Adjudication Jobs

Arbital Health seeks a seasoned Consulting Actuary to lead actuarial engagements, translate complex claims data into actionable insights, and partner with clients and engineering to scale value-based care solutions.

Evernorth seeks a Product Management Advisor to own regulated-market capabilities, ensure CMS compliance, lead enhancements, and serve as the SME for internal and client stakeholders.

Meijer seeks an entry-level Pharmacy Technician in Madison Heights to support prescription dispensing, inventory, and customer-facing pharmacy services in a fast-paced retail environment.

Meijer is hiring a Pharmacy Technician Level 1 in Avon, IN to assist with prescription filling, inventory, and customer-facing pharmacy duties while supporting clinical services and pharmacy initiatives.

Yuzu is hiring a Claims Resolution Specialist to process claims, support complex case resolution, and help evolve claims operations for innovative, tech-enabled health plans.

Sana is hiring a remote Claims Processor to accurately adjudicate medical claims, manage appeals, and support cross-functional teams to deliver an easy healthcare experience.

A senior IBMi/AS400 engineer role to lead technical delivery for CVS Health’s Rx claim adjudication systems, combining deep legacy platform expertise with modern cloud and DevOps practices.

Devoted Health seeks an experienced Payment Integrity Program Development Director to create and operationalize data-driven programs that reduce payment leakage and ensure Medicare Advantage payment accuracy.

Social Impact Driven

Crum & Forster’s Travel Insured International is hiring a Claims Analyst to process and adjudicate travel insurance claims with strong customer focus and attention to detail.

Sedgwick is hiring a Maryland-focused Workers' Compensation Claims Examiner to analyze, adjudicate, and negotiate lost-time claims for valued clients in a hybrid Baltimore role.

NYU is hiring a Title IX Program Manager to lead pre- and post-hearing processes, manage adjudication logistics and data tracking, and provide neutral support and policy guidance in cases of sexual and relationship misconduct.

St. Luke’s Health Plan is hiring a Pharmacy Benefits Specialist to manage prior authorizations, resolve PBM and claims issues, and serve as an on-the-ground subject matter expert for members and providers.

Humana seeks a Senior Claims Research & Resolution Professional to analyze Michigan Medicaid claims trends, resolve denials and underpayments, and collaborate with Provider Relations to improve billing accuracy and provider satisfaction.

Serve as a public-facing Community Associate at OATH, guiding New Yorkers through summons intake, case processing, calendaring and inquiries to ensure timely access to adjudication.

ORAU seeks an entry-level Security Assistant to support the FBI in Huntsville by executing clearance processing, database checks, security assessments, and administrative functions to maintain compliance with federal security standards.

Experienced healthcare reimbursement specialist needed to define and maintain hospital payer contracts in Experian Health's Contract Manager to ensure accurate claim valuations and patient estimates.

The NYC Law Department seeks an Assistant Supervisor — Benefits Examiner Level 2 to adjudicate workers' compensation claims, calculate benefits, coordinate medical examinations, and support supervisory duties.

Provide accurate, friendly pharmacy support at Meijer’s Jackson location by handling prescription processing, inventory tasks, and customer-facing pharmacy services.

Lead claims operations and automation efforts for a growing TPA-focused insurer to ensure accurate, compliant, and cost-effective adjudication for self-funded health plans.

Lead AHF’s health plan claims unit as the Claims Department Manager, overseeing claims adjudication, denials and appeals, team performance, and operational improvements to ensure accurate, timely reimbursement.

Meijer is hiring a Level 1 Pharmacy Technician in Troy, OH to support day-to-day pharmacy operations and deliver compassionate, accurate patient service.

TreviPay is hiring an experienced credit leader to run score-based small business adjudication, driving automation, policy-aligned decisioning, and high-volume operational excellence.