senior claims analyst

Elevance Health

<div>JR188434 Senior Claims Analyst 
CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services. 
CareBridge is seeking a Senior Claims Analyst professional to support reporting, analytics, and process improvements across the claim&rsquo;s lifecycle. In this role, you&rsquo;ll use your claims expertise and SQL/data skills to turn complex data into actionable insights, support claim corrections, and improve workflows.
You&rsquo;ll build reporting solutions, enhance submission performance, and partner with Product, Engineering, Finance, and Operations to improve and scale end-to-end claims processes.
Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. 
How you will make an impact: 
Claims &amp; Encounter Reporting<ul><li>
Build and maintain reporting to track the full claims lifecycle from submission to payer response.</li><li>
Create self-service tools for Operations, Finance, and Client Success.</li><li>
Reconcile data across systems to ensure accurate claim status tracking.</li></ul>
Claims Subject Matter Expertise<ul><li>
Act as an SME on claims structure, clearinghouse workflows, and payer responses.</li><li>
Support complex claim issues and partner with Product and Engineering to resolve data/workflow gaps and validate fixes.</li></ul>
Payer Configuration &amp; Onboarding<ul><li>
Support new payer implementations, including workflow setup and validation.</li><li>
Develop standardized monitoring for go-lives and streamline payer-specific processes.</li></ul>
Process Improvement &amp; Operations<ul><li>
Identify and resolve recurring submission issues.</li><li>
Partner cross-functionally to improve workflows, tools, and documentation.</li><li>
Support audits and quality reviews.</li></ul>
Minimum Requirements:<ul><li>
Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 6 years systems analyst or business analyst experience; or any combination of education and experience, which would provide an equivalent background.</li></ul>
Preferred Skills, Capabilities and Experiences:<ul><li>
5+ years of experience in provider-side claims, revenue cycle, or data management.</li><li>
Strong understanding of professional claim formats (837P), remittance advice (835), and clearinghouse workflows.</li><li>
Advanced SQL skills with experience querying complex healthcare production or analytics databases.</li><li>
Hands-on experience within a claims platform, including claim correction, resubmission, and configuration validation.</li><li>
Experience developing reports and dashboards using BI tools (e.g., Tableau, Power BI, Metabase)</li><li>
Ability to translate complex data into clear, actionable insights for business stakeholders.</li><li>
Strong cross-functional communication skills with experience partnering across Product, Engineering, Finance, and Operations.</li><li>
Experience working in value-based care environments.</li></ul> 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.</div>

