17 Claim Jobs

Good understanding of commercial in contracts. Understanding of Bank Guarantees, Insurance, Letter of credit etc. Experience in project costing Understanding of Claim management Preparation of Supply Bill Annexure with the help of Challan & MIR. Required Candidate profile Experience in project costing, contract, claim, billing

Wipro Limited is a leading technology services and consulting company that is dedicated to creating innovative solutions to meet the complex digital transformation needs of clients. With a comprehensive portfolio of capabilities in consulting, design, engineering, and operations, Wipro helps clients achieve their ambitious goals and create sustainable businesses for the future. With a global presence of over 230,000 employees and business partners in 65 countries, Wipro is committed to supporting customers, colleagues, and communities in a constantly changing world. For more information, you can visit us at www.wipro.com. You will be responsible for working with Java, Spring Boot, Microservices, and Angular8 and above. The essential skills required for this role include hands-on experience with Core Java/J2EE (Spring, Hibernate, MVC), working knowledge of Spring Boot, RabbitMQ & JBoss, expertise in Microservices, familiarity with CI/CD and DevOps initiatives, proficiency in the Spring Framework & Spring MVC, experience with a JS framework (Angular, React) or MEAN stack, working with IDEs like IntelliJ, Eclipse, or RAD, Rest-based web services, SQL queries, and MySQL. Additionally, testing experience in JUnit/Spock/Groovy, Agile methodologies (Scrum, Kanban), and familiarity with design patterns such as IOC, MVC, Singleton, and Factory are essential. It would be beneficial to have experience with Subversion, GIT & Maven, working in an Agile environment, using Code Quality Tools like Sonar, Checkstyle, Findbug, and DevOps-related toolsets. Excellent written and verbal communication skills are required, and experience in the healthcare domain (Provider/Claim/Member) is a plus. The role also requires expertise in Fullstack Java Enterprise and a minimum of 5-8 years of experience. Wipro is focused on reinventing itself and is seeking individuals who are inspired by reinvention and continuous growth. If you are looking to be part of a dynamic and purpose-driven organization that encourages personal and professional development, Wipro could be the place for you. Come join us and realize your ambitions in a business that values diversity and inclusion. Applications from individuals with disabilities are encouraged and welcome at Wipro.,

Job Requirements and Preferences: Basic Qualifications: Minimum Degree Required: Bachelor Degree Preferred Knowledge/Skills: Demonstrates abilities solutioning the Guidewire Suite of applications on premises and SaaS, with proven success executing all aspects of complex engagements within the Guidewire product suite achieving on-time and on-budget delivery, as well as the following: Demonstrates abilities and extensive experience working on Application Managed Services projects and solutioning the Integration of Guidewire Suite of applications on premises and SaaS, with proven success executing all aspects of complex engagements within the Guidewire product suite achieving on-time and on-budget delivery, as well as the following: Demonstrates abilities providing solution strategy and Application Evolution Services (AES, formerly AMS) delivery as a Senior Guidewire Developer Developer. Employees in the Senior Developer position should think of themselves and be regarded by the client as a trusted advisor and think strategically about how to create value using the Guidewire Suite of products; Demonstrates abilities delivering Guidewire application solutions as it will be critical that consultant in this position are capable of navigating both business processes as well as enterprise solution perspectives at high level and holistic view; Demonstrates abilities developing a scalable and robust Guidewire Solution Strategies in a hybrid IT landscape (on premises and Cloud); Demonstrates abilities and/or a proven record of success in developing independently new market-differentiated Guidewire solutions and supporting proposal development efforts; Senior Developer in these positions should be capable of delivering Advisory-level work and be able to discuss future enhancements in Guidewire roadmap discussions with the client; With a focus on AES, demonstrates expert abilities assisting clients in the support of Guidewire Suite solutions and improving business processes; and taking a proactive approach to quality; Demonstrates abilities developing solutions based on common issues facing clients in all lines of the P&C Industries (e.g., Auto, Home, Commercial, Workmans Comp, etc.). Demonstrates abilities identifying and addressing client needs by: Developing and sustaining impactful client relationships using networking, negotiation and persuasion skills to identify and sell potential new service opportunities; Preparing and presenting complex written and verbal materials; and, Defining resource requirements, project workflow, budgets, billing and collection; Demonstrates abilities working with global teams to achieve org vision, establishing direction and motivating members, creating a community of high performing professional consultants, creating an atmosphere of trust, leveraging diverse views, coaching staff, and encouraging improvement and innovation; As a Senior Developer will need to responsible for delivery and review of deliverables and ensuring delivery is following all defined processes; Demonstrates intimate abilities and/or a proven record of success developing strategy as well as writing, communicating, facilitating, and presenting cogently; to and/or for all levels of industry audiences, clients and internal staff and management, such as presentation slides, practice marketing materials, change management plans and/or project plans, workshops and whitepapers, practice, methodologies and tools, policies and procedures, and/or other standard business communications; Be comfortable, thrive, and available during sustained period of time of instability with client's Guidewire solution and escalations; and, Key contributor internally and externally with white papers, blogs, and training Technologies Deep experience in Guidewire PolicyCenter and working knowledge on Guidewire BillingCenter, ClaimCenter and ContactManager; Guidewire Integrations within xcenter and external applications and good experience on Apache camel, Edge API GOSU, Guidewire Event and Rules Framework and object oriented programming; JAVA scriptwriting, emphasizing hosting and consuming web services that leverage Java; Web service hosting and consuming, using Guidewire studio toolkits; XML Coding; ANT, MAVEN and code repository such as Clear Case, SVN, TFS Interested candidate can share the cv to indumathi.j@pwc.com

Customer Service rep represents the Service Centre which is responsible for delivering timely and accurate customer service through any/any/all the mediums i.e. on phone, web chat. The Customer Service Specialist post Go-Live/Certification is required to be an efficient communicator who is well versed with CS tools, domains, client plans and provisions. He/ may be aligned to one or multiple clients across various domains. She/he is required to effectively communicate complex client plans and provisions aimed at driving first call resolution. She/he is expected to provide effective solutions within the scope of defined client plans and provisions helping the participants make an informed decision. He/she will be required to adhere to Client Level & internal Service Level Agreements and creates a positive participant experience through their knowledge, personal service, confidence building and timely resolution. This role may be leveraged across multiple teams. PRINCIPAL DUTIES AND RESPONSIBILITIES: 100% of production time to be spent logged in on calls or web chat Answer calls & chats with an approach to deliver positive customer satisfaction Articulate complex client plans and provisions in a simplified and understandable manner helping participants make an informed decision Maintain internal & client defined quality on calls Understands and contributes positively in meeting client SLAs & targets Adheres to Customer Service Attendance & Accountability policies Ensures Customer Service Representative, Team & Client level targets (Customer Satisfaction, Service Level %, Average Handle Time, Session Time, Wait Time, Abandon Rate, Call back timeliness etc.) are met or exceeded consistently

I am hiring for this position for one of our Life Insurance clients. Role & responsibilities Prudent claim Assessment and management of end-to-end claim settlement /repudiations, including Life, Group claims Coordinate with Reinsurers /sales/customers for closure of claims within the regulatory framework and timelines Direct and oversee the maintenance of complete and accurate claim management records. Managing the claim teams on day-to-day claims transactions, guidance on claims philosophy, regulatory, and audit procedures Ensuring daily claim deliverables are met and claims decisions within prescribed SLA with quality Ensure customer centric approach while delivering sensitive area of death claims. Accuracy and Speed in delivery Customer satisfaction Quality in claims assessment/approvals Preferred candidate profile Graduate with required communication skills, A minimum of five to seven years progressively responsible previous insurance industry experience. Life Insurance domain knowledge Decision-making skills. MIS, MS Excel, Workflows , Group Asia and Life Asia system knowledge

