors that are at stake. Develop negotiation skills to negotiate claims and provide resolutions that satisfy our dealers/end users while creating the most favorable fiscal impact to our company.</div></li><li><div>
Develop an understanding of the proper selection, assignment, requirements, and performance of 3rd party independent inspectors, installers, or other service providers that we use in claims investigation and resolution.</div></li><li><div>
Become proficient in the initiation of claims, return authorizations, credit memos, and all other information process, documentation, and maintain the claim file/record, in compliance with claims procedures and corporate records retention policies.</div></li><li><div>
Develop and maintain in-depth knowledge of claims experience for dealers within assigned area. The trainee must develop an understanding of customers with high claims rates through consistent business analysis. Report specific trends and/or customer abuse of the claims process to internal Shaw departments. Must also participate with internal Shaw departments in developing strategic action plans to address high claims rates.</div></li><li><div>
Develop the ability to direct activity and follow up that moves the claim resolution process along with an optimal level of velocity without sacrificing thoroughness in the investigation and assessment.</div></li><li><div>
Be willing to travel for claims assessment, training, and to testify if deposed in reference to a claim.</div></li><li><div>
Participate in special projects, committees, and provide claims handling assistance and support for teammates, as required.</div></li><li><div>
Develop basic knowledge of credit, accounts payable, and accounts receivable policies and procedures.</div></li><li><div>
Develop and maintain knowledge of claims policies and procedures with expertise in product specification and construction, warranty information, manufacturing processes, installation techniques/requirements, maintenance, and repair.</div></li><li><div>
Be fully engaged in PX (Performance Experience) for accelerated growth and results of goals.</div></li></ul><div></div><div>
Knowledge, Skills, and Abilities:</div><ul><li><div>
Bachelor's Degree preferred or High School/GED. Previous claims experience is a plus.</div></li><li><div>
Must be able to effectively analyze job-related information.</div></li><li><div>
Must effectively demonstrate problem solving, negotiation and organization skills.</div></li><li><div>
Must be self-motivated and detail oriented.</div></li><li><div>
Must be able to manage multiple tasks simultaneously (work queues, etc.) within compressed time limits.</div></li><li><div>
Must be able to provide elevated levels of service and consistently demonstrate value in every aspect of the customer&rsquo;s experience.</div></li></ul><div></div><div>
Competencies:</div><ul><li><div>
Manage Work</div></li><li><div>
Communication/Collaboration</div></li><li><div>
Solve Problems</div></li><li><div>
Build Customer Satisfaction</div></li><li><div>
Adapt and Change</div></li><li><div>
Learn and Apply</div></li></ul><div></div><div>
THIS JOB DESCRIPTION IS NOT INTENDED TO INCLUDE ALL DETAILS OF THE WORK FUNCTIONS INHERENT IN THIS POSITION. ESSENTIAL DUTIES OF ANY POSITION MAY CHANGE WITHOUT PRIOR NOTICE DUE TO DIRECTIONS OR BUSINESS CONDITIONS. THE INFORMATION LISTED HERE IS DESIGNED TO HELP CANDIDATES QUALIFY THEMSELVES FOR NEW POSITIONS AND IMPROVE IN CURRENT POSITIONS. NO ONE IS GUARANTEED A PROMOTION OR POSITION BASED ON THE INFORMATION IN THIS DOCUMENT. ULTIMATELY, THE MANAGER FOR THE POSITION MUST DETERMINE WHO IS MOST QUALIFIED.</div><div></div><div>
Work Shift</div>
8 Hr non-rotating shift, Hrs fall to in punch day, Observed Calendar, shift starts AM<div></div><div>
Shaw Industries is an equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities.</div></div>