Senior Claims Analyst

The Hartford

<div>Sr Claims Analyst FL - CV08DE
We&rsquo;re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals &ndash; and to help others accomplish theirs, too. Join our team as we help shape the future. 
The Global Financial Lines Senior Claims Analyst - Allied Health Professional Liability manages complex primary and excess financial lines claims under claims‑made policies. This role applies strong technical expertise and sound judgment to evaluate, manage, and resolve claims in accordance with company standards and regulatory requirements.
Job duties include:
Claim File Management<ul><li>
Plan, recommend, reserve, and execute file strategies including investigation, valuation, disposition, and settlement of assigned claims of low to moderate exposure and/or complexity, in a manner consistent with corporate claim settlement policies and procedures, and statutory, regulatory and ethics requirements</li><li>
Appropriately escalate matters to Team Lead/management per escalation protocols</li><li>
Independently draft and issue timely reservation of rights letters on all files and independently draft denials for management review</li><li>
Properly assesses the exposure of assigned claims. Plan and organize, establish priorities, anticipate issues, determine realistic completion dates, know and communicate the status of assignments, appropriately manage vendors</li><li>
Demonstrate increasing ability and continued development with respect to appropriately interpreting and applying financial lines insurance coverage concepts, including how to trigger other insurance when indicated</li><li>
Demonstrate development regarding technical and jurisdictional expertise</li><li>
Maintain current knowledge of claim loss cost management initiatives, and utilize them appropriately and in a manner consistent with company practices and procedures</li><li>
Identify and properly utilize mitigation, subrogation, and other recovery opportunities</li></ul>
Customer Service<ul><li>
Maintain dedication to meeting or exceeding expectations and requirements of internal and external customers</li><li>
Obtain first-hand customer information; use it for improvements in products and services</li><li>
Establish and maintain effective relationships with customers, gaining their trust and respect. Demonstrate diplomacy and tact to effectively avoid or diffuse high-tension situations.</li></ul>
Business Acumen and Technical Expertise<ul><li>
Utilize verbal and numerical critical thinking skills to gather information, apply sound reasoning, and draw appropriate conclusions; make sound decisions based upon mixture of analysis, experience, and judgment.</li><li>
Accurately resolve coverage and compensability issues.</li><li>
Demonstrated experience investigating, evaluating, and successfully negotiating/mediating claims to appropriate disposition.</li><li>
Possess superior analytical and critical thinking skills.</li><li>
Excellent time management abilities</li><li>
Possess the technical knowledge to properly reserve claims</li><li>
Properly apply statutory laws and regulations of applicable jurisdiction</li><li>
Demonstrate advanced expertise to utilize claim management practices to effectively manage loss costs</li><li>
Contribute to loss cost management by recognizing potential for Subrogation and Special Investigation</li></ul>
Teamwork and Team Building<ul><li>
Support and help create a team environment that celebrates diversity and Inclusion</li><li>
Support and assist in building a high performing team with diverse characteristics, where individual differences are valued</li><li>
Build appropriate rapport and constructive and effective relationships with people inside and outside the organization</li><li>
This position will handle files in more than one claims systems</li></ul>
Qualifications<ul><li>
College degree required, J.D. strongly preferred</li><li>
At least two to three years of successful relevant experience handling third-party professional liability claims or litigation, with a career history of increasing responsibility</li><li>
Experience handling allied health or medical malpractice matters strongly preferred</li><li>
Technical expertise in managing claims</li><li>
Self-starter, resourceful and independent</li><li>
Ability to work in a fast-paced environment and ability to prioritize work</li><li>
Outside the box thinking to negotiate creative resolutions</li><li>
Strong computer proficiency in utilizing software programs, knowledge of ECOS claim system a plus</li><li>
Strong communication skills, oral, written, collaboration and negotiation</li><li>
Excellent time management and organizational skills</li><li>
Superior customer service skills</li><li>
Adept at managing conflict as an opportunity to listen and share information while negotiating a win/win outcome that supports The Hartford's and the insured&rsquo;s best interests</li><li>
State adjusting licenses will be required; a plus if already obtained</li><li>
Proficiency in using Microsoft Word and Excel</li><li>
Operate under the mindset of The Hartford's Behaviors: be courageous, break through, and better the experience</li></ul>
This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL, Alpharetta, GA) will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.
Compensation
The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford&rsquo;s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:
$108,800 - $163,200
Equal Opportunity Employer/Sex/Race/Color/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age</div>

Senior Claims Analyst - Allied Health Professional Liability

Fluor Corp.

<div>At Fluor, we are proud to design and build projects and careers. We are committed to fostering a welcoming and collaborative work environment that encourages big-picture thinking, brings out the best in our employees, and helps us develop innovative solutions that contribute to building a better world together. If this sounds like a culture you would like to work in, you&rsquo;re invited to apply for this role.
<div><div><div><h2 class="jobSectionHeader">Job Description
</h2></div><div><div>Fluor is seeking candidates for opportunities within our Program Delivery Support (PDS) team, working alongside the California High-Speed Rail Authority, to provide program delivery and program management services for one of the largest planned infrastructure projects in the U.S.
 
 
The system will connect the 500-mile stretch between the Los Angeles region with the San Francisco Bay Area, with up to 24 stations. The first phase of the program is currently under construction in California&rsquo;s Central Valley.
 
 
Under the general direction of the Director and Deputy Director of the PMO/forensics &amp; Claims, this role is responsible for developing forensic analyses and providing oversight of the PCM&rsquo;s analysis as required to determine responsibility, merit and quantification of cost and time extensions. This role is also responsible for reviewing and analyzing Contractors&rsquo; Time Impact Analyses and claims and assisting with the rebuttal responses. In addition to forensic analysis efforts, this role is responsible for assisting in areas such as estimating, takeoffs and design reviews. This role is within the Program Management &amp; Oversight Branch of the Program delivery Office.
 
