Average salary: Rs200,000 /yearly
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- ...Role : Adjudicator (Disagreement Resolution + Guideline Governance) Location: India | Type: Full-time | Reports to: Quality Lead / Program Lead Mission: Convert disagreement into defensible ground truth while continuously tightening the guideline system. About Us...SuggestedFull time
codvo.ai
Pune4 days ago - ...reimbursement methodologies, or pricing analytics ~Experience with healthcare data systems such as QNXT, Facets, or similar claims adjudication platforms ~Familiarity with ETL/ELT pipeline concepts and data warehouse architecture (enough to have informed conversations with...SuggestedFull timeContract workHybrid workWork at officeFlexible hoursNight shift
- ...issues, including: Conducting complainant, witness and subject employee interviews; Analyzing data from various internal systems; Case adjudication; Proposing remedial action based on investigation findings; Production of completed investigation documentation Independently...SuggestedTemporary workFlexible hours
Amazon Robotics
Pune6 days ago - ...and related data discrepancies. Develop and maintain working knowledge of S&N products and franchises to ensure accurate rebate adjudication. Maintain systems, trackers, and logs to monitor contract status and rebate and administrative fee processing for review by senior...SuggestedContract workHybrid workShift workNight shift
Smith & Nephew's gynecology business
Pune6 days ago - ...claims processes and operating models.Strong understanding of :- Pre-authorisation workflows- Reimbursement and cashless claims- Auto-adjudication and manual assessment flows Claims intake and registration- Medical coding and clinical pathways- Provider and hospital workflows-...SuggestedRemote job
- ...Providing three key elements of consultancy to find the right record solution, evidence review with on-the-spot verification with our adjudicators and licensing of the Guinness World Records trademarks. JOB PURPOSE: This position serves as a critical bridge between...SuggestedLong term contract
Guinness World Records
Pune5 days ago - ...clients, procedures, and modalities. Set and enforce standard operating models from intake de identification annotation QA/IRR adjudication dataset release + evidence packs. Ensure programs meet or exceed SLAs, quality thresholds, and release timelines at scale. Operating...SuggestedHourly payLong term contractFull timeHybrid workShift work3 days week
codvo.ai
Pune6 days ago 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- ...applications, conducting research into new record ideas, reviewing evidence, facilitating creative sessions, booking, advising and managing adjudicators, supporting internal departments, project managing large projects, providing expert knowledge on record breaking in their territory...SuggestedWork at officeLocal areaWorldwide
Guinness World Records
Pune5 days ago - ...Legaltranslate policies into executable rules and evaluators. Run stakeholder UAT cycles: test planning evidence collection false-positive adjudication iterative tuning. Manage vendor engagements: technical due diligence integration interfaces performance/SLA validation joint...SuggestedFull timeContract workHybrid work
HSBC
Punea month ago - ...the end‑to‑end lifecycle of credit risk rule development and validation, including credit line strategies, authorization rules, and adjudication actions across multiple risk platforms. The VP will partner closely with Credit Risk, Technology, Product, and Compliance teams...SuggestedFull time
Citi
Pune6 days ago - ...detection, phase recognition, SAM-style masks). ~ Quality, IAA & Release Gates ~Define gold sets and acceptance thresholds: ~Phase/event F1 ≥ 0.92 ~Tool mAP ≥ 0.85 ~Anatomy Dice ≥ 0.85 ~Run double-labeling (≥10%), adjudication, and weekly QA reviews....SuggestedShift work
codvo.ai
Pune6 days ago - ...strong advantage. ~ Working knowledge of benefits administration — plan configuration, member-provider relationships, and claims adjudication flows. Delivery & Program Management Demonstrated experience managing enterprise software delivery programs involving .NET...SuggestedContract workRemote jobFlexible hours
Simplify Healthcare
Pune6 days ago - ...Listed below are the primary job duties and responsibilities that are required: Review claims for legitimacy and accuracy Adjudicate claims by approving or denying them according to established guidelines. Conducts investigation of pended claims and follow up with...SuggestedFull timeNight shift
Mphasis
Pune6 days ago - ...: • Enforce zero-tolerance policies on substance abuse, ragging, bullying, and harassment (UGC-compliant). • Investigate and adjudicate disciplinary cases; conduct regular announced and surprise hostel inspections. • Oversee biometric/RFID entry logs, overnight absence...SuggestedFull timeLocal areaRelocationNight shiftWeekend work
Newton School
Pune3 days ago - ...degree (BSC, B-Pharma, B. Com, BA, Nursing, Life Science etc.) Experience: 1-3 years in any US Healthcare Process like Release of Information, Claims Adjudication/Adjustment, Medical Billing, RCM etc. Healthcare document retrieval experience will be an added advantage....
clinetic, an mro company
Pune6 days ago - ....g. hallucinations incorrect facts tone mismatches). Identify ambiguous or unclear cases and escalate them with clear notes for adjudication by reviewers or SMEs. Meet defined accuracy and throughput targets while maintaining quality; participate in daily/weekly productivity...Full timeInternshipHybrid workWork at officeLocal areaRemote job
Zendesk
Punea month ago Rs 1.5 - 4 lakhs p.a.
...cross functional interactions Extensive knowledge of the Property Casualty insurance lifecycle including underwriting rules claims adjudication and financial reporting Stay ahead of Guidewire Release cycles to evaluate new features eg Jutro digital frameworks or Advanced...LTM
Punea month ago- ...Program delivery (E2E): Stand up and run the annotation 'factory' from intake → de-ID → task orchestration → annotation → QA/IRR → adjudication → dataset release + evidence pack. Ontology + guidelines execution: Partner with clinical SMEs to operationalize a procedure-specific...Hourly payFull time
codvo.ai
Pune6 days ago - ...Master (SSM) or PMI-ACP certification. PMP or PRINCE2 certification is a strong plus. Experience working on PBM systems such as adjudication engines MTM platforms prior authorization tools or formulary management systems. Familiarity with CMS Part D guidelines HIPAA...Full timeHybrid workRemote job
EVERSANA
Punea month ago - ...that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for ~ You will be responsible for...Flexible hoursShift work
Accenture
Pune9 days ago - ...ensure required artifacts are complete for the Evidence Pack (QA results, sampling logs, sign-offs). Escalate systematic issues to Adjudication/Clinical Review (definition gaps, ambiguous classes, recurring edge cases). Deliverables (what you produce weekly) QA audit...Full time
codvo.ai
Pune6 days ago - ...Experience with data processing software/tool and platform is a plus. Experience: 0-3 years in any US Healthcare Process like Release of Information, Claims Adjudication/Adjustment, Medical Billing, RCM etc. Healthcare document retrieval experience will be an added advantage....Shift work
clinetic, an mro company
Pune6 days ago
