695 Medical Claims jobs in the United States

Claims Field Senior Property Adjuster



This position handles moderate to complex claims matters involving homeowner property insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include investigation, damages evaluation, negotiation strategies, and claims resolution of moderate to complex claims. The position employs discretion and independent judgment to ensure compliance with state and federal law and established company Best Practices.

Job Duties

Identify and obtain statements from insureds, vendors and witnesses. Conduct phone and/or field investigations to determine coverage and damages and differentiate between allegations and facts in each loss.

Communicate and interact with a variety of individuals. Explain benefits, coverages, and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues.

Evaluate and determine claim values upon receipt and assessment of property damage data.

Negotiate within settlement authority with insureds to resolve first claims.

Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.

Control expenses for areas of responsibility.

Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Objectively discern and address issues that may be questioned in audit. Coordinate with internal and external departments as required.

May attend and participate in legal proceedings.

Respond quickly and effectively to customer needs and problems.



Qualifications

~ Bachelors Equivalent combination of education and experience

~4-6 years Prior claims handling experience. Required

~4-6 years Property claims administration experience. Preferred

~1-3 years Experience in the construction industry. Preferred

~ Working knowledge of claims administration best practices and procedures.

~ Moderate knowledge of insurance, fault assessment, negligence and subrogation principles required.

~ Comprehensive understanding of vehicle and building repair procedures and third-party liability issues.

~ Working knowledge of Microsoft Office suite, general computer software and claims software.

~ Moderate leadership skills necessary.

~ Advanced organization and planning recognition skills required.

~ Advanced oral and written communication skills required.

~ Advanced interpersonal skills required.

~ Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

~ An insurance/claims adjuster license may be required for claims administration in specific states.





Travel Requirements



~ Claims field duties may involve company car usage and local travel to inspect accident scenes or first-party homeowner losses. (40% proficiency)





The starting pay range for this position is:



$37.64 - $50.16 Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

.

Remarkable benefits:

Health coverage for medical, dental, vision

401(K) saving plan with company match AND Pension

Tuition assistance

PTO for community volunteer programs

Wellness program

Employee discounts



Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity we win. All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.



AAA is an Equal Opportunity Employer



The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

ACSC Management Services Inc

Claims Senior Field Property Adjuster



We are expanding in Massachusetts and looking for Senior Field Property Adjusters in Massachusetts. This role will be Remote plus Field.



This position handles moderate to complex claims matters involving homeowner property insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include investigation, damages evaluation, negotiation strategies, and claims resolution of moderate to complex claims. The position employs discretion and independent judgment to ensure compliance with state and federal law and established company Best Practices.

Job Duties

Identify and obtain statements from insureds, vendors and witnesses. Conduct phone and/or field investigations to determine coverage and damages and differentiate between allegations and facts in each loss.

Communicate and interact with a variety of individuals. Explain benefits, coverages, and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues.

Evaluate and determine claim values upon receipt and assessment of property damage data.

Negotiate within settlement authority with insureds to resolve first claims.

Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.

Control expenses for areas of responsibility.

Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Objectively discern and address issues that may be questioned in audit. Coordinate with internal and external departments as required.

May attend and participate in legal proceedings.

Respond quickly and effectively to customer needs and problems.



Qualifications

~ Bachelors Equivalent combination of education and experience

~4-6 years Prior claims handling experience. Required

~4-6 years Property claims administration experience. Preferred

~1-3 years Experience in the construction industry. Preferred

~ Working knowledge of claims administration best practices and procedures.

~ Moderate knowledge of insurance, fault assessment, negligence and subrogation principles required.

~ Comprehensive understanding of vehicle and building repair procedures and third-party liability issues.

~ Working knowledge of Microsoft Office suite, general computer software and claims software.

~ Moderate leadership skills necessary.

~ Advanced organization and planning recognition skills required.

~ Advanced oral and written communication skills required.

~ Advanced interpersonal skills required.

~ Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

~ An insurance/claims adjuster license may be required for claims administration in specific states.





The starting pay range for this position is $78,200 - $104,100 annually.





Remarkable benefits:

Health coverage for medical, dental, vision

401(K) saving plan with company match AND Pension

Tuition assistance

PTO for community volunteer programs

Wellness program

Employee discounts (membership, insurance, travel, entertainment, services and more!)



Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity we win. All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.



AAA is an Equal Opportunity Employer

ACSC Management Services Inc

Claims Property Adjuster



This position supports the Property Claims operation by handling claims reported on Homeowner policies written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The position requires the handling of claims of low to moderate complexities. The primary functions include interpreting information from First Notice of Loss reports, loss investigation, coverage evaluation, claims resolution and negotiation strategies. Employs discretion and independent judgment to ensure compliance with state and federal laws. Applies technical and customer service best practices in accordance with company guidelines.