 
<ul><li>Perform forensic analyses and develop summary of findings; Develop causation reports documenting the chronology of events related to project delays; Present analysis finding to the Authority leadership team.
</li><li>Coordinates and work with the regional Authority staff, PCMs and other consultants in providing planning, development, reporting, and maintenance of data program wide
</li><li>Perform review and analysis of the construction schedule for risk identification, risk review, and risk assessments including providing recommendations on appropriate actions;
</li><li>Assist with other scheduling and regional project controls assignments and activities, 10% Develop What-if schedules and scenario analysis providing reasonable and realistic schedule forecasts
</li><li>Review Contractors&rsquo; claims and assist with responses and potential rebuttals
</li></ul></div><ul><li>Other duties maybe assigned
</li></ul></div></div><div><div><h2 class="jobSectionHeader">Basic Job Requirements
</h2></div><div><ul><li>Accredited four (4) year degree in Civil Engineering or Construction Science/Management or global equivalent in applicable field of study and ten (10) years of work-related experience or a combination of education and directly related experience equal to fourteen (14) years if non-degreed
</li></ul></div></div><div><div><h2 class="jobSectionHeader">Other Job Requirements
</h2></div><div><ul><li>Experience performing claims work.
</li><li>Experience in developing expert reports quantifying impacts and apportioning quantum to responsible parties.
</li><li>Work experience on large programs with proven track record.
</li><li>Experience with analyzing, reviewing cost estimates, schedules and time impact analyses, and excellent negotiations skills.
</li><li>Ability to produce oral and written presentations to client and other stakeholders.
</li><li>Strong work experience with MS Office application.
</li><li>Can communicate effectively with different disciplines to obtain scope of work and other information and manage the development and review of schedules.
</li><li>Knowledge of principles and practices of all project controls functions for a large-scale construction project and ability to carry out cost, estimating, design, schedule, and risk analysis.
</li><li>Must be a self-starter attitude with proactive, results-oriented focus. Proven accuracy, reliability and completeness in job accomplishment. Effective oral and written communication skills.
</li><li>Required Knowledge of; analysis methodologies for complex construction projects&rsquo;; claims management and support; construction contracts.
</li><li>Ability to write project reports. Must be able to interface with a variety of people with different technical levels and educational backgrounds; must be detail-oriented and highly organized; and must be able to produce accurate and timely results while maintaining a customer-service attitude.
</li></ul></div></div><div><div><h2 class="jobSectionHeader">Preferred Qualifications
</h2></div><div><ul><li>Professional certification as professional engineer or Quantity Surveyor
</li><li>Experience in developing expert reports quantifying delays and apportioning quantum to responsible parties 
</li></ul>#LI-SI1
</div></div></div>We are an equal opportunity employer. All qualified individuals will receive consideration for employment without regard to race, color, age, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, genetic information, or any other criteria protected by governing law.
Benefits Statement: Fluor is proud to offer a comprehensive benefits package designed to promote employee health, wellness, and financial security. Our offerings include medical, dental and vision plans, EAP, disability coverage, life insurance, AD&amp;D, voluntary benefit plans, 401(k) with a company match, paid time off (personal, bereavement, sick, holidays) for salaried employees, paid sick leave per state requirement for craft employees, parental leave, and training and development courses.
Market Rate Statement: The market rate for the role is typically at the mid-point of the salary range; however, variations in final salary are determined by additional factors such as the candidate&rsquo;s qualifications, relevant years of experience, geographic location, internal pay equity, and prevailing market conditions for the specific role.
Notice to Candidates: Background checks are carried out as part of any conditional offer made, including (but not limited to &amp; role dependent) education, professional registration, employment, references, passport verifications and Global Watchlist screening.
To be Considered Candidates: Must be authorized to work in the country where the position is located.
Salary Range: $107,000.00 - $193,000.00</div>

Senior Forensic Claims Analyst

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Senior Claims Analyst

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Claims Analyst - Allied Health Professional Liability

Senior Forensic Claims Analyst