Lead Product Manager, Claims and Eligibility Job at Spring Health (New York City)

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

New

Health & Safety Manager

We are seeking a Health & Safety Manager to join the Mowi Canada East Inc. team!...

Location

Canada

Salary:

Not provided

Mowi Poland

Expiration Date

March 28, 2026

Requirements

3+ years’ experience as a Health & Safety Professional
Post-Secondary qualification in Occupational Health & Safety
Leadership and project management experience
Well-developed English verbal and written communication
Good computer and document management skills
Understanding of OHS administration including WorkSafe claims management
Thorough knowledge of OHS regulations and requirements as they relate to marine environments
Ability to effectively liaise with regulatory officials
Effective presentation and employee training skills
A positive attitude, willingness to learn and participate in training opportunities

Job Responsibility

Manage our Health & Safety Department to support all aspects of the organization in the delivery of a comprehensive Occupational Health and Safety program
Working with the management team in a collaborative and productive manner to foster an engaged safety culture
Developing and monitoring health and safety initiatives
Leading the development and implementation of emergency response plans and procedures, including drills and exercises
Coordinating with regulatory agencies to ensure compliance with relevant laws, regulations, and permits
Prepare and manage a health and safety compliance budget
Leading investigations into incidents and accidents, determining the root cause and implementing corrective actions
Conducting workplace inspections and audits
Being a mentor for health and safety

What we offer

Competitive Wages
Permanent Full-Time Work
Matching Company paid Pension Plan (DCPP)
Health & Dental Flex Benefit Plan including Life & Disability Insurance
Employee Family Assistance Program including Telemedicine & Digital Pharmacy
Annual Employee Wellness Reimbursements
Potential for Annual Bonus and Employee Stock Options
Company provided Gear and PPE
Opportunity to work and travel with a large global company

Fulltime

Insurance staff position

Successful State Farm Agent is seeking a qualified professional to join their wi...

Location

United States , Forest

Salary:

30000.00 - 40000.00 USD / Year

State Farm Insurance Agent

Expiration Date

Until further notice

Requirements

Sales experience (outside sales or inside sales representative, retail sales associate, or telemarketing) preferred
Successful track record of meeting sales goals/quotas preferred
Excellent communication skills - written, verbal and listening
Enthusiastic about the role insurance and financial products play in helping people manage the risks of everyday life, recover from the unexpected, and realize their dreams
Self-motivated
Ability to make presentations to potential customers
Achieve mutually agreed upon marketing goals
Experience in marketing
Property and Casualty license (must have currently)
Life and Health license (must have currently)

Job Responsibility

Provide prompt, accurate, and friendly customer service. Service can include responding to inquiries regarding insurance availability, eligibility, coverages, policy changes, transfers, claim submissions, and billing clarification
Use a customer-focused, needs-based review process to educate customers about insurance options
Work with the agent to establish and meet marketing goals
Develop leads, schedule appointments, identify customer needs, and market appropriate products and services

What we offer

Bonus based on performance
Competitive salary
Paid time off
Training & development
Hourly pay plus commission/bonus
Paid time off (vacation and personal/sick days)
Valuable experience
Growth potential/Opportunity for advancement within my agency

Fulltime

Medical Billing Support Services Associate

The Medical Billing Support Services Associate I coordinate and performs all asp...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Understand the practice billing and collection system and process requirements for the automated and manual cash posting, batch balancing and reconciliation of cash receipts in the insurance billing process
Researches and analyzes un-posted cash on hand and unapplied cash to ensure timely posting and resolution
Investigate unapplied cash receipts and resolve or escalate in a timely manner to lead or supervisor
Reverses balance to credit or debit if charges were improperly billed
Contacts insurance carriers as necessary to determine correct payment application
Reviews correspondences related to refunds and or recoupments
Responsible for evaluating credit balances and ensuring that refunds are issued to the appropriate payer in a timely and accurate manner
Work with Finance and other Revenue Cycle Departments to optimize the cash posting, balancing and reconciliation process
Communicates issues related to payment posting and refunds from payers to management
Updates correct payer and resubmits claims to the payers

Job Responsibility

Coordinate and performs all aspects of the processing of cash receipts from automated and manual payers in accordance with training materials, scripts, and standard operating procedures
Performs a variety of duties which may include reviewing overpayments, credits and recoupments
Making phone calls and/or using payers web portals to check patient eligibility or confirming status of pending recoupments

What we offer

medical
vision
dental
life and disability insurance
company 401(k) plan

Director, Clinical Development

The Director of Clinical Development leads the team responsible for design, exec...

