15 Claim Adjudication Jobs

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. • • • Responsibilities Understand the process difference between PA and an RI claim and verify the necessary details accordingly. • Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • • Approve or deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

Job description We Are Hiring for International Semi voice Process Profile -: Claim Processing associate ( Semi voice) Languages req: Excellent English communication Requirement -: Good Communication Skills Exp-: 6m- 5 yrs in claims Shifts:Rotational Location : Bangalore Immediate joiners only *** Only 2 rounds of interview Job description Document claim file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate. exposure and complexity for Property and Content damage and Liability/Injury claims. Exercise judgement to determine policy verification and coverage determination by analysing applicable coverage for claims and determining whether the loss falls within the coverage. Exercise judgement to determine liability by gathering and analysing relevant facts, images; utilizing applicable coverages. Identify anomalies and patterns to identify fraudulent claims and refer to SIU team based on SOPs Work to have a timely resolution to claims with complete ownership from initiation/intake to settlement. Assess damages by calculating applicable damage or range of damages. Negotiate settlement of a claim by establishing the appropriate negotiation strategy and utilizing available resources within authority limits. Meet quality standards by following best practices Responsible for data integrity and the appropriate documentation of the claim file as well as for compliance with regulatory requirements. Accountability in customer satisfaction and execute on the strategy to provide the best claims service for host damage protection. Ensure customer service by proactively communicating information, responding to inquiries, following customer protocols and special handling instructions. Ensure legal compliance by following federal laws and regulations, and internal control requirements. Key skills required: Bachelor's degree or college Diploma. • Experience in P&C, Healthcare Claims dealing with damage, liability or injury claims. • Good knowledge of Insurance claims end-to-end value chain activities, challenges and best practices. • Good knowledge of how to evaluate injuries and damage using market tools and technology. •General knowledge of the coverages available under the damage protection, liability policy and some common exclusions. • Results driven, ability to multi-task, pay attention to detail and follow procedures. Proven leadership and time management skills in a team environment. Job Type: Full-time Qualification :Any graduates (Note: All the rounds are Held through telephonic) Email : careers@glympsehr.com NOTE: - Please call or whatsapp Manya @ 9606553811 / 9606557106 !!!Thanks & Regards HR TEAM!!!

We are currently hiring Medical Officers to handle the processing of cashless requests and health insurance claims for TPAs/Insurance companies and Manage volumes effectively & efficiently to maintain Turnaround time of processing cases.

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak excellent English. CTC – Upto 3.5 LPA.

Job description We Are Hiring for International Semi voice Process Profile -: Claim Processing associate ( Semi voice) Languages req: Excellent English communication Requirement -: Good Communication Skills Exp-: 6m- 5 yrs in claims Shifts:Rotational Location : Bangalore Immediate joiners only *** Only 2 rounds of interview Job description Document claim file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate. exposure and complexity for Property and Content damage and Liability/Injury claims. Exercise judgement to determine policy verification and coverage determination by analysing applicable coverage for claims and determining whether the loss falls within the coverage. Exercise judgement to determine liability by gathering and analysing relevant facts, images; utilizing applicable coverages. Identify anomalies and patterns to identify fraudulent claims and refer to SIU team based on SOPs Work to have a timely resolution to claims with complete ownership from initiation/intake to settlement. Assess damages by calculating applicable damage or range of damages. Negotiate settlement of a claim by establishing the appropriate negotiation strategy and utilizing available resources within authority limits. Meet quality standards by following best practices Responsible for data integrity and the appropriate documentation of the claim file as well as for compliance with regulatory requirements. Accountability in customer satisfaction and execute on the strategy to provide the best claims service for host damage protection. Ensure customer service by proactively communicating information, responding to inquiries, following customer protocols and special handling instructions. Ensure legal compliance by following federal laws and regulations, and internal control requirements. Key skills required: Bachelor's degree or college Diploma. • Experience in P&C, Healthcare Claims dealing with damage, liability or injury claims. • Good knowledge of Insurance claims end-to-end value chain activities, challenges and best practices. • Good knowledge of how to evaluate injuries and damage using market tools and technology. •General knowledge of the coverages available under the damage protection, liability policy and some common exclusions. • Results driven, ability to multi-task, pay attention to detail and follow procedures. Proven leadership and time management skills in a team environment. Job Type: Full-time Qualification :Any graduates (Note: All the rounds are Held through telephonic) Email : careers@glympsehr.com NOTE: - Please call or whatsapp Manya @ 9606553811 / 9606557106 !!!Thanks & Regards HR TEAM!!!

