Top 238 Claims adjuster Jobs in Fairfield, Nj

Claims Manager, Audit & Complaints
MetroPlusHealth —New York, NY
- $100,000 - $120,000 a year
- Hybrid work
- 5 years
- Research
- Master's degree
Quick Apply
Senior Workers Compensation Adjuster
TheBest Claims Solutions —Newark, NJ
- $37.50 an hour
- Temporary
- 5 years
- Office
- Bachelor's degree
11d
Senior GL Claims Adjuster
Masis Professional Group —Basking Ridge, NJ
- $34 - $36 an hour
- Hybrid work
- Microsoft Excel
- Customer service
- Analysis skills
Quick Apply
9d
PIP- Personal Injury Protection Representative (I/II/ Sr.)
NJM Insurance Group —Parsippany-Troy Hills, NJ
- $51,120.55 - $94,140.80 a year
- Full-time
- Hybrid work
- Customer service
- Medical office experience
- Mid-level
- Paid parental leave
- Disability insurance
Quick Apply
Senior Inland Marine Technical Claims Specialist
TheBest Claims Solutions —New York, NY
- $55 - $70 an hour
- Temporary
- Remote
- 7 years
- Bachelor's degree
- Senior level
Claims Adjuster Trainee
Progressive —Rutherford, NJ
- $64,500 - $69,000 a year
- Monday to Friday
- Hybrid work
- Office
- US work authorization
- Experience equivalent to degree accepted
- Health savings account
- Disability insurance
19h
Field Property Adjuster - New Jersey
National General —Newark, NJ
- $56,000 - $92,000 a year
- Online Application
- Remote
- Mid-level
- US work authorization
- Fair chance
Bodily Injury Adjuster - Extended Handler
National General —New York, NY
- $50,000 - $124,500 a year
- Online Application
- Remote
- No experience needed
- Mid-level
- Case management
1d
Bodily Injury Litigation Adjuster (Homeowner Liability)
National General —New York, NY
- $56,000 - $105,140 a year
- Online Application
- Remote
- Mid-level
- Mentoring
- US work authorization
Workers Compensation Adjuster
TheBest Claims Solutions —Newark, NJ
- $33 - $43 an hour
- Temporary
- Remote
- Mid-level
- 2 years
- Commercial
8d
Investigator A (Claims)
NJ Transit —Newark, NJ
- Writing skills
- Mid-level
- Driver's License
- Health insurance
- Dental insurance
Multi Line Adjuster Trainee
GEICO —New York, NY
- $29.00 - $45.28 an hour
- Full-time
- Writing skills
- High school diploma or GED
- Driver's License
- Paid training
8d
PIP- Personal Injury Protection Rep (I/II/ Sr.)
NJM Insurance Group —Parsippany-Troy Hills, NJ
- $51,120.55 - $94,140.80 a year
- Full-time
- Customer service
- Mid-level
- Bachelor's degree
- Paid parental leave
- Disability insurance
Multi-Line Adjuster
GEICO —New York, NY
- $36.63 - $57.49 an hour
- Full-time
- Remote
- Writing skills
- Mid-level
- High school diploma or GED
8d
Field Property Claims Adjuster: Hackensack, NJ
Farmers Insurance Group —Jersey City, NJ
- $23.22 - $47.07 an hour
- Background check
- Microsoft Outlook
- Customer service
- Paid training
- Paid parental leave
Claims Adjuster (Hackensack)
J. Fletcher Creamer & Son, Inc —Hackensack, NJ
- $63,000 - $94,000 a year
- Hybrid work
- Mid-level
- 3 years
- High school diploma or GED
- Employee stock purchase plan
- Paid holidays
Quick Apply
Workers' Compensation Complex Claims Adjuster (NJ)
Berkshire Hathaway GUARD Insurance Companies —Parsippany-Troy Hills, NJ
- $50,000 - $80,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- High school diploma or GED
- Dental insurance
- 401(k)
1d
Liability & Litigation Adjuster
Hippo Insurance —Morristown, NJ
- $110,000 - $133,000 a year
- 6 years
- Mid-level
- High school diploma or GED
- Disability insurance
- Dental insurance
Quick Apply
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
SIU INVESTIGATOR - Newark, NJ
Origin Investigations Inc —Newark, NJ
- $25 - $40 an hour
- Remote
- Mid-level
- Analysis skills
- Travel
- Mileage reimbursement
- Health insurance
Quick Apply
10d