Location

United States

Salary:

165000.00 - 200000.00 USD / Year

Loyal

Expiration Date

Until further notice

Requirements

DVM or equivalent
8–12+ years of experience in clinical development in animal health clinical development
Demonstrated experience designing and leading clinical trials, including protocol authorship, data review, and cross-functional collaboration
Prior oversight of safety evaluation, study conduct, and interpretation of clinical endpoints
Strong understanding of evidence requirements for regulatory approval
Ability to lead in a fast-paced, high-accountability biotech environment
Direct experience with FDA-CVM VICH guidelines
Experience in companion animal medicine
Background working with veterinary clinics, practice networks, or decentralized trial models

Job Responsibility

Own the clinical development strategy for our portfolio of veterinary drug programs, including target product profiles, pivotal pathway planning, and key endpoints aligned with CVM expectations
Build and manage detailed timelines for product development
Communicate strategy and development timelines across multiple teams within Loyal
Design companion animal clinical trials (pilot, field safety, and pivotal effectiveness studies) with appropriate statistical powering, endpoint justification, inclusion/exclusion parameters, and handling of operational constraints
Develop protocols, investigator brochures, SAP inputs, and essential documents tailored for investigators and staff in veterinary practice settings
Work closely with statisticians on statistical design, randomization schemes, interim analyses, and data quality plans
Partner with clinical operations to execute protocols with GCP compliance and serve as medical expert throughout in-life phase
Provide medical and scientific oversight for all clinical studies, including: Eligibility decisions, Case reviews and AE/SAE reporting, Protocol deviations and issue escalation, Interpretation of clinical data trends during trial execution
Support Clinical Operations with site engagement strategy, investigator training, and owner-facing communication frameworks
Partner with Veterinary Affairs on real-world applicability, disease models, and clinician feedback loops

What we offer

Full-coverage health insurance — medical, dental and vision — for you and your dependents
$1,000 home office equipment stipend
$1,200/year learning budget for books, courses, etc.
$250/month wellness budget for gym, cleaners, spa, food, etc.
All 3-day weekends are turned into 4-day weekends
Unlimited vacation and paid holidays
Paw-ternity leave — adopt a dog and get a day off with your new family member
Competitive salary
Company equity options grant for new hires

Fulltime

People Experience and Operations Senior Associate (Medical Services)

The People Operations Coordinator will be responsible for overseeing and executi...

Location

Egypt , New Cairo

Salary:

Not provided

Pepsico

Expiration Date

Until further notice

Requirements

1-2 Years of experience in HR Shared Services process and SLA management
Service management and ticket management system experience
Customer orientation
Process management and continuous improvement with a focus on optimization and productivity
Technical / Functional Skills & Knowledge of HR Tools and Interfaces
High level of accuracy and attention to details
Strong communication skills
Demonstrated track record of strong service delivery
Very good English language skills

Job Responsibility

Manage end-to-end medical services for employees, ensuring consistent and high-quality service delivery across the market
Oversee employee medical enrollment processes, including new hires, dependents, exits, terminations, and option changes
Manage relationships with medical vendors, ensuring service quality, SLA compliance, issue resolution, and budget adherence
Ensure timely review and submission of medical claims payments to payroll for inclusion in the monthly payroll cycle
Review, validate, and process medical insurance invoices in line with contractual terms and enrolled population data
Ensure streamlined and integrated medical services processes from technical, functional, and customer perspectives, supporting accurate decisions on eligibility, entitlements, and system integration
Monitor and report on service delivery performance against SLAs and KPIs, driving continuous improvement initiatives
Ensure accurate transaction tracking, data integrity, and consistent service delivery across all medical processes
Document and maintain updated medical processes and knowledge materials in alignment with relevant stakeholders
Conduct medical benefits orientations and open enrollment sessions

Senior Employee Benefits Specialist

Allied Universal® is hiring a Senior Benefits Specialist. The Senior Benefits Sp...

Location

United States , Irvine

Salary:

24.00 - 28.00 USD / Hour

Allied Universal®

Expiration Date

Until further notice

Requirements

High school diploma or equivalent (e.g., GED)
Minimum of four (4) years of benefits administrative experience in a fast-paced environment
Knowledge of all pertinent federal and state regulations, filing and compliance requirements affecting employee benefits programs, including ERISA, ACA, COBRA, FMLA, ADA, Section 125, and DOL requirements
Ability to maintain sensitive information in a strictly confidential manner, exhibiting a high degree of ethics, professionalism and service orientation in all activities and all interactions with internal and external individual
Proactive problem solver and collaborative team player with strong attention to detail, flexibility, and initiative, exercising sound judgment and discretion while effectively operating with minimal supervision
Advanced proficiency in MS Office products (Word/Excel/PowerPoint/Outlook), and Internet and website navigation
analytical and technical support in the delivery of benefit administration
Outstanding verbal and written communication skills required with the ability to successfully interact at all levels of the organization while functioning as a team player
Willingness to take direction and critical feedback, and adapt to improve skills and effectiveness with a positive attitude
Must be able to manage multiple priorities and meet deadlines while maintaining attention to detail and handling stressful situations calmly and professionally in a fast-paced environment

