Claims Operations Associate II Job at Engage Cleveland (Richfield, OH)

Quality Assurance Financial Auditor II

The Quality Assurance Financial Auditor II is responsible for performing Quality...

Location

United States

Salary:

51000.00 - 80070.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Audit experience with the investigation, determination and reporting of financial processes
Work experience in Microsoft Office suite of applications including advanced Excel, Word, PowerPoint
Experience conducting root cause analysis in an auditing capacity
Experience conducting analytical work and providing creative ideas for problem solving
Work experience requires written and verbal communication that is clear, concise, grammatically correct, and professional
Experience handling confidential information
Associate degree from an accredited institution

Job Responsibility

Conduct moderately complex to complex quality audits of provider claims, pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products
Audit the work of more junior auditors and identify opportunities for coaching and/or training
Identify and communicate issues identified through audits and recommended solutions relevant to business operations
Assist management in preparing departmental reports policies and procedures
Mentor and coach Financial and/or Operations QA auditors
Participate as a Subject Matter Expert on various process improvement projects designed to meet departmental and operational needs
Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate projects in partnership with Business Operations
Analyze errors and determine root causes for appropriate classification
Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure the quality of the network
Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including contractual provisions, authorizations and Healthfirst policy and procedure

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Logistics Operations Associate II

Logistics Operations Associate II is responsible for the execution of logistics ...

Location

United States of America , Diamond Bar

Salary:

24.59 - 32.58 USD / Hour

Niagara Bottling

Expiration Date

Until further notice

Requirements

Minimum Qualifications: 2 Years – Experience in Field or similar manufacturing environment
2 Years - Experience in Position
0 Years – Experience managing people/projects
Minimum Required: High School Diploma

Job Responsibility

Daily communication/coordination with plants/3PLs related to the flow of shipments in/out of facilities including issue resolution and solutions
Dock Schedule Appointment Management of all Niagara facilities in the region
Execution of RMAs end to end including claims being filed
Trouble shooting system issues impacting orders that need to ship
Experienced with WMS (E80, Manhattan, TMS (OTM) and EBS
General exception management and issue resolution
Escalation to leadership team when appropriate
Provide overflow support to Execution Support team as needed
Carrier Pick-Up Appointment changes and coordination
Order/Shipment Source Location changes and coordination

What we offer

Paid Time Off for holidays, sick time, and vacation time
Paid parental and caregiver leaves
Medical, including virtual care options
Dental
Vision
401(k) with company match
Health Savings Account with company match
Flexible Spending Accounts
Expanded mental wellbeing benefits including free counseling sessions for all team members and household family members
Family Building Benefits including enhanced fertility benefits for IVF and fertility preservation plus adoption, surrogacy, and Doula reimbursements

Fulltime

Vendor Relationship Manager

The Vendor Relationship Manager is responsible for the end-to-end management of ...

Location

United Kingdom , Birmingham

Salary:

Not provided

Social Value Portal Ltd

Expiration Date

Until further notice

Requirements

Degree in any discipline (preferred but not essential)
Strong experience in governance, internal controls, audit, risk management, or compliance (typically 5+ years)
Demonstrable knowledge of regulatory frameworks and governance best practices
Proven experience managing third-party service providers, preferably within insurance claims (DCAs, law firms, loss adjusters)
Strong knowledge of insurance regulation, and oversight requirements (e.g., PRA, FCA, Lloyd’s Oversight Principles, Solvency II, Outsourcing and Third Party Risk Management)
Excellent vendor management, negotiation, and relationship-building skills
Strong analytical ability with experience producing MI, dashboards, and performance reports
Ability to influence senior stakeholders and drive improvement through others
Experience managing or operating within formal governance structures and assurance frameworks
Excellent written and verbal communication skills

Job Responsibility

Strategic Alignment: Understanding business priorities as determined by the Head of Claims Business Management and Group Claims Management Committee and aligning with stakeholder goals
Translating strategy into actionable plans
Connecting the dots across departments
Vendor Lifecycle Management: Lead sourcing and selection processes for DCAs, law firms, and loss adjusters
Conduct due diligence and onboarding assessments to ensure alignment with claims, compliance, and regulatory requirements
Manage onboarding activities, including contractual agreements, service level definitions, reporting requirements, and training
Oversight and Performance Management: Develop and maintain an oversight framework for DCAs, law firms, and loss adjusters in line with PRA, FCA, Lloyd’s, CID, California Solvency II, Consumer Duty and Consumer Code of Practice obligations
Monitor vendor performance against KPIs, SLAs, and compliance standards, producing regular MI and dashboards for senior management and committees
Conduct periodic audits, file reviews, and quality assurance checks to identify risks, inefficiencies, or breaches
Ensure claims vendors deliver fair outcomes for policyholders, balancing indemnity spend with customer service

Compliance Auditor II

The Compliance Auditor II will assist in the overall quality, compliance, and au...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate's degree required
Strong interpersonal and written and verbal communications skills required
Strong data analytics and interpretation skills preferred
Knowledge and experience in using EPIC, Word, Excel, PowerPoint, PowerBI and similar Office programs preferred
RHIT, RHIA, RN, CHC, CPC or similar credential preferred

Job Responsibility

Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits
Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements
Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required
Performs and follows established audit work steps and procedures
Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions
Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect CHRISTUS and its subsidiaries
Document all issues received, actions taken, and resolutions
Collaborates with Compliance Director, VP, Compliance on external audits and reviews
Coordinates and performs timely medical record and claims reviews across CHRISTUS Health departments
Works jointly with Compliance Directors, VP, Compliance on the compliance work plan, risk assessments, and quarterly Board Committee reports

