139 Healthcare Professionals jobs in Riverdale

As the Healthcare Claims Examiner, you will directly handle Healthcare Claims.

Key Accountabilities/Deliverables:

• Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.
• Provide oversight on claims portfolios within the primary casualty book. Maintain direct contact with insureds, agents, and brokers.
• Provide oversight on claims portfolios handled by TPAs within the excess casualty book.
• Engage in rigorous ALAE control and management, by competently selecting, instructing, and managing 3rd party vendors, as appropriate.
• Gather and analyse information necessary to make an accurate evaluation of the claim by delivering effective resolution of claims, make decision within established authority levels and identifying settlement issues.
• Establish reserves pursuant to established reserving protocols and reserve authority procedures.
• Successfully and proactively resolve complex and/or high exposure claims, promptly limiting exposure to the Company. Substantial involvement in mediation negotiations will be required.
• Adhere to the Panel Counsel Program and all Litigation Management Guidelines.
• Meet all Reporting Requirements by completing reports timely and accurately, including Large Loss Reports.
• Liaise and attend meetings with the underwriting team regarding claim trends and other areas of interest.
• Work with external customers to address questions, resolve problems and maintain rapport.
• Occasional domestic travel may be required to attend mediations and/or trials.
• Undertaking general office administrative duties as and when required.
• Proactively expanding and maintaining awareness of the current market/industry and attend continuing education programs when available.
• In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require.

Technical Knowledge and Understanding:

• Must possess a general understanding and knowledge of state and federal laws as they apply to US Specialty Healthcare claims.
• Must possess a general understanding of policy language/coverages applicable to US Specialty Healthcare.
• Must understand medical terminology.
• Computer skills good working knowledge of Windows 10. MS Office, Excel and basic computer setup/troubleshooting.
• Previous experience with an electronic (paperless) claim system.

Experience:

• College degree required.
• Must be licensed as a claims adjuster in their home state multi-state licensure is preferred.
• A minimum of 5 years of claims adjusting or legal experience is required. A background in US Healthcare Professional/General Liability is preferred.
• A prior history of employment as a Healthcare professional or Medical Malpractice attorney is a plus.
• Must have experience handling Primary and Excess claims. Additional experience handling Reinsurance is preferred.
• Ability to travel for meetings, mediations and trials as required.
• Ability to negotiate and be persuasive.
• Possess strong communication and writing skills.
• Must be detail oriented and organized.
• Must possess the ability to work independently and as a team member.
• Must be a self-starter and possess problem solving skills.
• Must be able to manage pending caseloads, additional projects and meet all deadlines as set by management

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa for this position. #LI-Hybrid #LI-Remote

At Core Specialty, you will receive a competitive salary and opportunities for professional development and advancement. We offer medical, dental, vision, and life insurances; short and long-term disability; a Company-match of 100% of a 6% contribution 401(k) plan; an Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program

Our client is an A+ rated leading carrier in the healthcare professional liability space and in search of an experience Lead Underwriter to join their complex healthcare professional liability division. This role can be housed in multiple office locations throughout the US including Atlanta, NYC, and Chicago. The Lead Underwriter will join an expanding team and contribute to both underwriting production as well as product guidelines, appetite, and pricing development. This is a fantastic opportunity for an experienced Underwriter to join a motivated team and continue to drive the build out of a book of business. Ideal candidates will have non-admitted expertise in E&O coverage for large and complex healthcare coverages. Requirements: 5+ years of medical professional liability underwriting experience required Experience with non-admitted coverage ideal #J-18808-Ljbffr

Company Overview:

Leading with our core values of Quality, Integrity, and Opportunity, MedInsight is one of the healthcare industry's most trusted solutions for healthcare intelligence. Our company purpose is to empower easy, data-driven decision-making on important healthcare questions. Through our products, education, and services, MedInsight is making an impact on healthcare by helping to drive better outcomes for patients while reducing waste. Over 300 leading healthcare organizations have come to rely on MedInsight analytic solutions for healthcare cost and care management.

MedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk management and regulatory compliance, data analytics and business transformation as well as a range of other consulting and technology solutions.

Position Summary:

The MedInsight team develops an industry-leading data warehouse and analytics suite for major healthcare companies including insurers, providers, and public entities. We are a tech healthcare data company transforming how the industry understands and consumes healthcare data. We are accelerating and looking for a Healthcare Data Analyst to join our team. This position focuses on healthcare data profiling and analysis tasks that require quantitative reasoning skills, knowledge of tools and technologies used in data analysis, and an interest in the US healthcare industry. This person's primary duty will be to work with our consultants and healthcare analytics team by researching healthcare analytics inquiries, onboarding new data sources and supporting daily operations of the MedInsight business intelligence solution.