Job Duties

Conduct phone investigations to determine coverage and damages. Identify and obtain statements from insureds, vendors, and witnesses. Responsible for maintaining proper activities and service levels.

Communicate and interact with a variety of individuals, including members, insureds and claimants. Explain policy coverages, benefits, and claims process either verbally and/or in writing which complies with regulatory and statutory requirements. Recognize and appropriately address common coverage issues.

Evaluate, assess, make decisions, and negotiate within settlement authority with insureds to resolve first-party claims in multiple markets. Demonstrate proficiency with assessment of personal property, property damage, loss of use, and claims technology and tool usage.

Coordinate with internal and external departments as required.

May attend and participate in legal proceedings.

Respond quickly to insured needs and problems.



Qualifications

~ Bachelors Equivalent combination of education and experience

~1-3 years Prior claims handling experience. Required

~4-6 years Property claims handling experience Preferred

~ Working knowledge of claims administration best practices and procedures.

~ General knowledge of fault assessment, negligence and subrogation principles desired.

~ Working knowledge of Microsoft Office suite, general computer software and claims software.

~ Moderate organization and planning recognition skills required.

~ Moderate oral and written communication skills required.

~ Moderate interpersonal skills required.

~ Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

~ An insurance/claims adjuster license may be required for claims administration in specific states.





The starting pay range for this position is $25.48 $28.03 per hour. Additionally, you will be eligible to participate in our incentive program based upon your team and individual performance.





Remarkable benefits:

Health coverage for medical, dental, vision

401(K) saving plan with company match AND Pension

Tuition assistance

PTO for community volunteer programs

Wellness program

Employee discounts (membership, insurance, travel, entertainment, services and more!)



Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity we win. All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.



AAA is an Equal Opportunity Employer



The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

ACSC Management Services Inc

Claims Senior Field Property Adjuster



We are expanding in Massachusetts and looking for Senior Field Property Adjusters in Massachusetts. This role will be Remote plus Field.



This position handles moderate to complex claims matters involving homeowner property insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include investigation, damages evaluation, negotiation strategies, and claims resolution of moderate to complex claims. The position employs discretion and independent judgment to ensure compliance with state and federal law and established company Best Practices.

Job Duties

Identify and obtain statements from insureds, vendors and witnesses. Conduct phone and/or field investigations to determine coverage and damages and differentiate between allegations and facts in each loss.

Communicate and interact with a variety of individuals. Explain benefits, coverages, and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues.

Evaluate and determine claim values upon receipt and assessment of property damage data.

Negotiate within settlement authority with insureds to resolve first claims.

Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.

Control expenses for areas of responsibility.

Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Objectively discern and address issues that may be questioned in audit. Coordinate with internal and external departments as required.

May attend and participate in legal proceedings.

Respond quickly and effectively to customer needs and problems.



Qualifications

~ Bachelors Equivalent combination of education and experience

~4-6 years Prior claims handling experience. Required

~4-6 years Property claims administration experience. Preferred

~1-3 years Experience in the construction industry. Preferred

~ Working knowledge of claims administration best practices and procedures.

~ Moderate knowledge of insurance, fault assessment, negligence and subrogation principles required.

~ Comprehensive understanding of vehicle and building repair procedures and third-party liability issues.

~ Working knowledge of Microsoft Office suite, general computer software and claims software.

~ Moderate leadership skills necessary.

~ Advanced organization and planning recognition skills required.

~ Advanced oral and written communication skills required.

~ Advanced interpersonal skills required.

~ Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required

~ An insurance/claims adjuster license may be required for claims administration in specific states.





The starting pay range for this position is $78,200 - $104,100 annually.





Remarkable benefits:

Health coverage for medical, dental, vision

401(K) saving plan with company match AND Pension

Tuition assistance

PTO for community volunteer programs

Wellness program

Employee discounts (membership, insurance, travel, entertainment, services and more!)



Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity we win. All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.