Fulltime

Compliance Auditor II

The Compliance Auditor II will assist in the overall quality, compliance, and au...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate's degree required
Strong interpersonal and written and verbal communications skills required
Strong data analytics and interpretation skills preferred
Knowledge and experience in using EPIC, Word, Excel, PowerPoint, PowerBI and similar Office programs preferred
RHIT, RHIA, RN, CHC, CPC or similar credential preferred
In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits
Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with VP/Senior/Manager/Director on more complex issues or investigations
Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required
Performs and follows established audit work steps and procedures
Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions
Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect CHRISTUS and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact
Document all issues received, actions taken, and resolutions
Collaborates with Compliance Director, VP, Compliance on external audits and reviews, which are initiated by government agencies or government-contracted organizations
Coordinates and performs timely medical record and claims reviews across CHRISTUS Health departments (HIM, Case Mgt., PFS, CTC)

Fulltime

Qa financial auditor ii

The Quality Assurance Financial Auditor II is responsible for performing Quality...

Location

United States

Salary:

68900.00 - 99620.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Audit experience with the investigation, determination and reporting of financial processes
Work experience in Microsoft Office suite of applications including advanced Excel, Word, PowerPoint
Experience conducting root cause analysis in an auditing capacity
Experience conducting analytical work and providing creative ideas for problem solving
Work experience requires written and verbal communication that is clear, concise, grammatically correct, and professional
Experience handling confidential information
Associate degree from an accredited institution

Job Responsibility

Conduct moderately complex to complex quality audits of provider claims, pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products
Audit the work of more junior auditors and identify opportunities for coaching and/or training
Identify and communicate issues identified through audits and recommended solutions relevant to business operations
Assist management in preparing departmental reports policies and procedures
Mentor and coach Financial and/or Operations QA auditors
Participate as a Subject Matter Expert on various process improvement projects designed to meet departmental and operational needs
Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate projects in partnership with Business Operations
Analyze errors and determine root causes for appropriate classification
Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure the quality of the network
Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including contractual provisions, authorizations and Healthfirst policy and procedure

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Senior Risk Consultant II - Marine

At Allianz Commercial (AzC), we are the global leader for insuring corporate and...

Location

Canada , Toronto

Salary:

113495.00 - 176673.00 USD / Year

Allianz

Expiration Date

Until further notice

Requirements

A minimum 7 years’ loss prevention engineering experience in an area relevant to his/her LoB in the insurance industry
Good knowledge and professional experience in business sectors
Insurance risk consulting experience and a professional engineering license is a definite plus
Experience working in a Global Organization with the ability to adapt to change
A bachelor’s Degree in Engineering discipline (preferably in a line associated with his/her line of business)
Other discipline will be considered in conjunction with extensive technical experience
A demonstrable engineering/technical expertise
Commitment to maintaining knowledge of developments and new technologies in field
Able to work technical loss control topics
Knowledge of specific business sectors

Job Responsibility

Complete desk top reviews and risk assessments (pre & post loss) for underwriting evaluating and summarizing exposures and controls
Work with underwriting, claims, the client and the broker where appropriate to develop customized loss control programs including locations to be surveyed (or included as part of continuing service), scope and cost of risk consulting services
Generate and review required reports and recommendations
Meet reporting deadlines in accordance with departmental performance objectives
Survey client operations obtain appropriate data, identify hazards, discuss findings with appropriate parties
Generate loss control reports, recommendations etc
Appoint/monitor 3rd parties ensuring adequate contract/controls in place with budgets agreed up front
Check and ensure quality of work provided by 3rd parties
Assist AzC and clients with respect to ongoing or specific projects
Support technical training presentations for internal and external clients as required/appropriate

What we offer

Hybrid working model
Great compensation and benefits package
Generous bonus scheme and pension
Career development and digital learning programs
International career mobility
Support for flexible working, health, and wellbeing
Private healthcare
Generous parental leave benefits
Opportunities to be engaged in shaping a future that is safe, inclusive, and sustainable

Fulltime

New

Customer Experience Specialist

We are looking for a dedicated Customer Experience Specialist to join our team o...

Location

United States , Newport, KY

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Strong focus on detail and accuracy in all tasks
Proven experience in customer service or order entry, preferably within a manufacturing or distribution environment
Familiarity with SAP systems is an advantage but not mandatory
Proficiency in Microsoft Excel and multi-browser navigation
Ability to compose clear and well-structured email correspondence
Demonstrated ability to adapt quickly and follow standard operating procedures
Availability to work on-site four weekdays during the contract period

Job Responsibility

Accurately enter and validate orders, ensuring all entries are reviewed and approved by the team or manager
Process and track shipment numbers upon request to maintain timely communication
Provide quotes for component pricing and manage warranty claims efficiently
Assist with order and portal management functions, adhering to established procedures
Follow company protocols to meet deadlines and maintain service level agreements
Communicate professionally with both internal teams and external stakeholders
Support standard practices and contribute to maintaining operational consistency
Collaborate effectively with a team of three to ensure smooth workflow during the coverage period

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Operations Associate II

Engage Cleveland

Location:
United States , Richfield, OH

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 26, 2026

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Claims Operations Associate II

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Location:United States , Richfield, OH

Category:Insurance

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:March 26, 2026

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Job Posted:
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