• Internal Investigator 2 Criminal

    New York State Civil Service (Bronx, NY)
    …Investigator 2 will be responsible for the following duties:*Perform pre- adjudication investigations and assist other investigators. Trace, interview, and subpoena ... investigations to appropriate parties.*Coordinate the appearance of witnesses at adjudication proceedings and explain procedures to them.*Testify in adjudication more
    New York State Civil Service (09/16/25)
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  • Construction Project Controls Specialist

    AECOM (Douglas, AZ)
    …US work authorization. + Applicants must be able to successfully pass Federal Adjudication for an HSPD-12 Tier 1 Security Credential. + This position is anticipated ... will be required. + Client background screening and fingerprinting and security adjudication will be required (\*) + This position does not include sponsorship… more
    AECOM (09/13/25)
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  • Copay Support/Claims Processing Specialist - Earn…

    AssistRx (Phoenix, AZ)
    …Care Providers. The Copay Support/Claims Processing Specialist will adjudication , troubleshoot claim rejections, claim reversals, allocation deficiencies, ... on enrollment discrepancies (missing info and duplicates) + Partners with claim adjudication vendors ensure proper claims processing and data integrity. + Monitor… more
    AssistRx (09/13/25)
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  • Manager, Test COE

    CVS Health (Hartford, CT)
    …requirements into test scenarios to validate configurations and associated claim adjudication logic. + Trouble-shooting (HealthRules Payer) HRP repair edits and ... and test results. + 3+ years of HRP experience. + Claims adjudication background. **Preferred Qualifications** + Knowledge of Medicare Advantage products, claim… more
    CVS Health (09/12/25)
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  • Claims Examiner

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …+ Research and document pertinent information on claims requiring adjudication . Apply medical policy, contractual provisions, and operational procedures to ... ensure accurate adjudication and/or adjustment. + Reprice Workers' Comp and No-Fault...procedures. + 1+ year computer medical billing or claims adjudication systems experience. + Excellent written and oral communication,… more
    Brighton Health Plan Solutions, LLC (09/11/25)
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  • Senior Claims Research & Resolution Professional

    Humana (Lansing, MI)
    …provider questions. + Work with internal resources and systems (eg, claims adjudication system) to provide the Perfect Experience in all provider interactions with ... Qualifications** + 5+ years of technical experience with claims systems, adjudication , submission processes, coding, claims dispute resolution, and/or other related… more
    Humana (09/11/25)
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  • Pharmacy Claims Representative 2

    Dragonfly Health (Mesa, AZ)
    …supervisor or manager._ 1. Assist pharmacies with real-time and retrospective claims adjudication . Adjust and correct authorizations in dispensing and PBM systems to ... (6) months of pharmacy technician experience. * Experience with pharmacy claims adjudication is required. Specialized Knowledge, Skills & Abilities: * PBM or billing… more
    Dragonfly Health (09/10/25)
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  • Administrative Law Judge

    Drug Enforcement Administration (Arlington, VA)
    …substance registrations. Promoting and maintaining efficient operation of his/her assigned Adjudication Unit (AU) to include regular updates of relevant databases ... addressed. Experience in adversarial litigation (especially multi-day proceedings) and timely adjudication of a high volume of cases. Excellence in legal writing… more
    Drug Enforcement Administration (09/02/25)
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  • Mgr,Network Mgt (IC)

    CVS Health (Austin, TX)
    …for new and renewing PBM clients, supporting all delivery systems and adjudication platforms. Key Responsibilities: + Develop, analyze, and submit pricing outputs ... organizational and decision-making skills. + Provide technical expertise in claims adjudication , business rules, network structures, and testing support. + Perform… more
    CVS Health (08/27/25)
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  • Assistant Attorney General - Water Resources/Water…

    State of Colorado (Denver, CO)
    …for Colorado water law and a desire to work on the appropriation, adjudication , administration, and protection of surface and groundwater water rights on behalf of ... Section of the Colorado Water Conservation Board (CWCB) in the acquisition, adjudication , and protection of instream flow water rights. The Unit also advises… more
    State of Colorado (08/27/25)
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