Hi All Greetings......... We Are Hiring for the Following Company Company Details Company: ISpacesoftware solutionsIndia Pvt ltd Exp : 0 -3 Years Qualification : Any Degree work Hours: 7PM -4AM ( us shifts ) working days: 5 days ( sat & sunis fixed week off) Location : Madhapur ,Hyderabad Work mode: WFO Role : Customer Support Executive F2FInterview ADRESS : Cybergateway, Hi-Tech City Phase -II, Madhapur, Benefits Travel Allowances : 2k per month Job description : Experienceinteracting withInternational (US) customers / Clients. Experience on Eligibility Verification (EBV) Awareness on US HealthInsurance guidelines, the claims submission process and procedures. Good knowledge / work experience on US Healthcare Process. Good to have Experience on filling out complexinsurance claim forms Analysing Explanation of Benefits (EOB) forms to ensureinsurance companies have paid for charges Following up with the appropriate parties (insurance companies and patients) to ensure bills are paid Understand and analyse the patient records Determining the correct codes for patient records Using codes to billinsurance providers Interacting with physicians and assistants to ensure accuracy Keeping track of patient data over multiple visits Managing detailed, specifically codedinformation Maintaining the patient confidentiality andinformation security Good verbal and written communication skills. Note: DentalInsurance. Note : Intersted Candidates Share Cv to Following Mail ID [HIDDEN TEXT] About Diensten Tech Ltd (DTL) : Diensten Tech Ltd (DTL)is anIT Service Organization, having focus on Professional Services, Corporate Trainingincluding eLearning Digital Content Solutions and Managed Services to provide business benefits to their customers and prospectsin the shortest possible time with high quality delivery solutions at competitive rates. We are a next-generationIT consultancy service provider that helps enterprises reimagine their businesses for the digital age. We provide end-to-end professional solutions to make large companies and organizations more competitive by combiningin-depth knowledge of a wide range of business sectors andinnovative technologies with a fully collaborative approach. We are a lifelong learning partner for enterprises, helping them build skillsin emerging technologies at scale. Please visit www.dienstentech.com for moreinformation Looking forward to your prompt response.

Hello All, Greetings from Hexaware Technology!. Great Job Opportunity for Guidewire Developer Professional. If interested, please share your CV with the below details to JyothiB@Hexaware.com Current CTC: Expected CTC: Notice Period: Location:Bangalore/Chennai/Mumbai/Pune/Noida/Ahmadabad/Coimbtore Job Description: Assist in implementing and customizing Guidewire PC/CC/BC Integ solutions for P&C insurance domain. Skills: GW PC/CC/BC Integ, C#, Java, SQL, scripting, troubleshooting, and team collaboration. Qualifications: Bachelor's degree, 3-10 years experience, certifications preferred.

We're Hiring: Business Development Executive, US Healthcare (Medical Billing & Credentialing) Location: Manekbaug, Ahmedabad 380015 (Relocating soon to Prahladnagar) Shift: US Shift (Night Shift) Work from Office Apply at: hr@collabglobus.com Company: Collab Softech Pvt Ltd. (www.collabsoftech.com.au) Experience Required: 13 Years At Collab Softech , we are expanding our presence in the US Healthcare outsourcing industry and are looking for a dynamic Business Development Executive to help us scale. If you have experience in Medical Billing, Credentialing, or RCM , and are driven by targets and client success, this opportunity is for you. Key Responsibilities: Identify and engage potential clients in the US healthcare sector (clinics, hospitals, billing companies, solo providers). Pitch a comprehensive suite of services, including Medical Billing, Provider and Facility Credentialing, as well as Revenue Cycle Management (RCM). Develop strategies for lead generation and outreach via email, LinkedIn, and other platforms. Maintain strong client relationships and act as a bridge between clients and delivery teams. Track and manage the sales pipeline using CRM tools; report progress and forecast to management. Research market trends, competition, and new business opportunities in the US healthcare space. Prepare business proposals, service decks, pricing models, and contracts. Must Have: Prior experience working with US-based clinics, medical billing firms, or provider credentialing services . Excellent communication & negotiation skills (US client handling experience preferred). Strong understanding of US healthcare processes and terminology (HIPAA, CMS, etc.). Willingness to work on the night shift (US time zone) . Were hiring! If you have the drive for business development and a background in US healthcare, this is your opportunity to shine.

Job Summary - A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Appeals and Grievances Managed Services (AGMS) team will provide you with the opportunity to act as an extension of our healthcare clients' business office. We specialize in appeal and grievances functions and addressing member complaints for health plans and their business partners. We leverage our clients customized workflows and associated automations in conjunction with clients data advanced data analysis and quality assurance processes to enable our clients to achieve better compliant results, which ultimately allows them to provide better services to their members. Required Field of Study (BQ): Any Graduation Minimum Year(s) of Experience : US 2+ years of experience in US Health care Payor side Required Knowledge/Skills (BQ): US Healthcare Experience Experience in Appeals & Grievances (A&G, Medicare/Medicaid) Preferred Knowledge/Skills *: Strong verbal and written communication skills, including letter writing experience. Excellent English skills with the ability to read, comprehend, write and communicate verbally with stakeholders & customers. Ability to work with firm deadlines, multi-task, set priorities and pay attention to details Ability to successfully interact with members, medical professionals, health plan and government representatives. Knowledge on Appeals & Grievances and Medicare/Medicaid Proficiency with Microsoft Word, Excel, and PowerPoint. Excellent organizational, interpersonal and time management skills. Must be detail-oriented and an enthusiastic team player. Knowledge of Pega computer system a plus. Responsibilities: As an Associate, youll work as part of a team of problem solvers with consulting and industry experience, helping our clients solve their complex member, provider and business issues. Specific responsibilities include, but are not limited to: Analyzes, evaluates and resolves member & provider appeals, disputes, grievances, and/or complaints from health plan members, providers and related outside agencies in accordance with the standards and requirements established by the Centers for Medicare and Medicaid and/or health plan. Prepares and organizes case research, notes, and documents. Contacts the member/provider through written and verbal communication. Requests, obtains and reviews medical records, notes, and/or detailed bills as appropriate. Applies contract language, benefits, and review of covered services. Conducts research, fact checking and analysis and recommends appropriate course of action and next steps for management review. Research claim / service authorization appeals and grievances using support systems to determine appeal and grievance outcomes inclusive of claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. Determines appropriate language for letters and composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. Communicates resolution to members (or authorized) representatives. Works with provider & member services to resolve balance bill issues and other member/provider complaints. Assures timeliness and appropriateness of responses per state, federal and health plan guidelines. Responsible for meeting production standards set by the department. Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. Desired Knowledge / Skills: 2+ years of experience in US Health care Payor side 1 + years of processing experience in Appeals & Grievance Denial Management Knowledge on US Health Care, Claims Adjudication, Rework & A&G Experience Level: 2+ years Shift timings: Flexible to work in night shifts (US Time zone)

Designing & developing Oracle objects such as Tables, Views, Indexes, Stored Procedures & Functions in PL/SQL, Packages in PL/SQL, Materialized Views, Dynamic SQL.Design & develop Oracle objects for high-performing database batch processes, Required Candidate profile Exp. in analyzing, designing building of complex database transaction, reporting solutions Performance tuning, monitoring slow performing SQL.Database design for transactional &reporting applications

International Chat/Voice Process is hiring for the Customer Service Executive. Post: Customer Service Executive / Customer Support Executive (Chat/Voice Process) Process:- Voice Process / Chat Process (Chat/Voice Process) Note:- Work From Office. Salary :- 3 Lack CTC to 6 Lack CTC Min 1 Year international BPO Experience Language Mandatory:- Hindi & English Communication. Roles and Responsibilities This is a premium Chat/Voice process for enterprise business of our telecom partner (Customer Service) Grad with Relevant experience ( Chat/Voice Customer service Exp ) mandate . Flexible to work in any shift Rotational . Working days 5 days working Candidate should be Ok with Rotational Offs . Ok with travelling on their own and should be ok even if Sunday is not a fixed Off / Week off. Contacting existing customers as well as prospective customers Obtaining customer information and other relevant data. Asking questions to the customer and understanding their need Resolving customer queries and issues related to the products and service . Note:- 5 days Working and 2 Week Rotational Off 24/7 Rotational Shifts (Male & Female both)

International Chat/Voice Process is hiring for the Customer Service Executive. Post: Customer Service Executive / Customer Support Executive (Chat/Voice Process) Process:- Voice Process / Chat Process (Chat/Voice Process) Note:- Work From Office. Salary :- 3 Lack CTC to 6 Lack CTC Language Mandatory:- Hindi & English Communication. Roles and Responsibilities This is a premium Chat/Voice process for enterprise business of our telecom partner (Customer Service) Grad with Relevant experience ( Chat/Voice Customer service Exp ) mandate . Flexible to work in any shift Rotational . Working days 5 days working Candidate should be Ok with Rotational Offs . Ok with travelling on their own and should be ok even if Sunday is not a fixed Off / Week off. Contacting existing customers as well as prospective customers Obtaining customer information and other relevant data. Asking questions to the customer and understanding their need Resolving customer queries and issues related to the products and service . Note:- 5 days Working and 2 Week Rotational Off 24/7 Rotational Shifts (Male & Female both)

Connects- We are hiring for Guidewire Integration Developers with 4+ years of experience to join our team immediately! Positions available in Chennai, Bangalore, Hyderabad. It's a fantastic opportunity to work with a great team. Showcase your skills and experience now! Apply Now! Requirements: Well versed in Guidewire Integration design and development. Preferred knowledge on EDGE and JUTRO framework. Must have worked on integrations with GW Xcenters, GW Portals and external applications. Strong knowledge in Guidewire platform such as Gosu scripting / UI / Data Model. Exposure to Guidewire Cloud Platform. Good knowledge in Webservices such as SOAP and Restful API, XML, Json schema, Messaging, GXModel, batch processes, work queues and Integration gateway. Expertise in designing the integrations of GW centers with external services Guide Wire Cloud Certification is must. Good to have Property and Casualty Insurance knowledge. If interested in the above requirement, please reply with the below requested details at the earliest. Total Exp in Guidewire(PC/CC/BC)- Exp in GW Integration- Exp in Webservices such as SOAP and Restful API- Official Notice Period- Last working date (if any):- Current CTC- Expected CTC- Offers Holding any- Current Location- Preferred Location- Interested in 3 Days Work from Office(Chennai/Bangalore/Hyderabad)?- Date of Birth (DOB)- Interview Availability(Teams Video)- Alternate Mobile No-Any Gap in Carrier / Education- Interested in (2 PM - 10 PM Shift) - Regards Deepan- TA deepankumar.j@htcinc.com

Dear Candidate, We have a Job Opening for Export Finance in Reputed Industry at Noida. Requirement Details: Location : Harihar, Karnataka Designation: Deputy Manager/Asst. Manager or Manager- Finance Experience: 6 to 8 Years Qualification: CA qualified is mandatory Expected Notice Period : Immediate to 30 days Required Profile: The person should be having exposure in distributor expenses. The person should know how to take care of claims and expenses of the distributor in India and abroad. The person should be able to automate the process. Automation will be the 50% parts of the job role. The person will be reviewing the clams and expenses in terms of automation. Analysis on budgeted expenditure and actual expenditure of TME. Driving automation and process improvements to enhance efficiency, accuracy. If you are interested, kindly share your updated CV to cg12@convate.com with below details. Kindly fill the below details: 1. Reason for job change: 2. Current Salary: 3. Expected Salary: 4. Joining Time needed Request you to kindly refer any of your friends or colleagues relevant and interested to the opportunity shared. About Convate Consultancy Recruitment Firm: Estd in 2004, Convate (team of 60 recruiters) is a leading International Recruitment Company having operations in Bangalore and Dubai. We specialize in the recruitment of IT/Healthcare/Engineering in India and the Middle East. Convate provides a learning-based work culture with a strong opportunity to grow in the years to come. Thanks and Regards, Snigdha Jha Recruitment Specialist Cg12@convate.com 9172215407 Convate Consultancy Services Pvt Ltd