Primary Responsibilities:

• Work both independently and in a cross-functional team environment.
• Write complex SQL queries to support analytics needs.
• Develop, maintain, and support processes for data feasibility tests, data quality checks, data validations, and sense-checking of results.
• Monitor data quality, troubleshoot, and resolve data issues to ensure data integrity.
• Develop technical specifications for analyses of healthcare data.
• Support documentation of analysis results and methodologies. Capture, develop, and document data definitions, business rules, and data quality requirements.
• Perform ad hoc analyses of healthcare data using SQL Server, Azure Databricks, and other tools.
• Conduct data analysis to support various analytic solutions.
• Create and produce reports and other deliverables, such as ad hoc requests, dashboards, etc.
• Create accurate work products and meet task and project deadlines.
• Interpret data, analyze results, and provide insights to determine operational impact, trends, and opportunities.
• Investigate client questions and participate in discussions with clients.
• Write code while adhering to programming best practices for code clarity and efficiency.
• Review, research, and summarize data validation artifacts.
• Develop reports and deliverables for management.
• Work independently on assigned tasks, i.e., plan, organize, problem solve and meet established deadlines.
• Manage multiple priorities in a fast-paced environment.
• Prioritize work under time pressure. Follow-through and exceptional attention to detail on all project tasks are essential.
• Identify and define both process and data improvements.
• Communicate seamlessly within the team.
• Enhance knowledge through continuous learning and challenging project assignments.
• Follows Quality Risk Management (QRM) guidelines and MedInsight policies.
• Acts in accordance with MedInsight core values.
  
  

Preferred Skills and Experience:

Candidates must be team players with excellent interpersonal skills. They must also have some experience/ familiarity with data analysis using large data sets. Experience with healthcare datasets is a significant plus.

Education/experience:

• Bachelor's degree in healthcare, business, science, mathematics, economics, informatics, or related field
• Programming Experience: Experience with Microsoft SQL Server, Python, PySpark, Databricks, T-SQL, or other scripting skills.

Skills:

• Experience coding in SQL or similar language
• Strong analytical ability
• Healthcare data knowledge
• Knowledge of business intelligence, data warehousing, and relational databases
• Microsoft Excel
• Effective oral and written communication
• Punctual and reliable
• Team player with positive and energetic attitude

What makes this a great opportunity?

• Join an innovative, high growth company with a solid industry track record
• Bring your expertise and ideas to directly impact and help build the next generation of MedInsight products and solutions
• Enjoy significant visibility in your work and be recognized for your wins
• Work for a company that values your wellbeing and professional growth, offering a flexible work environment, generous benefits package, and investment in the development of your career

Location

This is a remote role. The expected application deadline for this job is August 31, 2025.

Compensation

The overall salary range for this role is $54,900 - $02,120. For candidates residing in:

• Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, Pennsylvania, Virginia, Washington, or the District of Columbia the salary range is 60,390 - 93,610.
• New York City, Newark, San Jose, or San Francisco the salary range is 65,880 - 102,120.
• All other locations the salary range is 54,900 - 85,100.

A combination of factors will be considered, including, but not limited to, education, relevant work experience, qualifications, skills, certifications, etc.

Milliman Benefits:

We offer a comprehensive benefits package designed to support employees' health, financial security, and well-being. Benefits include:

• Medical, Dental and Vision - Coverage for employees, dependents, and domestic partners.
• Employee Assistance Program (EAP) - Confidential support for personal and work-related challenges.
• 401(k) Plan - Includes a company matching program and profit-sharing contributions.
• Discretionary Bonus Program - Recognizing employee contributions.
• Flexible Spending Accounts (FSA) - Pre-tax savings for dependent care, transportation, and eligible medical expenses.
• Paid Time Off (PTO) - Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis.
• Holidays - A minimum of 10 paid holidays per year.
• Family Building Benefits - Includes adoption and fertility assistance.
• Paid Parental Leave - Up to 12 weeks of paid leave for employees who meet eligibility criteria.
• Life Insurance & AD&D - 100% of premiums covered by Milliman.
• Short-Term and Long-Term Disability - Fully paid by Milliman.

Equal Opportunity

All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, national origin, disability, or status as a protected veteran.