Average salary: Rs588,849 /yearly
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- ...Claims Adjudication Associate Location: Infopark, Kochi Qualification: Any Degree Experience: 2+ Years Salary: 5LPA- 7LPA FACETS Experience: Preferred / Added Advantage Shift: 6:00 PM – 3:00 AM We are looking for a detail-oriented Claims...SuggestedFull timeShift work
Rs 8 lakh p.a.
...Assistant Manager – Claims Adjudication Location: Infopark, Kochi Qualification: Any Degree Experience: Minimum 5+ Years Salary: ₹8LPA Shift: 6:00 PM – 3:00 AM Responsibilities Lead and manage a team handling US healthcare claims adjudication processes...SuggestedFull timeShift work- ...workflows. In this role, you’ll use your real-world pharmacy experience to create realistic prescription-processing and medication-adjudication scenarios, develop reference answers, and evaluate AI-generated responses for accuracy, safety, and proper workflow judgment....SuggestedHourly payWeekly pay40 hours per weekOngoing contractContract workFor contractorsRemote jobFlexible hours
- ...the development and validation of fraud detection mechanisms, conduct clinical audits of claims, provide technical support to claims adjudication processes, and contribute to capacity-building and fraud prevention initiatives. Depending on experience, the selected candidate...SuggestedFull timeImmediate start
- ...operations, or related payer/provider functions. ~Experience with healthcare platforms such as provider data management systems, claims adjudication systems, Facets, QNXT, or similar tools would be an advantage. ~Familiarity with healthcare coding systems, including CPT, HCPCS,...SuggestedFull timeContract workHybrid workWork at officeFlexible hoursNight shift
- ...handled correctly. Identify, flag, and categorize document-processing defects. Escalate ambiguous or complex cases for further adjudication. Apply consistent judgment and attention to detail across high-volume review workflows. Help improve review protocols and...SuggestedContract workFor contractorsRemote jobFlexible hours
- ...Full-cycle medical billing Regulatory and compliance operations HIPAA privacy Healthcare internal audit Payer-side claims adjudication Appeals and grievances Benefit configuration Provider networks Utilization management Coding audit Clinical...SuggestedHourly pay40 hours per weekLong term contractFull timeContract workFor contractorsWork at officeRemote jobFlexible hours
Rs 6.5 - 9.5 lakhs p.a.
...(P&C) Insurance. At least 2 years of hands-on experience in a team handling or supervisory role. Proven experience in claims adjudication, claims adjusting, and end-to-end claims processing. Preference for candidates holding CPCU or equivalent insurance designations...SuggestedFull timeWork at officeImmediate startShift workNight shift- ...Board IPO assignments Secretarial Audit Due Diligence SHA / SPA Drafting NBFC & RBI Compliance MCA & RBI Compounding / Adjudication Matters Mergers & Corporate Restructuring Corporate Advisory & Client Handling Send your CV: ****@*****.***...SuggestedImmediate start
- ...adherence to SLAs and regulatory guidelines. Implement and monitor controls to prevent fraud, abuse, and leakage. Ensure accurate adjudication and timely closure of claims. 2. Floor & Resource Management Manage daily floor operations including team rostering, shift...SuggestedFull timePart timeFixed term contractShift work
- ...RCM system integrations, including: 1. Eligibility & Benefits Verification (EBV) 2. Prior Authorization 3. Claims Submission & Adjudication 4. Billing, Payments, AR, and Denials ● Build and manage system-to-system integrations beyond RCM when required. ● Develop...SuggestedFull time
- ...Role Responsibilities Construct enterprise insurance scenarios for complex commercial underwriting, multi-stakeholder claims adjudication, and regulatory compliance review cycles at Fortune 500 carriers. Build insurance tasks across F500 underwriting, risk...SuggestedRemote jobContract workSummer work
- ...Facets G6 Ecosystem Engineering & Refactoring - Architect core claims solutions covering Facets G6 real-time/batch processing, pre-adjudication validation, and claim-editing engines. - Manage EDI data streams and end-to-end transaction data management configurations. Refactor...SuggestedLong term contractPermanent employmentContract workRemote job
- ...manage internal annotators and external vendors; allocate work and track throughput, quality, and cost. - Design sampling, review, adjudication, gold-set, inter-annotator agreement, and audit processes. - Maintain dataset versions, metadata, provenance, consent and usage...SuggestedFull time