CommonSpirit Health

<div><b>Job Summary and Responsibilities</b><div><br>
The Manager, Operations Enablement will be a key leader of the central operational areas listed and report to the VP of Operations and Data Engineering. This manager will have oversight of numerous management responsibilities and support several cross functional capabilities; Benefits/Enrollment, Claims Operations, Eligibility/EDI and other overall implementation efforts that support these assigned transactional operational functions of the MSO. This manager will also operationalize and enable processes across these areas to support internal partnerships. Responsible for leading and developing a team of claims trainers, and business analysts who support the operational excellence and quality improvement of the claims processes and analyst support to the organization. Works closely with the claims directors, benefit/enrollment managers, and supervisors to identify training needs, design and deliver training programs, monitor and evaluate training outcomes, and provide ongoing coaching and feedback. Collaborates with internal change management to identify and implement best practices, process improvements, and innovative solutions that enhance the efficiency and effectiveness of these operational areas.</div><ul><li>
Overall identification and develop recommendations for training playbooks, process improvements, efficiencies for the assigned operational areas. Ensuring stakeholder and leadership alignment to correlating processes throughout the MSO.</li><li>
Manage and coach a team of business analysts, and claims trainers who provide operations shared services to the PHSO.</li><li>
The BA team will provide operational analyst support to all functional areas within the MSO. This will include reporting/analyst deliverables for leadership and/or functional areas, dashboards on functional performance, analyzing report data and accepting and intake of internal stakeholder requests for BA support.</li><li>
Oversee the design and delivery claims training programs and materials that enhance the skills and knowledge of the claims staff and providers.</li><li>
Develop SOPs, DLPs for assigned areas, product recommendations, raise or address operational gaps, and continuously look for ways to improve the business and member/provider experience</li><li>
Support claims operations on provider claims payment investigation and resolution of known errors, developing streamline processes to support the business.</li></ul><br>
<b>
Job Requirements</b><div><br>
Required</div><ul><li>
High School Graduate or GED</li><li>
5+years experience required in healthcare administration environment, with an understanding of managed care services and implementing/enabling new processes.</li><li>
5+ years of experience implementing and enabling new processes with crossfunctional teams</li><li>
3+ years of people management experience, with a preference for experience managing team members under different functional responsibilities</li></ul><div><br>
Preferred</div><ul><li>
Bachelors Other in business, healthcare administration or similar field, upon hire and</li><li>
10+ years of experience implementing and enabling new processes with crossfunctional teams, upon hire and</li><li>
5+ years of experience in implementing and enabling new processes with crossfunctional teams in a healthcare, managed care services environment., upon hire</li></ul><b>
Where You'll Work</b><div><br>
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health&rsquo;s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.<br>
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health &amp; Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.</div><div>
One Community. One Mission. One California</div><b><br>
Pay Range</b><br>
$52.04 - $77.42 /hour</div>

Manager Managed Care Claims

Berkshire Hathaway GUARD Insurance Companies

<div>Overview:
<p><b>
Good Things Start Here.</b></p><p>
Good things are happening at Berkshire Hathaway GUARD Insurance Companies&mdash;an A+ (Superior) rated, nationwide Property &amp; Casualty insurer backed by Berkshire Hathaway. With supportive leadership, collaborative teams, and opportunities to grow, GUARD is a place where people build meaningful, long‑term careers.</p><p><b>
Good Things You Can Count On.</b></p><ul><li>
Hybrid schedule: 2 days remote / 3 in‑office</li><li>
Predictable hours (no nights, weekends, or holidays)</li><li>
Competitive pay + generous PTO</li><li>
Medical, dental &amp; vision starting day one</li><li>
401(k), tuition reimbursement &amp; longevity bonuses</li></ul>
Responsibilities:
<p>
The Claims Manager will provide leadership and oversight in the Complex Liability Claims Unit, with a primary focus on California‑based claims. This role is responsible for ensuring consistent, compliant, and financially sound claim outcomes across a complex, litigated portfolio within one of the most challenging jurisdictions in the country.</p><p></p><p><br>
As a key leader within the claims organization, this position partners closely with internal stakeholders to manage severity, reserving discipline, litigation strategy, and regulatory compliance, while developing a high‑performing team aligned with carrier best practices and business objectives.</p><div></div><div><br>
Key Responsibilities:</div><ul><li>
Lead, manage, and develop a team of claims professionals handling Complex Liability claims nationwide, with a significant concentration of California exposure.</li><li>
Provide technical oversight and strategic direction on California litigated claims, ensuring alignment with carrier guidelines, risk appetite, and severity management objectives.</li><li>
Review, analyze, and approve claim reserves to ensure accuracy, consistency, and actuarial integrity, with particular attention to California loss drivers.</li><li>
Ensure claim files reflect timely investigation, appropriate evaluation, and well‑documented decision‑making in compliance with California statutory and regulatory requirements.</li><li>
Partner with California panel counsel to establish litigation strategies, manage budgets, and drive disciplined resolution practices.</li><li>
Attend and participate in mediations, trials, and settlement conferences, as needed, to support resolution strategy and risk mitigation.</li><li>
Conduct regular file audits focused on compliance, documentation quality, reserving practices, and adherence to carrier standards.</li><li>
Develop and implement training initiatives to strengthen the team&rsquo;s California technical expertise, consistency, and judgment.</li><li>
Collaborate with Underwriting, Legal, SIU, Actuarial, and Finance partners to support portfolio performance, loss trend analysis, and enterprise risk management.</li><li>
Prepare and deliver reporting on California claim trends, KPIs, severity drivers, and operational metrics to senior leadership.</li><li>
Drive continuous improvement initiatives focused on efficiency, cost containment, and service excellence.</li><li>
Manage and evaluate preferred vendors, including California defense counsel, independent adjusters, and other service providers, ensuring performance, accountability, and cost control.</li></ul>
Qualifications:
<div>
Qualifications</div><ul><li>
Bachelor's degree required or equivalent combination of education and relevant claims management experience.</li><li>
Demonstrated experience supervising litigated liability claims within a carrier environment.</li><li>
Strong working knowledge of California liability law, litigation practices, and regulatory compliance.</li><li>
Proven ability to manage high‑exposure and complex California claim portfolios with a focus on severity and financial outcomes.</li><li>
Experience partnering with Actuarial, Underwriting, and Legal on reserving, strategy, and portfolio performance.</li><li>
Strong leadership and talent‑development capabilities within a structured claims organization.</li><li>
Excellent written and verbal communication skills, including executive‑level reporting.</li><li>
Strong organizational, analytical, and technical skills.</li><li>
Ability to balance technical judgment, operational discipline, and business objectives.</li></ul><p><b>
Salary $85,000 - $125,000 + bonus</b></p><p><b>
In accordance with applicable pay transparency laws, this range represents a good</b><b>‐</b><b>faith estimate. Final compensation will be determined based on factors such as experience, credentials, geographic location, and other considerations permitted by law.</b></p><p><b>
This role may be based out of any of our office locations, including:</b></p><p><b>
New York, NY; Parsippany, NJ; Conshohocken, PA; Wilkes‑Barre, PA; Alpharetta, GA; Rosemont, IL; Plano, TX; Scottsdale, AZ; and Rancho Cordova, CA.</b></p></div>

Prairie States Enterprises, Inc.