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claims adjuster jobs near fairfield, nj

Claims Manager, Audit & Complaints

MetroPlusHealth -
New York, NY

Quick Apply

Job Details

$100,000 - $120,000 a year

Qualifications

Medicare
Bachelor's degree
Health insurance knowledge
Medicare regulations
Data-driven problem-solving
Medicaid regulations
Medicaid
Healthcare reimbursement methods
Stakeholder relationship building
Stakeholder management

Full Job Description

Position Overview

Reporting to the Director of Claims Quality, the Claims Manager, Audit & Complaints will oversee operational excellence and regulatory compliance by collaborating with cross-departmental teams to ensure that claims-related
regulatory audits and complaints are thoroughly researched and addressed in a timely manner.

Scope of Role & Responsibilities

Working under the direction of and in collaboration with the Director of Claims Quality, the Claims Manager, Audit & Complaints will:

Act as a liaison for external audits conducted by DOH, CMS, and other regulatory entities related to claims operations
Coordinate audit preparation, assist with documentation collection, internal reviews, SME engagement, and timely submission of materials
Review audit findings and prepare an Executive Summary for Claims Leadership which identifies compliance gaps and deficiencies.
Collaborate with Claims Leadership, Compliance, and upstream operational teams to develop corrective action plans
Monitor and manage corrective action plan implementation, ensuring milestone dates are met
After correction action plans are implemented, periodically audit workflows and processes to ensure ongoing compliance and adherence
Review Claims teams’ complaint triage findings, supporting documents and responses prior to submission to the team managing the complaint to ensure clarity, accuracy, and alignment with regulatory expectations

Working in collaboration with the Regulatory Complaints and the Complaints & Grievance teams gather statistics of complaints related to claims adjudication errors or outcomes, track and trend. The Claims
Manager, Audit & Complaints will:

Identify trends, root causes, and systemic issues impacting accurate claims adjudication and claims quality. Collaborate with Claims leadership to identify systems fixes and configuration
corrections needed. Ensure CPI and or CRF tickets are submitted timely; monitor tickets to ensure timely implementation.
Drive continuous improvement initiatives by translating findings into scalable process and product enhancements
Partner cross-functionally to identify and suggest workflow changes to improve outcomes and quality results.

Required Education, Training & Professional Experience

Bachelor’s degree from an accredited college or university in an appropriate discipline required.
Master’s degree in business, healthcare or public administration preferred.
Minimum 5-7 years experience in a health plan environment, with strong experience in claims operations, compliance, audit, or product management.
Strong knowledge of claims lifecycle, adjudication processes, and reimbursement methodologies
Experience with Medicaid and Medicare products, particularly within New York State
Demonstrated ability to identify operational issues and implement effective, scalable solutions

Professional Competencies

Ability to work cross-functionally and influence without direct authority
Excellent analytical, problem solving, and data interpretation skills
Deep understanding of claims operations and regulatory requirements
Process improvement and operational excellence mindset
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fast-paced, evolving environment
Highly collaborative with strong stakeholder engagement and decision-making skills
Demonstrated sound judgment balancing compliance, operational, and business needs
Commitment to MetroPlusHealth’s Mission, Vision, and Values

#LI-Hybrid

#MHP50

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Refine Your Search

claims adjuster jobs in fairfield, nj

Claims Manager, Audit & Complaints

Senior Workers Compensation Adjuster

Senior GL Claims Adjuster

PIP- Personal Injury Protection Representative (I/II/ Sr.)

Senior Inland Marine Technical Claims Specialist

Claims Adjuster Trainee

Field Property Adjuster - New Jersey

Bodily Injury Adjuster - Extended Handler

Bodily Injury Litigation Adjuster (Homeowner Liability)

Workers Compensation Adjuster

Investigator A (Claims)

Multi Line Adjuster Trainee

PIP- Personal Injury Protection Rep (I/II/ Sr.)

Multi-Line Adjuster

Field Property Claims Adjuster: Hackensack, NJ

Claims Adjuster (Hackensack)

Workers' Compensation Complex Claims Adjuster (NJ)

Liability & Litigation Adjuster

SIU Investigator

SIU INVESTIGATOR - Newark, NJ

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