AAA is an Equal Opportunity Employer

ACSC Management Services Inc

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
For more than 25 years, NTT DATA Services have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.
NTT DATA Services currently seeks a **Medical Claims Processors** to join our team in **remotely.**
**Role Responsibilities**
To serve as a **Medical Claims Processor within the Xcelys environment** , you **must have a minimum of 3 years hands-on, working experience within its environment** . You should also provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations.
**Role Responsibilities:**
1. Adjudication & Review
+ Process comprehensive medical claims using Xcelys and associated subsystems
+ Resolve complex pends, coding issues, and contract exceptions
+ Author overpayment/underpayment determinations and coordinate appeals
1. Quality & Compliance
+ Engage in quality reviews, audits, root cause analyses
+ Monitor accuracy, variance, and rework metrics
+ Ensure alignment with regulatory and internal compliance guidelines
1. Support
+ Act as escalation point and subject matter expert
1. Process & System Improvement
+ Participate in system testing, UAT, and workflow enhancements
+ Recommend improvements, document system and process changes
1. Reporting & Analytics
+ Prepare production, pending, and quality reports
+ Identify trends and recommend corrective actions
1. Cross-Functional Collaboration
+ Liaise with provider relations, legal, IT, compliance teams
+ Support internal initiatives related to claims systems / operational improvements
**Required Skills/Experience**
+ 3+ years claims adjudication experience
+ Minimum 3 years' experience in Xcelys
+ 2+ years in coding (CPT, ICD-10, HCPCS)
+ 2+ years provider contracts, pricing, regulatory guidelines experience
+ Verifiable high school diploma or GED
+ Must be able to work 8am-5pm PST
**Preferences**
+ Excellent analytical and communication skills
+ Experience training staff or acting as a mentor
+ Familiarity with system testing and documentation
+ Ability to manage high-volume workload and meet performance metrics
About NTT DATA Services:
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is **$20.00** . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
For more than 25 years, NTT DATA Services have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.
NTT DATA Services currently seeks a **Medical Claims Processors** to join our team in **remotely.**
**Role Responsibilities**
To serve as a **Medical Claims Processor within the Xcelys environment** , you **must have a minimum of 3 yr hands-on, working experience within its environment** . You should also provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations.
**Role Responsibilities:**
Adjudication & Review
+ Process comprehensive medical claims using Xcelys and associated subsystems
+ Resolve complex pends, coding issues, and contract exceptions
+ Author overpayment/underpayment determinations and coordinate appeals
Quality & Compliance
+ Engage in quality reviews, audits, root cause analyses
+ Monitor accuracy, variance, and rework metrics
+ Ensure alignment with regulatory and internal compliance guidelines
Support
+ Act as escalation point and subject matter expert
Process & System Improvement
+ Participate in system testing, UAT, and workflow enhancements
+ Recommend improvements, document system and process changes
Reporting & Analytics
+ Prepare production, pending, and quality reports
+ Identify trends and recommend corrective actions
Cross-Functional Collaboration
+ Liaise with provider relations, legal, IT, compliance teams
+ Support internal initiatives related to claims systems / operational improvements
**Required Skills/Experience**
+ 5+ years claims adjudication experience
+ Minimum of 1 year experience in Xcelys
+ 2+ years in coding (CPT, ICD-10, HCPCS)
+ 2+ years provider contracts, pricing, regulatory guidelines experience
+ Verifiable high school diploma or GED
+ Must be able to work 8am-5pm PST
About NTT DATA Services:
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is **$20.00** . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

Description
Job Title: Medical Claims Auditor - RN Auditor
Location: Massachusetts - 90% Remote
Job Type: 1 Year Contract - Potential for Perm Hire
Hours: 40 hours per week
Start Date: December 1, 2025
Job Description
We are seeking a qualified Auditor with healthcare experience to support Program Integrity activities for a state healthcare program. This role focuses on conducting both desk and onsite audits of healthcare providers to ensure compliance with contractual standards and regulatory requirements.
Responsibilities
+ Conduct audits (onsite and desk-based) of healthcare providers in alignment with state program guidelines
+ Travel locally as required to perform onsite audits (1-4 times per month)
+ Evaluate claims and provider documentation for compliance and accuracy
+ Collaborate with internal audit teams and leadership to maintain audit quality standards
+ Document findings and present audit outcomes clearly and effectively
+ Use Microsoft Office tools to manage reports, track audits, and communicate outcomes
+ Adhere to defined Service Level Agreements (SLAs) for audit completion and reporting
Requirements
Required Qualifications
+ 3-5 years of experience in auditing, compliance, or claims analysis within a healthcare setting
+ Proficiency in Microsoft Office (Word, Excel, Outlook, etc.)
+ Ability to travel locally as needed
+ Strong analytical, organizational, and communication skills
+ RN (Registered Nurse)
+ Experience working in a Program Integrity role or similar environment is strongly preferred
Preferred Qualifications
+ Experience with MMQ/MDS assessments
+ Background in claims and coding audits
+ Strong presentation and stakeholder communication skills
Certifications & Licensing
+ RN license
Interview Process
+ Rounds: 2
+ Format: Phone interviews
How to Apply
If you meet the qualifications and are interested in this opportunity, please submit your resume and a brief cover letter detailing your relevant experience.
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