<div>
 <strong>
  MEDICAL CLAIMS ANALYST (FULL-TIME / REMOTE / HYBRID)
  <br/>
  <br/>
 </strong>
 <strong>
  This is a full-time position with a hybrid remote work arrangement in our Sheboygan, WI location. No weekends, holidays or on-call rotations. Ideal candidate will work in Wisconsin.
  <br/>
  <br/>
 </strong>
 Prairie States Enterprises, Inc. is a third party administrator, a benefits industry leader, and a trusted advisor to self-insured companies and their employees. We provide a complete range of medical benefit management services, all performed in-house, and to exacting standards of excellence.
 <br/>
 <br/>
 <strong>
  Job Summary
  <br/>
  <br/>
 </strong>
 Position responsibilities include the adjudication and processing of medical, dental, and vision claims while interpreting coding and medical terminology in relationship to the diagnosis and medical procedures. This position requires high level skills in customer service, claims processing, and internal interface with other departments
 <br/>
 <br/>
 <strong>
  Summary Of Essential Job Functions
 </strong>
 <br/>
 <br/>
 <ul>
  <li>
   Provides claims adjudication services by reviewing, researching, investigating, adjudicating and processing claims for assigned relationships.
  </li>
  <li>
   Provides high-level customer service when interacting with members, Human Resource contacts, employees, providers, and internal staff.
  </li>
  <li>
   Has the ability to read and comprehend instructions and draft short correspondence, and memos. Also has the ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
  </li>
  <li>
   Understands all aspects of plan documents for assigned groups, and groups within their assigned pod.
  </li>
  <li>
   Demonstrates understanding of electronic claims from exceptions to pass-through audits. Should also be able to identify potential large claims and have a good understanding of the stop-loss process and pend claims appropriately.
  </li>
  <li>
   Performs daily duties and processes claims with minimal direction and asks questions appropriately.
  </li>
  <li>
   Is responsible and accountable for the accurate and timely entry of claims data. Claims data must be entered with a high level of quality and in accordance with department claims policies and procedures.
  </li>
  <li>
   Consistently meets established productivity and quality standards:
  </li>
  <ul>
   <li>
    Minimum turn-around time is 10 days for clean claims. Claims requiring further investigation will be paid within 1 month unless extenuating circumstances arise and are documented.
   </li>
   <li>
    Once additional information is received, claims must be paid within 10 days from receipt of the documentation.
   </li>
   <li>
    Required to meet the department standards related to procedural and financial accuracy.
   </li>
  </ul>
  <li>
   Assists in answering overflow of outside phone calls, directing the call to the appropriate person or handling the call if that person is not available.
  </li>
  <li>
   Other Claims Dept duties and special projects as assigned.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Position Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   High School Diploma or GED required. Post HS education in medical field and medical terminology highly preferred.
  </li>
  <li>
   Experience &ndash; 1 to 3 years experience in an insurance or medical office setting.
  </li>
  <li>
   Strong customer service and communication skills required.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  COMPETENCIES
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Change Management &ndash; Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
  </li>
  <li>
   Effective Communication &ndash; Demonstrates effective and responsive communications following the appropriate reporting structure.
  </li>
  <li>
   Accountability/Results &ndash; Achieves and/or exceeds result based goals that were specific, measurable, and timely.
  </li>
  <li>
   Teamwork &ndash; Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
  </li>
  <li>
   Customer Satisfaction &ndash; Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
  </li>
  <li>
   Professional Growth &ndash; Takes ownership of one&rsquo;s professional growth within one&rsquo;s current position and to advancement at PSE.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  PHYSICAL DEMANDS / WORK ENVIRONMENT
  <br/>
  <br/>
 </strong>
 This is sedentary position which requires the individual to sit for long periods of time and the proper positioning/posturing for extensive viewing of computer screens and computer related work is required. It is encouraged that individuals intermix this sedentary time with periodic movement within one&rsquo;s office space and/or to other office areas to counteract the sedentary nature of this position.
 <br/>
 <br/>
 The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 <br/>
 <br/>
 <strong>
  To the selected candidate, we offer:
  <br/>
  <br/>
 </strong>
 Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, personal days, 401k with match, wellness and exercise membership and more. Click HERE to view our full-time benefits flyer.
 <br/>
 <br/>
 Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.
 <br/>
 <br/>
 If this sounds like you and you&rsquo;re seeking career growth with an exciting new career path in overseeing the quality of health care for our clients and their members, please send your cover letter and resume following the instructions for this site.
 <br/>
 <br/>
 Prairie States Enterprises
 <br/>
 <br/>
 Equal Opportunity Employer
</div>


Medical Claims Analyst (full-time / remote / hybrid)