Job Responsibility

Assist with benefits administration of group benefits programs (group health, dental, vision, short-term and long-term disability, life insurance and flexible spending plans) on a daily basis, including monitoring and researching weekly benefit deduction changes and updates
Serve as a subject matter expert and primary point of contact for employee benefit inquiries, providing high-quality service and support to colleagues and HR teams by resolving complex or escalated matters and assisting employees through the benefits hotline during open enrollment and other peak periods
Perform quality checks and audits to ensure accurate benefits data and compliance adherence, support compliance testing and annual audits, and investigate and resolve significant, complex, or unusual issues raised by management or colleagues
Serve as a liaison between colleagues and carriers, handing or facilitating requests for contribution adjustments, refunds, or other administrative changes
Act as liaison for all insurance carriers and third-party administrators for employee eligibility, claim and plan coverage inquiries, providing accurate and timely responses. Coordinates directly with third party administrators to research and resolve issues
Lead the implementation, testing, and maintenance of new and existing carriers EDI files with internal and external teams
Support both automated and manual benefits processes while documenting and maintaining detailed administrative procedures for all assigned benefit responsibilities, including upkeep of the benefits website and share drive to ensure accurate and accessible information
Assist with annual open enrollment activities, including the timeliness of elections to carriers, as well as the annual ACA reporting process by gathering data from third-party administrators, audits, research, and answering employees’ questions
Coordinate daily benefits processing. Handle enrollments, COBRA, terminations, qualifying life event changes, beneficiaries, disability, accident and death claims, and National Support Orders, Employee and Wage verifications, maintain group benefits database and update employee records
Assist with special projects assigned by management team

What we offer

Medical, dental, vision, retirement plan, basic life, AD&D, and disability insurance
Eight paid holidays annually, five sick days, and four personal day
Vacation time offered at an accrual rate of 3.08 hours biweekly. Unused vacation is only paid out where required by law.

Fulltime

Senior Employee Benefits Specialist

The Senior Benefits Specialist provides support for Health & Welfare benefit pro...

Location

United States , Irvine

Salary:

24.00 - 28.00 USD / Hour

Allied Universal®

Expiration Date

Until further notice

Requirements

High school diploma or equivalent (e.g., GED)
Minimum of four (4) years of benefits administrative experience in a fast-paced environment
Knowledge of all pertinent federal and state regulations, filing and compliance requirements affecting employee benefits programs, including ERISA, ACA, COBRA, FMLA, ADA, Section 125, and DOL requirements
Ability to maintain sensitive information in a strictly confidential manner, exhibiting a high degree of ethics, professionalism and service orientation in all activities and all interactions with internal and external individual
Proactive problem solver and collaborative team player with strong attention to detail, flexibility, and initiative, exercising sound judgment and discretion while effectively operating with minimal supervision
Advanced proficiency in MS Office products (Word/Excel/PowerPoint/Outlook), and Internet and website navigation
analytical and technical support in the delivery of benefit administration
Outstanding verbal and written communication skills required with the ability to successfully interact at all levels of the organization while functioning as a team player
Willingness to take direction and critical feedback, and adapt to improve skills and effectiveness with a positive attitude
Must be able to manage multiple priorities and meet deadlines while maintaining attention to detail and handling stressful situations calmly and professionally in a fast-paced environment

Job Responsibility

Assist with benefits administration of group benefits programs (group health, dental, vision, short-term and long-term disability, life insurance and flexible spending plans) on a daily basis, including monitoring and researching weekly benefit deduction changes and updates
Serve as a subject matter expert and primary point of contact for employee benefit inquiries, providing high-quality service and support to colleagues and HR teams by resolving complex or escalated matters and assisting employees through the benefits hotline during open enrollment and other peak periods
Perform quality checks and audits to ensure accurate benefits data and compliance adherence, support compliance testing and annual audits, and investigate and resolve significant, complex, or unusual issues raised by management or colleagues
Serve as a liaison between colleagues and carriers, handing or facilitating requests for contribution adjustments, refunds, or other administrative changes
Act as liaison for all insurance carriers and third-party administrators for employee eligibility, claim and plan coverage inquiries, providing accurate and timely responses. Coordinates directly with third party administrators to research and resolve issues
Lead the implementation, testing, and maintenance of new and existing carriers EDI files with internal and external teams
Support both automated and manual benefits processes while documenting and maintaining detailed administrative procedures for all assigned benefit responsibilities, including upkeep of the benefits website and share drive to ensure accurate and accessible information
Assist with annual open enrollment activities, including the timeliness of elections to carriers, as well as the annual ACA reporting process by gathering data from third-party administrators, audits, research, and answering employees’ questions
Coordinate daily benefits processing. Handle enrollments, COBRA, terminations, qualifying life event changes, beneficiaries, disability, accident and death claims, and National Support Orders, Employee and Wage verifications, maintain group benefits database and update employee records
Assist with special projects assigned by management team

What we offer

Medical, dental, vision, retirement plan, basic life, AD&D, and disability insurance
Eight paid holidays annually, five sick days, and four personal day
Vacation time offered at an accrual rate of 3.08 hours biweekly. Unused vacation is only paid out where required by law.

Fulltime

Lead Product Manager, Claims and Eligibility

Spring Health

Location:
United States , New York City

Category:
IT - Software Development

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 18, 2026

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