Thryve Digital Health LLP is looking for a Business Analyst with Claims along with FEP(Mandatory) experience. If your profile suits for the below opportunity. Share your interest by applying Or you can InMail to rubhashree.madhavan@thryvedigital.com Role Summary: This job provides expertise for standard to moderately complex problem solving and in-depth understanding of system functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs. May troubleshoot errors, conduct impact analyses, and/or solve data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. May provide guidance to Associate level employees. Job Role : Business Analyst - Claims Adjudication with FEP Experience - 6-9 Years Work Location - Chennai/Hyderabad Work Mode - Hybrid Shift - 3PM - 12AM Essential Responsibilities Analyze Claims Tickets : Research/analyzes provider/Claims issue at hand Determines if provider/claim specific or global issue Actions taken could be ticket submissions to HMHS, pricing updates, provider file updates, collaboration with various internal stakeholders or Provider Relations, communications sent to Operations on global issues Requests cleanup report once issue is corrected, if required Follows cleanup through completion and notifies Provider Relations Facilitate process improvement meetings and/or discussions. Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and document current and future state business processes. Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies Assist in the development of desktop procedures and/or training material. Coordinate, monitor, and report on the progress of clean-up projects to ensure adherence to defined project schedule Communicate effectively with customers and colleagues. Successfully articulate issues, problems, and solutions. The experience we are looking to add to our team require: 6-9 years experience in Claims and Adjustments in Federal Employee Program (FEP) business Business Analyst with minimum 2 years of experience in FEP . Claims and Adjustment subject matter expertise Can adjudicate and adjust the claims BlueCard Home and Host knowledge Strong claims research skills are a must High level of systems and business knowledge Knowledge of INSINQ, Oscar, OCWA, CPBRE (Oscar Benefits), FEP Direct Business Process Improvement Collaborative Problem Solving Excellent analytical and problem-solving skills Bachelors or masters degree in any discipline Good verbal and written skills Good analytical and interpersonal skills Exceptional people management Good to have: AHM or any equivalent certification Additional quality/operational certifications Business acumen on Adjustments and Offset/Recovery

Working Model: Hybrid Notice Period: Immediate to 30 Days Roles & Responsibilities: 4-10 years of overall years of IT experience. Performed Guidewire claimCenter configuration as well as integration developer. Must be Guidewire certified in any of the Xcenters, preferably claimCenter Guidewire Configuration Development experience(Gosu, Rules Engine, Data Model,PCF, Wizards, Workflow, Activity and Product Model development). Experience of Invoicing, claim Types, Charge Distributions, Payments, Delinquency process, Commissions, etc Possess good knowledge in Message queue, events, Batch, Web services, API. Knowledge of PolicyCenter would be preferred. Experience in Agile SCRUM or SAFe methodology P & C Insurance domain knowledge is required. Cloud Implementation experience/knowledge is beneficial. Convert User Stories to code to configure the application or integrate it with other applications. Design and execute unit tests and implement the same with a continuous integration tool/environment.

Role & responsibilities Oversee and manage the end-to-end claims process, ensuring timely processing and adherence to internal policies Analyze claims data to identify trends, assess process gaps, and evaluate financial impact Prepare and present reports including claim status, pending settlements, and loss projections to senior management Collaborate with internal teams and external partners to resolve operational challenges and enhance efficiency Act as the primary point of contact for claim-related insights, fostering clear communication among stakeholders Identify and implement best practices to improve claim management accuracy and efficiency