Female Candidates can apply. Must have Min 1+yrs exp as a Team Leader from International Voice Chat Process BPO. Must know KPI's CSAT/NPS/AHT and Have Team Leading Skills. US Shifts Fluent English Call 8447780697 send CV monu@creativeindians.com

Job description We Are Hiring for International Semi voice Process Profile -: Claim Processing associate ( Semi voice) Languages req: Excellent English communication Requirement -: Good Communication Skills Exp-: 6m- 5 yrs in claims Shifts:Rotational Location : Bangalore Immediate joiners only *** Only 2 rounds of interview Job description Document claim file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate. exposure and complexity for Property and Content damage and Liability/Injury claims. Exercise judgement to determine policy verification and coverage determination by analysing applicable coverage for claims and determining whether the loss falls within the coverage. Exercise judgement to determine liability by gathering and analysing relevant facts, images; utilizing applicable coverages. Identify anomalies and patterns to identify fraudulent claims and refer to SIU team based on SOPs Work to have a timely resolution to claims with complete ownership from initiation/intake to settlement. Assess damages by calculating applicable damage or range of damages. Negotiate settlement of a claim by establishing the appropriate negotiation strategy and utilizing available resources within authority limits. Meet quality standards by following best practices Responsible for data integrity and the appropriate documentation of the claim file as well as for compliance with regulatory requirements. Accountability in customer satisfaction and execute on the strategy to provide the best claims service for host damage protection. Ensure customer service by proactively communicating information, responding to inquiries, following customer protocols and special handling instructions. Ensure legal compliance by following federal laws and regulations, and internal control requirements. Key skills required: Bachelor's degree or college Diploma. • Experience in P&C, Healthcare Claims dealing with damage, liability or injury claims. • Good knowledge of Insurance claims end-to-end value chain activities, challenges and best practices. • Good knowledge of how to evaluate injuries and damage using market tools and technology. •General knowledge of the coverages available under the damage protection, liability policy and some common exclusions. • Results driven, ability to multi-task, pay attention to detail and follow procedures. Proven leadership and time management skills in a team environment. Job Type: Full-time Qualification :Any graduates (Note: All the rounds are Held through telephonic) Email : careers@glympsehr.com NOTE: - Please call or whatsapp Manya @ 9606557106 / 9606553811 !!!Thanks & Regards HR TEAM!!!

Greetings from Firstsource !!! HR Spoc - Madhubala Looking for US Healthcare Professionals !! Experience : 1- 4 Years Process : Non Voice - Skill : Claims Adjudication & Claims Adjuster!! US Healthcare experience. Work location : Navalur Chennai Required : Experience in International Healthcare BPO Education - Any Graduates and Diploma(10+3)can apply. Willing to work in Night Shift/rotational shifts. If interested , Share your resumes to Madhubala.suresh@firstsource.com Interested folks can directly Walk-in to Location: 5th floor, 4th block, Sandhiya Infocity(Bayline Infocity), OMR Rajiv Gandhi Salai, Navalur, near to AGS Bus Stop, Chennai, Tamil Nadu 603103. Walk - in time: 11:00 Am - 2:00 Pm Walk - in date: Monday to Friday Note: Bring your educational documents, Pan card, Aadhar card (both original and xerox) Contact person: Madhubala Contact Number - 7299080894(whatsapp only) Mention Hr name(Madhu) on top of your resume Refer your friends who are interested with similar experience. Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or madhubala.suresh@firstsource.com

Greetings from NTT DATA, Roles &Responsibilities of this position are: Supervises team ensuring highest quality of service is provided to clients. Monitors performance of team and reports results and issues to higher-level leadership. Assists team with escalated client or account issues. Manages the hiring, staffing, and maintaining of a diverse and effective workforce. Responsible for career development / planning, performance and pay discussions of team members. Interacts with clients and internal departments to resolve issues. Leads staff to complete assignments using established guidelines, policies, and procedures. Demonstrates professional courtesy and represents the company in a positive manner in all areas of internal and external communications. Responsible for appropriate record keeping, required reports, and ensuring related administrative functions are correct and maintained. Compiles and analyzes data to identify trends for root cause analysis. Metrics Management - Data driven approach towards Metric Management and ensure the assigned team members meet their desired level of performance on all metrics. Skills Required Role: Team Lead - Claims Adjudication Skill: Claims Adjudication (US Healthcare Process) Work Location: Chennai Solid communication skills. Solid analytical / problem solving skills. Ability to make quick decisions and agility to implement action items in expedited time frame. Strong MS Office skill set to perform reporting duties. Interested candidate please share me your resume to Ganga.Venkatasamy@nttdata.com

Job Description: Medical Record Retrieval and Release of Information Specialist Position Overview: We are seeking dedicated and detail-oriented Medical Record Retrieval and Release of Information (ROI) Specialists to join our healthcare team. The position is responsible for efficiently and accurately retrieving, processing, and releasing medical records in accordance with healthcare regulations and policies. This is a hybrid role with both calling and non-calling responsibilities. There are two types of positions available: Non-Voice Process (200 positions) Key Responsibilities: For Non-Voice Process (200): Retrieve medical records from healthcare facilities, ensuring accuracy and completeness of records. Ensure compliance with HIPAA and other regulatory standards regarding the privacy and security of medical records. Process release of information requests for authorized parties such as patients, legal entities, insurance companies, and other healthcare providers. Organize and maintain medical records in both paper and electronic formats, ensuring they are accessible and easily retrievable. Coordinate with other departments (e.g., billing, insurance) to provide requested information while safeguarding patient confidentiality. Review and verify records for completeness and accuracy before releasing them. Perform audits of medical records to ensure accuracy and compliance with regulatory standards. Skills & Qualifications: Experience in healthcare administration or medical records management (preferred). Knowledge of HIPAA regulations and patient confidentiality. Strong communication skills (for calling positions). Excellent attention to detail and organizational skills. Ability to work efficiently and accurately in a fast-paced environment. Experience with medical records systems and software (e.g., Epic, Cerner, etc.) preferred. Ability to handle sensitive information with professionalism and discretion. Salary & Benefits: Competitive salary based on experience. Health and Accidental insurance. Interested candidates can call/WhatsApp on 9311316017 (HR Manish Singh) or email on Manish.singh2@pacificbpo.com .

