45 Payer Jobs

Job Title: Director of IT - Provider Team Department: Information Technology Summary: The Director of IT - Provider Team is a key leadership role responsible for the successful delivery of application development projects and programs within the Payor - Provider domain. This role requires a strong technical background, proven leadership skills, and extensive delivery experience in the US Healthcare Payer industry, particularly within the Provider domain. The Director will lead a team of Developers, Product Owners, and Business Analysts, ensuring alignment with organizational goals and effective resource utilization. Operating in a matrixed environment, the Director will be a skilled relation...

Role & responsibilities The Vice President of Delivery Excellence (QA & Testing) will oversee all testing and quality assurance initiatives to ensure delivery of high-quality healthcare technology solutions. The role focuses on strategic leadership, process optimization, and driving continuous improvement through innovation and transformation in QA and testing functions. Key Responsibilities Develop and execute a company-wide testing and QA strategy aligned with business goals. Lead large QA/testing teams across multiple projects and geographies. Implement advanced tools, methods, and automation to improve efficiency and effectiveness. Promote a culture of quality, excellence, and continuous...

Role & responsibilities The Vice President of Delivery Excellence (QA & Testing) will oversee all testing and quality assurance initiatives to ensure delivery of high-quality healthcare technology solutions. The role focuses on strategic leadership, process optimization, and driving continuous improvement through innovation and transformation in QA and testing functions. Key Responsibilities Develop and execute a company-wide testing and QA strategy aligned with business goals. Lead large QA/testing teams across multiple projects and geographies. Implement advanced tools, methods, and automation to improve efficiency and effectiveness. Promote a culture of quality, excellence, and continuous...

Responsibilities : Own the product vision and roadmap for premium billing and reconciliation capabilities, aligning with business goals and regulatory requirements. Build a product that encompasses - Group Billing, Individual Billing, Medicare Billing & reconciliation, Medicaid Billing & Reconciliation, Marketplace Exchange Billing Collaborate with stakeholders across finance, operations, compliance to gather and prioritize requirements. Define and maintain a product backlog with clear, actionable user stories and acceptance criteria. Lead Agile ceremonies including sprint planning, backlog grooming, and reviews with cross-functional teams. Ensure seamless integration with EDI 820 processing...

Responsibilities : A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your teams towards developing optimized high quality code deliverables, continual knowledge management and adherence...

Position: Director of Engineering - Payer Clinical (IT Delivery) Experience: 18+ years Location: Hyderabad / Chennai Note : NO Ops/BPO Role Summary We are seeking a seasoned IT Delivery Leader with proven expertise in the US Healthcare Payer domain , specifically within clinical IT delivery . The successful candidate will drive delivery excellence across programs such as Utilization Management, Care Management, and Appeals & Grievances , ensuring strategic alignment with business goals and client expectations. This role demands strong leadership, delivery governance, and a deep understanding of healthcare payer clinical systems. Key Responsibilities Lead and manage end-to-end IT delivery for...

Position: Director Payer - Clinical (IT Delivery) Experience: 18+ years Location: Hyderabad / Chennai Note : NO Ops/BPO Role Summary We are seeking a seasoned IT Delivery Leader with proven expertise in the US Healthcare Payer domain , specifically within clinical IT delivery . The successful candidate will drive delivery excellence across programs such as Utilization Management, Care Management, and Appeals & Grievances , ensuring strategic alignment with business goals and client expectations. This role demands strong leadership, delivery governance, and a deep understanding of healthcare payer clinical systems. Key Responsibilities Lead and manage end-to-end IT delivery for clinical progr...

Mega Walk-in Drive US Healthcare (Claims Adjudication) Date: 19th & 20th September 2025 Time: 11:30 AM 4:00 PM Venue: Sagility, KCT Tech Park, Thudiyalur Rd, Saravanampatti, Coimbatore, Tamil Nadu 641049 We Are Hiring Experienced Professionals! Join our growing team in US Healthcare Claims Adjudication Minimum Requirement 3.6+ years of experience in US Healthcare (Claims Processing & Adjudication) Additional Opportunities in Sagility : We have openings for WFM & Training functions Also for Internal Contact Center Operations (Inbound calls) Open Positions Team Leader Operations Quality Specialist Subject Matter Expert (SME) Process Trainer Quality Team Leader Assistant Manager Operations Depu...

Mega Walk-in Drive US Healthcare (Claims Adjudication) Date: 19th & 20th September 2025 Time: 11:30 AM 4:00 PM Venue: Sagility, KCT Tech Park, Thudiyalur Rd, Saravanampatti, Coimbatore, Tamil Nadu 641049 We Are Hiring Experienced Professionals! Join our growing team in US Healthcare Claims Adjudication Minimum Requirement 3.6+ years of experience in US Healthcare (Claims Processing & Adjudication) Additional Opportunities in Sagility : We have openings for WFM & Training functions Also for Internal Contact Center Operations (Inbound calls) Open Positions Team Leader Operations Quality Specialist Subject Matter Expert (SME) Process Trainer Quality Team Leader Assistant Manager Operations Depu...

Urgent hiring for Team leader operations for claims adjudication from US Healthcare. Looking for immediate joiners or less than 30 days' notice period. Interested folks can reach out to below mentions contact persons. Job Title: Team Leader Claims Adjudication Location: Indore, Coimbatore, Bangalore Department: Claims Operations Reports To: Manager Claims Adjudication Role Overview: The Team Leader Claims Adjudication is responsible for supervising a team of claims processors/adjudicators to ensure accurate and timely adjudication of healthcare/insurance claims in line with policies, compliance requirements, and service-level agreements (SLAs). The role involves performance management, proce...

