Top 205 Claims associate Jobs in North Carolina

Claims Adjudication Associate
Judi Health —Charlotte, NC
- $98,800 - $123,500 a year
- Hybrid work
- Mid-level
- Bachelor's degree
- Leadership
Quick Apply
Research Associate
University of North Carolina at Chapel Hill —Chapel Hill, NC
- $70,000 - $90,000 a year
- Full-time
- Mid-level
- Master's degree
- University
- Health insurance
- Retirement plan
11d
Licensed Psychologist/Psychological Associate
CAROLINA PSYCHOLOGICAL ASSOC PA —Durham, NC
- $50,000 - $85,000 a year
- Part-time
- Private practice
- Experience working with individuals with developmental disabilities
- Mid-level
- Mileage reimbursement
- Disability insurance
Quick Apply
Mental Health Therapist / Counselor (LCMHC, LCSW, LMFT or Associates)
Anna Thames Counseling PLLC —Monroe, NC
- $72 - $104 an hour
- Choose your own hours
- Private practice
- LMFT
- Licensed Clinical Social Worker
- Continuing education credits
- Professional development assistance
Quick Apply
4d
Retail Fulfillment Associate - Reserve
Biltmore Workforce Management —Woodfin, NC
- From $17.09 an hour
- Part-time
- High school diploma or GED
- Ability to lift 50 pounds
- Math
Quick Apply
11d
Associate Actuary
Centene —North Carolina
- $87,700 - $157,800 a year
- Full-time
- Remote
- Research
- Mid-level
- SQL
- Paid holidays
- Health insurance
14d
Account Associate - State Farm Agent Team Member
Mike Shoffner - State Farm Agent —Graham, NC
- $70,000 - $100,000 a year
- Full-time
- Sales
- Office
- Organizational skills
- Health insurance
- 401(k)
Quick Apply
Account Associate - State Farm Agent Team Member
Matt Dubyoski - State Farm Agent —Indian Trail, NC
- $60,000 - $80,000 a year
- Full-time
- Sales
- Office
- Organizational skills
- Health insurance
- 401(k)
Quick Apply
Account Associate - State Farm Agent Team Member
Chris Canady - State Farm Agent —Rocky Mount, NC
- $60,000 - $80,000 a year
- Full-time
- Office
- Organizational skills
- Communication skills
- Health insurance
- Paid time off
Quick Apply
Account Associate - State Farm Agent Team Member
Roger O'Connell - State Farm Agent —Davidson, NC
- $55,000 - $75,000 a year
- Full-time
- Sales
- Office
- Organizational skills
- Health insurance
- Dental insurance
Quick Apply
Associate Director, Corporate Compliance - Operations
United Therapeutics —Research Triangle Park, NC
- $145,500 - $205,000 a year
- Full-time
- Remote
- 7 years
- Finance
- Analysis skills
- Paid parental leave
- Employee stock purchase plan
Billing Associate
Pinehurst Medical —West End, NC
- Full-time
- Medical office experience
- High school diploma or GED
- 1 year
Quick Apply
Associate Client Services Operations Analyst
IntApp —Charlotte, NC
- Email
- Mid-level
- Office
- Bachelor's degree
- Paid time off
Warehouse Associate
KENDELL DOORS & HARDWARE INC —Greensboro, NC
- $20 - $25 an hour
- Part-time
- Background check
- Computer literacy
- ERP systems
- Health savings account
- Paid holidays
Quick Apply
4d
Patient Account Associate- Duke Homecare and Hospice
Duke Health —Durham, NC
- Full-time
- Computer literacy
- Medical office experience
- HIPAA
Account Associate - State Farm Agent Team Member
Tim Farless - State Farm Agent —Holly Springs, NC
- $50,000 - $75,000 a year
- Full-time
- Sales
- Office
- Organizational skills
- Paid time off
- Opportunities for advancement
Quick Apply
Account Associate - State Farm Agent Team Member
Daniel Connor - State Farm Agent —Mooresville, NC
- $45,000 - $60,000 a year
- Full-time
- Sales
- Office
- Organizational skills
- Paid holidays
- Paid time off
Quick Apply
(USA) Backroom Associate - Sam's Club
Sam's Club —Winston-Salem, NC
- $18 - $26 an hour
- 18 years or older
- High school
- Merchandising
- Paid jury duty
- Disability insurance
Sr. Associate Analyst, Pharmacy Collections
McKesson —Cary, NC
- $24.83 - $41.39 an hour
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Research
Account Associate - State Farm Agent Team Member
Kyle Mills - State Farm Agent —High Point, NC
- $55,000 - $75,000 a year
- Full-time
- Sales
- Office
- Organizational skills
- Health insurance
- Paid time off
Quick Apply

I want to receive the latest job alert for claims associate in north carolina

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

claims associate jobs near north carolina

Account Representative jobs in Mooresville, NC

Warehouse Associate jobs in Greensboro, NC

Backroom Associate jobs in Winston-Salem, NC

Actuary jobs in North Carolina

Research Associate jobs in Chapel Hill, NC

Director Of Compliance jobs in Research Triangle Park, NC

Account Representative jobs in Rocky Mount, NC

Customer Service Analyst jobs in Charlotte, NC

Accounts Assistant jobs in Durham, NC

Mental Health Therapist jobs in Bellevue, WA

Mental Health Therapist jobs in Joliet, IL

Mental Health Therapist jobs in Fayetteville, AR

Mental Health Therapist jobs in California

Mental Health Worker jobs in New York, NY

Masters Degree Clinical Mental Health Counseling jobs in New Jersey

Global Mental Health jobs in Remote

Cna Home Health jobs in Las Vegas, NV

Customer Service Representative jobs in San Antonio, TX

Account Representative jobs in Sylacauga, AL

Enterprise Account Executive jobs in Austin, TX

Claims Adjudication Associate

Judi Health
Charlotte, NC

Quick Apply

Job Details

$98,800 - $123,500 a year

Qualifications

Project team coordination
Liability determination
Healthcare dispute resolution
Appeals
Insurance dispute resolution
Operations coordination
Health insurance policy knowledge
Regulatory compliance in claims processing
Claims negotiation
Public Cloud
Quality improvement
Medical insurance appeals management
Data interpretation
Leading team collaboration initiatives
Insurance policy review
Productivity software
Achieving project delivery timelines
Subrogation claims
Insurance claims appeal handling
Escalation handling
Cross-functional team management
Project stakeholder communication
Cross-functional communication