Any Graduate 06 months exp in insurance domain or Property and casualty Book Roll Endorsement Underwriting Call/Whatsapp RASHMI 8130669625 Required Candidate profile 1 Year bpo experience Candidate must be okay with walkin interview Excellent communication skills required.

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak Hindi & Malayalam. CTC – Upto 3.5 LPA.

Role: TM / STM claims adjustor *************************************************** IMMEDIATE JOINERS REQUIRED Send your updated CV directly to: 9152808909 **************************************************** Role Mandates :- Min 7-8 years of experience 2 yrs in people management role. Responsible for end-to-end claims adjustor Candidate should be flexible with shifts Location is Pune

Walk-in |TCS Bengaluru Hiring for Claim Adjudication Specialist Interview Date : May 10th, 2025 Interview Time : 10 AM onwards (Entry is closed at 12:30 PM) Venue : Tata Consultancy Services Ltd, Think Campus, Phase 2, Electronic City, Bengaluru 560100 Role : Claim Adjudication Specialist Desired Experience Range : 5-8 yrs Shift : Should be comfortable with night shift & in a 24X7 shift environment Mode of Working : Work from Office Position Overview : We are seeking a skilled Senior Executive - India HRO Benefits and Claims Processing with 5-8 years of hands-on experience in managing claims adjudication and processing with a strong focus on India and International claims processing. The ideal candidate will be well-versed in various types of Claim processing (example gym reimbursement claims, vaccination claims, wellbeing benefits claims , school reimbursement claims , Salary advance claims etc for global regions (India , Europe , SE Asia, Middle East etc) This role demands a meticulous professional with a strong command of English and the ability to work effectively with global stakeholders. Key Responsibilities: 1. Claims Processing & Adjudication: Efficiently process and adjudicate India-specific and global benefits claims, ensuring accuracy and compliance with policies. Validate claims documentation, including gym reimbursement claims, vaccination claims, wellbeing benefits claims, school reimbursement claims, Salary advance claims etc. for global regions. Identify discrepancies in claims and ensure timely resolutions in line with company guidelines. Knowledge and working experience of Darwin and workday and service now is mandatory. Experience in similar claim processing is a must. Knowledge of ticket management tools like SNOW is a Plus. 2. Stakeholder Engagement: Collaborate with global stakeholders to align claims processing practices with global standards. Communicate effectively with internal teams, external vendors, and claimants to ensure smooth claim management. 3. SLA & KPI Management: Demonstrate a strong understanding of Service Level Agreements (SLAs) and Key Performance Indicators (KPIs). Consistently meet or exceed SLA requirements for claims processing while maintaining high-quality standards . 4. Policy Adherence & Process Improvement: Ensure adherence to company policies, local regulations, and international best practices in claims management. Proactively identify and recommend process improvements to enhance efficiency and accuracy. Qualification & Skillset: Graduate and specialization in Human resources. 58 years of experience in India / Global HRO benefits and claims processing , with substantial exposure to India-specific claims adjudication . Strong understanding of various types of claims, advances, reimbursements and benefits eligible for claims. Expertise in verifying and validating claim-related documents. Exceptional command of English , with the ability to communicate fluently and professionally. Proven experience collaborating with global stakeholders across regions. Deep understanding of SLAs and KPIs and a track record of achieving or exceeding them. Key Skills: Benefits & Reimbursement Claims Adjudication and Processing Knowledge of Darwin and Workday tool - Mandatory Documentation Validation Global Stakeholder Management Process Improvement and Compliance SLA & KPI Adherence Excellent Communication and Analytical Skills Working Conditions: Flexible working 24*7 shift timings. Work from Office (No work from home) Agile to extended work hours when needed to meet deadlines without prompting. Eligibility : Minimum 15 years of regular, full-time education (10 + 2 + 3) Mandatory Documents to carry : Hard Copy of Resume, One Copy Passport Size Photo, Original and photocopy of Govt. ID proof. Mandatory Requirements (How to generate your EPCN) EPCN number is mandatory for eligibility of the interview. Follow the steps below to register and mention the EPCN number on your resume Step 1: Visit https://ibegin.tcs.com/iBegin/ Step 2: Click to login Step 3: Click New user (Register with us) Step 4: Select "BPO" in areas of interest and complete the registration. (Fill the details) Step 5: Once completed, your TCS no. will be generated which starts from EP2025XXXX. Step 6: You will receive the EP number on your personal e-mail ID.

Greetings from NTT DATA, Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 3-8 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Interested Candidate Please share me your Resume to Ganga.Venkatasamy@nttdata.com