Role: Healthcare Business Analyst Work Mode: Hybrid Exp: 5 to 10 years Shift: 5 PM to 2 AM IST (Starlight work shift) Role & responsibilities Responsible for detailed assessment which includes data mapping/file loads and analysis of source data needed for the solution. Responsible for creation of Business Requirement Document which may include data mapping and Business Process flow diagrams. Coordinate with Business stakeholders for requirements gathering, clarifications and query resolution. Ability to work on Discovery phase of a project and create Assessment and Recommendation document Work closely with client business stakeholders to understand and finalize functional and non-functional ...

Role: Healthcare Business Analyst Work Mode: Hybrid Exp: 5 to 10 years Role & responsibilities Responsible for detailed assessment which includes data mapping/file loads and analysis of source data needed for the solution. Responsible for creation of Business Requirement Document which may include data mapping and Business Process flow diagrams. Coordinate with Business stakeholders for requirements gathering, clarifications and query resolution. Ability to work on Discovery phase of a project and create Assessment and Recommendation document Work closely with client business stakeholders to understand and finalize functional and non-functional requirements for solution implementation. Prefe...

Candidate should be currently working as a Manager / Assistant Manager on papers in US Healthcare for Provider Data Management. Work Location - Hyderabad Shift - US rotational shifts Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Kenedy at 9620999035 for more details.

Candidate should be currently working as a Manager / Assistant Manager on papers in US Healthcare for Claims adjudication process. Work Location - Chennai / Hyderabad Shift - US rotational shifts Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Kenedy at 9620999035 for more details.

Certifications: CPC - Certified Professional CCS - Certified Coding Specialist CIC - Certified Inpatient Coder Advanced knowledge of medical coding software platforms (e.g., 3M Code Finder, Optum360, True Code, Epic, Cerner, etc.). Minimum 5 years of experience in Inpatient DRG coding. Outpatient medical coding experience is added advantage. Mandatory working experience on US healthcare automation projects. Knowledge on automation tools Knowledge of programming language would be added advantage alike. Python SQL R, etc. Payer experience is added advantage. Expertise in Microsoft outlook/excel/word/Power BI. Primary Roles and Responsibilities: Automation of DRG Coding to streamline repetitive...

Candidate should have experience working as a Team Leader OR Quality analyst for US healthcare process. Shift - US rotational shifts Work Location - Hyderabad Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Candidate should have experience working as a Process Trainer in Claims adjudication process for US Healthcare Shift - US rotational shifts Work Location - Hyderabad Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Candidate should have team handling experience in US Healthcare for Enrollment process. Work Location - Bangalore Shift - US Shifts Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Hi, Greetings! This is regarding a job opportunity for the position of Data Modeller with a US based MNC in Healthcare Domain. This opportunity is under the direct pay roll of US based MNC. Job Location: Pune, Mundhwa Mode of work: Hybrid (3 days work from office) Shift timings: 1pm to 10pm About the Company: The Global MNC is a mission-driven startup transforming the healthcare payer industry. Our secure, cloud-enabled platform empowers health insurers to unlock siloed data, improve patient outcomes, and reduce healthcare costs. Since our founding in 2017, we've raised over $81 million from top-tier VCs and built a thriving SaaS business. Join us in shaping the future of healthcare data. Wi...

Title/Designation : Product Consultant/ Payer Integration Lead/Architect Role : Payer Core Solutioning Location : Navi Mumbai/ Pune/ Bangalore/ Chennai/ Gurgaon/ Hyderabad Work Mode: Hybrid Exp: 12 to 15 years Role & responsibilities: Candidate will be part of our Payer consulting team, responsible for working with clients on implementing key solutions, work closely with client account leads in identifying new transformational opportunities with accounts and develop proactive proposals thereby contributing to overall account growth and client success Actively participate in client presentations, proposal walkthroughs, demos to convey CitiusTech solution & value proposition Work with customer...

Title/Designation : Product Consultant/Architect Role : Customer Success - Payer Core Solutioning Location : Navi Mumbai/ Pune/ Bangalore/ Chennai/ Gurgaon/ Hyderabad Work Mode: Hybrid Exp: 12 to 15 years Role & responsibilities: Candidate will be part of our Payer consulting team, responsible for working with clients on implementing key solutions, work closely with client account leads in identifying new transformational opportunities with accounts and develop proactive proposals thereby contributing to overall account growth and client success Actively participate in client presentations, proposal walkthroughs, demos to convey CitiusTech solution & value proposition Work with customer deli...

Title/Designation : Sr. Payer Integration Lead / Architect Role : Customer Success - Payer Core Solutioning Location : Navi Mumbai/ Pune/ Bangalore/ Chennai/ Gurgaon/ Hyderabad Work Mode: Hybrid Exp: 12 to 15 years Role & responsibilities: Candidate will be part of our Payer consulting team, responsible for working with clients on implementing key solutions, work closely with client account leads in identifying new transformational opportunities with accounts and develop proactive proposals thereby contributing to overall account growth and client success Actively participate in client presentations, proposal walkthroughs, demos to convey CitiusTech solution & value proposition Work with cus...

Gainwell Technologies LLC Summary As a Sr Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas. Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support...

Gainwell Technologies LLC Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services. We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiaries natio...

Gainwell Technologies LLC Summary Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services. We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiari...