593 Claims Adjudication Jobs - Page 3

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Responsibilities: Prepare ILAs, Final Survey Reports, and requirement letters Maintain records of claim intimation, surveyor visits, documents, and reports Follow up with insured/internal teams to reduce TAT Enter claims data into CMS software Provident fund Health insurance

Hiring for AR caller profile for One of the leading MNC's. Required 12 months of experience in AR follow-up for US healthcare. Salary Up-to 45K In-hand Saturday Sunday Fix Off Both side Cabs To Apply, Call or WhatsApp CV on ANISHA - 9354076916 Required Candidate profile 1. Minimum 12 months of experience in AR Calling. 2. Excellent communication skills, both verbal and written. 3. Familiarity with medical billing and Denial Management. Perks and benefits Both side Cabs, Meals and Medical Insurance.

SUMMARY We are looking for a dynamic and student - focused Academic Counsellor to join our team. You will play a key role in guiding students towards skill development programs, supporting them in making informed career decisions, and ensuring a smooth enrolment process. Salary: 12,000 20,000 per month Key Responsibilities Counsel students about various skilling and certification programs. Follow up on leads via phone, WhatsApp, and walk-ins to convert into admissions. Understand student profiles and recommend suitable programs. Manage end-to-end admission processes, documentation, and follow-ups. Maintain accurate records of inquiries, admissions, and progress updates. Coordinate with the training and placement teams for student onboarding. Achieve monthly counselling and enrollment targets. Requirements Minimum 6 months to 2 years of experience in education sales, outreach, admissions, counselling, academic counsellor or any related field Location: Bangalore Benefits Be a part of a mission-driven organization impacting youth careers. Growth - oriented work culture with learning opportunities. Performance - based incentives and recognition. Send your CV to WhatsApp 9142302925

SUMMARY We are looking for a dynamic and student-focused Academic Counsellor to join our team. You will play a key role in guiding students towards skill development programs, supporting them in making informed career decisions, and ensuring a smooth enrolment process. Salary: 12,000 20,000 per month Key Responsibilities Counsel students about various skilling and certification programs. Follow up on leads via phone, WhatsApp, and walk-ins to convert into admissions. Understand student profiles and recommend suitable programs. Manage end-to-end admission processes, documentation, and follow-ups. Maintain accurate records of inquiries, admissions, and progress updates. Coordinate with the training and placement teams for student onboarding. Achieve monthly counselling and enrollment targets. Requirements Minimum 6 months to 2 years of experience in education sales, outreach, admissions, counselling, academic counsellor or any related field Location: Pune Benefits Be a part of a mission-driven organization impacting youth careers. Growth - oriented work culture with learning opportunities. Performance - based incentives and recognition. Send your CV to WhatsApp 9142302925

Project Role : Business Analyst Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Must have skills : Computer System Validation (CSV) Good to have skills : AAAP (Accenture Advanced Analytics Platform)Minimum 3 year(s) of experience is required Educational Qualification : be Summary :As a Business Analyst, you will engage in a variety of tasks that involve analyzing organizational processes and systems. Your typical day will include assessing the current state of business models, identifying customer requirements, and defining future states or business solutions. You will conduct research, gather data, and synthesize information to support decision-making and improve operational efficiency. Collaboration with cross-functional teams will be essential as you work to align business objectives with technological capabilities, ensuring that solutions are both effective and sustainable. Roles & Responsibilities:- Expected to perform independently and become an SME.- Required active participation/contribution in team discussions.- Contribute in providing solutions to work related problems.- Facilitate workshops and meetings to gather requirements and feedback from stakeholders.- Develop and maintain documentation related to business processes and system requirements. Professional & Technical Skills: - Must To Have Skills: Proficiency in Computer System Validation (CSV).- Good To Have Skills: Experience with AAAP (Accenture Advanced Analytics Platform).- Strong analytical skills to assess business processes and identify areas for improvement.- Ability to communicate effectively with stakeholders at all levels of the organization.- Experience in creating process maps and documentation to support business analysis. Additional Information:- The candidate should have minimum 3 years of experience in Computer System Validation (CSV).- This position is based at our Pune office.- A be is required. Qualification be