ALEC Holdings

<div>
 <p>
  <strong>
   Job Location:
  </strong>
  Qiddiya, Riyadh, Saudi Arabia
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Who We Are?
  </strong>
 </p>
 <p>
  ALEC Engineering and Contracting L.L.C. (ALEC), part of ICD, is a leading GCC construction company known for delivering complex, high-profile projects. With 20+ years of experience, ALEC builds across sectors including airports, hospitality, retail, and high-rises.
 </p>
 <p>
  In the KSA, ALEC has delivered many of the nation&rsquo;s most iconic developments, operating as a fully integrated contractor through specialist business units that provide end-to-end construction solutions.
 </p>
 <p>
  <br/>
 </p>
 <p>
  ALEC provides strategic leadership, operational oversight, and shared services that support the performance and growth of all businesses within the Group. From governance, finance, and talent to innovation, digital systems, and sustainability, the Head Office acts as the central hub that enables each business unit to deliver with confidence, consistency, and excellence across the construction and engineering value chain.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Role Overview
  </strong>
 </p>
 <p>
  The Contracts &amp; Claims Manager acts as the key focal point for all project stakeholders, ensuring a single, authoritative source of truth for contractual, claims, and commercial information
 </p>
 <ul>
  <li>
   Drives structured, auditable workflows for contracts, claims, and records
  </li>
  <li>
   Interfaces with Corporate HQ counsel to align on dispute strategy and risk
  </li>
  <li>
   Manages negotiations and disputes with high EQ, knowing when to resolve collaboratively and when to escalate
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  The initial role will be project based, with a potential future role within the organization as head of Contract &amp; Claims for the KSA business.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Key Responsibilities
  </strong>
 </p>
 <p>
  <strong>
   1. Contract Administration
  </strong>
 </p>
 <ul>
  <li>
   Lead contract interpretation and administration.
  </li>
  <li>
   Advise project leadership on contractual rights, obligations, and risk exposure.
  </li>
  <li>
   Ensure compliance with contractual notice provisions and timelines.
  </li>
  <li>
   Oversee proper documentation and record-keeping systems.
  </li>
 </ul>
 <p>
  <strong>
   2. Claims &amp; Dispute Management
  </strong>
 </p>
 <ul>
  <li>
   Develop and implement the project claims strategy.
  </li>
  <li>
   Lead preparation, review, and submission of:
  </li>
  <li>
   Extension of Time (EOT) claims
  </li>
  <li>
   Prolongation and disruption claims
  </li>
  <li>
   Acceleration claims
  </li>
  <li>
   Manage dispute resolution processes including negotiation, mediation, DAB, and arbitration.
  </li>
  <li>
   Interface with external legal counsel where required.
  </li>
 </ul>
 <p>
  <strong>
   4. Stakeholder Coordination
  </strong>
 </p>
 <ul>
  <li>
   Liaise with Client, Engineer, and key stakeholders regarding contractual matters.
  </li>
  <li>
   Coordinate with planning, operations, and commercial teams for claim substantiation.
  </li>
  <li>
   Provide contractual reports to senior management and corporate leadership.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Qualifications &amp; Experience
  </strong>
 </p>
 <ul>
  <li>
   Bachelor&rsquo;s degree in Law, Engineering, Construction Management, Quantity Surveying or related field.
  </li>
  <li>
   Master&rsquo;s degree in Construction Law or Arbitration (preferred).
  </li>
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   15+ years of experience in construction contract administration and claims.
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   Experience on large-scale mega projects, preferably in the Middle East.
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   Extensive knowledge of FIDIC contract forms.
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   Strong understanding of arbitration rules (e.g. LCIA).
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   Work Environment
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   Based on-site with frequent interaction with project and corporate leadership.
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Contracts & Claims Manager