- ...to ensure correct handling of identifying and sensitive elements. Flag and categorize defects, escalating ambiguous cases for adjudication. Work across various document types, including commercial contracts, IP agreements, and tax filings. Ensure precision and...SuggestedRemote jobContract workSummer work
- ...clearinghouse reports daily to identify claim acceptance, rejections, and required corrections. Track claims from submission through adjudication and follow up on pending, denied, or underpaid claims. Reconcile remittance advices (835s/EOBs) against expected reimbursement...Work at officeImmediate startWork from homeUS shiftShift work
- ...and card network requirements. Maintain accurate documentation and audit trails for all underwriting decisions. Support timely adjudication of applications within defined SLAs. Escalate complex/high-exposure cases to Senior Underwriters or Management. Contribute to...Full timeWork at officeImmediate startFlexible hoursShift work
- ...validate detection performance. Owns the measurement methodology and safeguards the integrity of all published detection figures. Adjudicates whether findings are genuine, setting and maintaining the triage standard used across the team. Runs the standing evaluation...Immediate start
- ...testing. The role will focus on validating Oracle Health Insurance (OHI) service definitions, medical coding configurations, claims adjudication, eligibility, benefits, authorizations, and related product rules.Key Responsibilities :- Validate OHI service definitions,...
- ...a Business Analyst, preferably in data integration and reporting environments- Experience with healthcare payer datasets - claims adjudication, benefit management, enrollment, utilization managementTechnical Skills :- Proficiency in SQL/SSRS and PowerBI for querying and validating...
- ...examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims needs to be completed adhering to required TAT and quality SLA. Key Responsibility: 1. Production, Quality 2....Shift work
- ...investigations. All exercises use mock information and do not require access to live systems or client data. What You’ll Do Adjudicate transaction-monitoring alerts using alert information, KYC/CDD profiles, and transaction histories. Document alert dispositions...Hourly payWeekly pay40 hours per weekContract workFor contractorsRemote jobFlexible hours
- ...Not Provided Posted 1 week ago Job Be an early applicant About the job Lead and manage a team of Non-Medical Claims Adjudicators handling Cashless and Reimbursement health insurance claims. Ensure timely and accurate adjudication of claims in accordance with...Immediate start
- ...reports, claim submissions, and dispute-related documentation. Support expert witnesses and legal teams in arbitration, litigation, adjudication, and mediation proceedings. Present findings and recommendations to senior client stakeholders, legal counsel, and project teams...For contractorsHybrid workWorldwide
- ...modernization.The ideal candidate will have a deep understanding of healthcare payer processes, Facets architecture and data models, claims adjudication, enrollment, provider and benefit administration, and enterprise healthcare integrations.The candidate will be responsible for...
- ...Claims Processors to support US healthcare payer claims operations Responsible for accurate and compliant end-to-end medical claims adjudication within the TriZetto Facets platform, ensuring proper application of benefits, pricing logic, provider validation, and payer rules....Contract workImmediate start
Rs 20 per hour
...Payment process Assess compliance with the latest industry standards and regulations Audit of Clinical coding for accurate system adjudication and data analytics Boost documentation and reporting accuracy • Review of Tarrif & Identify abuse and renegotiation of tarrif...Full timeRemote jobRecruitkar
Thane19 days ago- ...requirements and implementation in the claims process. Creating detailed standard operating process for seamless functioning of claims adjudication Case management of potential cases to Network team, maintaining data of referred/saving achieved/impact against cashless outgo....Full timePart timeFixed term contractWeekend work
- ...industry credibility, strong commercial acumen, and experience supporting formal dispute resolution proceedings including arbitration, adjudication, litigation, mediation, and expert witness assignments. Job Responsibilities Strategic Leadership & Engagement Oversight...Full timeContract workRemote jobFlexible hours
- ...Payer (HRP). Validate local claims processing workflows, business rules, benefits, pricing, and claims adjudication. Test and validate EDI 837 files and associated claims-processing workflows....Remote jobLocal area