Full Job Description

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
Judi®, the industry's leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we're rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Location: Hybrid (Local to NYC, Denver, or Charlotte area)

Position Summary:

Capital Rx is seeking a self-driven Claims Adjudication associate to support the Medical claims adjudication workflow for JUDI Health, Capital Rx's enterprise health platform.

The Claims Adjudication Associate is responsible for evaluating claims submitted by policyholders or providers to determine their validity, coverage, and proper reimbursement amounts. They serve as the critical link between the services rendered and financial compensation, aiming to prevent improper payments and resolve billing disputes.

Position Responsibilities:

Evaluate complex medical claims, coverage issues, and benefit determinations by reviewing claim facts, plan documents, applicable laws and regulations, medical coding information, and supporting documentation to determine or recommend appropriate claim outcomes.
Interprets complex policy and benefit language, identifying applicable coverage provisions, assessing claim risk, and resolving escalated or non-routine claim matters.
Make coverage, liability, payment, adjustment, recovery, subrogation, stop-loss, and recoupment determinations or recommendations that have financial, operational, client, or regulatory impact.
Negotiate or support resolution of complex claim issues with internal stakeholders, providers, members, networks, and other parties, including escalation of significant matters and recommendations for settlement or corrective action when appropriate.
Serve as a subject matter resource to Customer Care, Operations, and other client-facing teams by providing guidance on complex claims, benefit interpretation, adjudication logic, inquiry management, and claim-resolution strategy.
Manage and prioritize escalated claims-related workflows, including appeals, subrogation, payment issues, stop-loss, adjustments, and member/provider inquiries, based on contractual obligations, regulatory requirements, business risk, and client impact.
Build and maintain trusted relationships with stakeholders by advising on claims-adjudication processes, communicating recommendations, and supporting resolution of complex or sensitive claim matters.
Provide guidance during implementations and client support activities regarding adjudication infrastructure, processing workflows, reporting, inquiry management, and complex claim scenarios.
Identify execution risks, operational gaps, and compliance or client-impact issues; develop mitigation strategies; and recommend or implement process improvements that support automation, quality, efficiency, and risk reduction.
Lead or contribute to cross-functional initiatives that improve adjudication workflows, system capabilities, reporting, controls, and stakeholder experience.
Participate in meetings, client discussions, escalation reviews, and other business-critical activities outside standard business hours when necessary to support implementation, regulatory, or client-service needs.
Maintain adherence to the Capital Rx Code of Conduct, privacy requirements, regulatory obligations, and internal policies, including identifying and reporting potential noncompliance.

Minimum Qualifications:

Bachelor's degree strongly preferred; equivalent combination of relevant education and experience may be considered.
2+ years of progressive experience in health plan, TPA, medical claims, benefits administration, claims operations, or related healthcare operations environment.
Demonstrated experience interpreting benefit plans, coverage provisions, claims policies, applicable laws and regulations, and operational requirements to resolve complex or escalated claim matters.
Proven ability to exercise discretion and independent judgment when evaluating competing information, determining appropriate claim outcomes, assessing business risk, and making recommendations on matters of significance.
Strong understanding of medical claims adjudication, coordination of benefits, adjustments, appeals, subrogation, stop-loss, member/provider inquiries, and related operational impacts.
Experience leading cross-functional initiatives, influencing stakeholders, improving processes, driving high performance, meeting deadlines, and executing on deliverables.
Exceptional project management, prioritization, problem-solving, communication, and organizational skills, with the ability to shift between competing priorities and meet organizational goals.
Ability to communicate complex claims, benefit, operational, and client-impact issues clearly to internal and external stakeholders.
Proficient in Microsoft Office Suite and able to adapt to software such as Jira, Miro, Confluence, GitHub, AWS Redshift, and other operational or reporting platforms.
Ability to work effectively with virtual teams while maintaining confidentiality, privacy, and professional standards.

Preferred Qualifications:

Medicare/Medicaid experience preferred

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.

Quick Apply

Refine Your Search

claims associate jobs in north carolina

Claims Adjudication Associate

Research Associate

Licensed Psychologist/Psychological Associate

Mental Health Therapist / Counselor (LCMHC, LCSW, LMFT or Associates)

Retail Fulfillment Associate - Reserve

Associate Actuary

Account Associate - State Farm Agent Team Member

Account Associate - State Farm Agent Team Member

Account Associate - State Farm Agent Team Member

Account Associate - State Farm Agent Team Member

Associate Director, Corporate Compliance - Operations

Billing Associate

Associate Client Services Operations Analyst

Warehouse Associate

Patient Account Associate- Duke Homecare and Hospice

Account Associate - State Farm Agent Team Member

Account Associate - State Farm Agent Team Member

(USA) Backroom Associate - Sam's Club

Sr. Associate Analyst, Pharmacy Collections

Account Associate - State Farm Agent Team Member

I want to receive the latest job alert for claims associate in north carolina

Related Searches

Explore jobs in more locations

About Judi Health

Job Seeker Tools

Employer Tools

Browse

Stay Connected