Speridian Technologies

<div><h2 class="jobSectionHeader"><b>Job Title:</b> Principal Product Manager Claims and Encounters</h2><h2 class="jobSectionHeader">
Location: Remote (Working hours are Monday-Friday PST)<br>
Division: Medical Enterprise System Modernization Division (MESMD), Behavioral Health Transformation Project (BHT)<br>
Department: California Department of Health Care Services (DHCS)</h2><h2 class="jobSectionHeader">
Must work on shore in the US. We cannot sponsor or transfer an H1B Visa for this role.
</h2><b>About the Behavioral Health Transformation (BHT) Initiative</b><br>
California&rsquo;s behavioral health system is undergoing one of the most significant transformations in its history. Driven by new legislation&mdash;including the Behavioral Health Services Act and related reforms&mdash;DHCS is working to modernize how behavioral health services are delivered, tracked, and improved across the state.<br>
The BHT initiative is a multi-year effort to re-architect the way DHCS partners with counties and providers to deliver care, measure outcomes, and produce transparency, and accountability. This work requires a new generation of digital tools, data infrastructure, and service delivery models. <b>At its core, BHT is about making real changes in the lives of Californians&mdash;ensuring every dollar spent can be tied to improved access, quality, and health outcomes.</b><br>
<br>
We are seeking a strong, multidisciplinary, Principal Product Manager to drive the modernization of our claims and encounter capabilities supporting Behavioral Health Transformation (BHT).<br>
While DHCS receives claims and encounter submissions today, the systems are fragmented and lack transparency for counties, providers, and managed care plans. We are building user-facing operational software that enables submitting entities to directly manage submission quality, reconciliation status, and reporting accuracy &mdash; and to be accountable for the integrity of their data.<br>
This role requires deep, hands-on experience owning Medicaid claims and encounter systems. The ideal candidate understands adjudication workflows, CMS reporting requirements, healthcare interoperability standards, and how operational systems drive accountability.<p><b><br>
Statement for Speridian Technology</b></p><p>
Speridian Technology is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Reasonable accommodations are available for qualified individuals with disabilities during the application process.</p><br>
This is a senior individual contributor role operating and owning outcomes at the intersection of policy, operations, data standards, compliance, and engineering.<br>
<br>
What You&rsquo;ll Do<ul><li>
Translate the strategic requirements for BHT operational systems into an executable roadmap aligned to statutory deadlines.</li><li>
Own roadmap prioritization, epics, and user stories and ensure adherence to all technical delivery standards.</li><li>
Work directly with operations and data policy teams to transform state and federal financial and accountability reporting obligations into clear, implementable product requirements.</li><li>
Own the modernization and user experience of external-facing claims and encounters management software enabling submission, validation, reconciliation, transparency, accountability and compliance.</li><li>
Design user workflows that improve data quality at the source and give counties, providers, managed care plans, and DHCS visibility into submission status, data quality, state and federal compliance.</li><li>
Coordinate and drive the development of enterprise business process maps, data models, and technical architecture with policy, data, and engineering partners.</li><li>
Ensure claims and encounter systems integrate seamlessly with Medical Enterprise Systems.</li><li>
Define measurable outcomes tied to compliance, timeliness, reconciliation accuracy, and operational performance</li></ul><br>
Required Experience<br>
Candidates must demonstrate:<ul><li>
10+ years of product management experience in healthcare technology</li><li>
Direct ownership of Medicaid or government healthcare claims and/or encounter systems</li><li>
Deep understanding of:</li><li>
Claims adjudication workflows</li><li>
Managed care encounter reporting</li><li>
CMS Medicaid reporting requirements</li><li>
CPT/HCPCS/ICD coding structures</li><li>
Substantial experience with healthcare data standards, including:</li><li>
USCDI</li><li>
HL7 / FHIR APIs</li><li>
Standard code sets and validation frameworks</li><li>
Experience translating regulatory and reporting requirements into system functionality</li><li>
Experience operating within California state reporting environments strongly preferred</li></ul>
Strongly Preferred<ul><li>
Experience modernizing or consolidating fragmented claims or encounter systems</li><li>
Experience building submission engines, validation services, or transaction gateways</li><li>
Familiarity with MITA and Medicaid Enterprise modernization</li><li>
Experience enabling user-facing operational tools that improve data quality and compliance</li><li>
Experience working in complex public-sector or managed care environments</li></ul><br>
What Success Looks Like<ul><li>
Submitting entities have clear visibility into claims and encounter status and data quality</li><li>
Validation and reconciliation workflows are transparent and standardized</li><li>
Data quality improves at the point of submission rather than through downstream correction</li><li>
Claims and encounter capabilities integrate cleanly with other DHCS operational systems</li><li>
Operational accountability across delivery systems measurably increases</li></ul><br>
Why This Role Matters<br>
Claims and encounter systems are foundational to Medi-Cal oversight, reporting, and payment integrity. Modernizing these capabilities enables transparency, improves data quality at the source, and strengthens accountability across California&rsquo;s behavioral health delivery system.<br>
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Principal Product Manager, Claims and Encounters

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