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for Communication SkillsTeamwork & CollaborationProblem-Solving & Critical ThinkingAdaptability & Willingness to LearnTime Management & Organization Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Role & responsibilities Shift timings (05:30 PM - 02:00 AM & 06:30 PM to 03:00 AM) Hybrid Mode - Work from office Life Claims Adjudicator: The Individual Insurance Claims department plays a crucial role with our clients as we offer them financial help when they most need it. We are looking for a motivated individual who is eager to learn to hold the position of Claims Adjudicator. The position offers the possibility to progress internally through our career ladder. Life Claims Adjudicator Role summary: The Claims Adjudicator is responsible for the assessment of claims for individual insurance. Main Accountabilities: Assess the documentation received for a claim in order to reach a decision Determine how the contract applies to each claim Communicate clearly and proactively with clients, advisors and various professionals and effectively manage their expectations Maintain established service standards Evaluate opportunities for process improvements and actively participate in team initiatives and projects Competencies: Knowledge of individual life insurance Excellent written and verbal communication skills with an ability to handle written inquiries of a sensitive nature 5 years of client service experience or 2 years in a claims environment Strong problem solving and analytical skills Attention to detail Team player with a positive attitude and commitment to provide quality service Ability to balance high work volumes and inquiries Good organizational and time-management skills Solid PC skills with knowledge of Word and Excel Requirements: College diploma/university degree/CEGEP degree or relevant experience Knowledge of MLIF, Ingenium, CSW, Filenet and IBM Notes English Knowledge of individual life insurance Assets: Education involving knowledge of Medical terminology First Level LOMA diploma or dedication to work towards attaining it Preferred candidate profile

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: 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. 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. Work from Office only Pune address: C-Wing, First Floor, Manikchand Icon, Balkrishna Sakharam Dhole Patil Rd, Sangamvadi, Pune, Maharashtra 411001 Mumbai address: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to WhatsApp to 9632777628

Charge entry and Payment Posting Knowledge about ICD 10 and CPT codes Knowledge about Insurances, Denials, Rejections Posting payments and adjustments from ERAs and EOBs Applying refunds on identified overpayments

Degree/Diploma in Mechanical, Electrical, Electronics Engineering claim documents, images, videos, technical reports submitted by field engineers clients Interact with clients insured parties, brokers, email clarify loss details and resolve queries

Book your interview slot WhatsApp your profile @ 9623462146 / 7391077622 or Dipika@infiniteshr.com ******Hiring for P & C Insurance Team Manager / Sr TM , Salary upto 14.00L*** ****Hiring Team Manager Insurance process**** Salary upto 10 LPA Exp: 6 to 15 Yrs Salary : Upto 14 Lacs Regards Dipika Sharma 9623462146 7391077622 8888850831

We are Hiring hybrid wfh Back office Process Backoffice Marine/Motor Claims Insurance (Min 3yr To 9yrs BPO),Sal 8.00 LPA ( Pune ) Process : UK Marine Insurance Process : WhatsApp call only Dipika- 9623462146 / 7391077622 / 8888850831 Regards Dipika 9623462146

Fairmont Hotels & Resorts is looking for Finance Associate (Fresher) - Navi Mumbai to join our dynamic team and embark on a rewarding career journey Assisting with the preparation of operating budgets, financial statements, and reports Processing requisition and other business forms, checking account balances, and approving purchases Advising other departments on best practices related to fiscal procedures Managing account records, issuing invoices, and handling payments Collaborating with internal departments to reconcile any accounting discrepancies Analyzing financial data and assisting with audits, reviews, and tax preparations Updating financial spreadsheets and reports with the latest available data Reviewing existing financial policies and procedures to ensure regulatory compliance Providing assistance with payroll administration Keeping records and documenting financial processes Excellent collaboration and communication skills

We are looking for a skilled AR Caller to join our team at Prodat IT Solutions, responsible for medical billing and ensuring timely payments. The ideal candidate will have 1-6 years of experience in the field. Roles and Responsibility Manage and resolve outstanding accounts receivable issues. Conduct thorough reviews of patient records and billing information. Develop and implement effective strategies to improve cash flow. Collaborate with internal teams to ensure accurate and efficient billing processes. Identify and address denials by investigating root causes and resubmitting claims as necessary. Maintain accurate and up-to-date records of all interactions with patients and insurance companies. Job Requirements Strong knowledge of medical billing principles and practices. Excellent communication and problem-solving skills. Ability to work effectively in a fast-paced environment and meet deadlines. Proficiency in using computer software applications and technology. Strong analytical and organizational skills with attention to detail. Ability to maintain confidentiality and handle sensitive information with discretion.

""" Checks for completeness and appropriateness of source data. Involved in fact finding, information search and data gathering. Verifies and compiles data. Identifies and resolves routine and recurring problems. Skills Required Ability to analyze and process transactions based on rules. Able to integrate knowledge as a skilled specialist. Possess strong domain knowledge in Healthcare and Insurance domain. """

Checks for completeness and appropriateness of source data. Involved in fact finding, information search and data gathering. Verifies and compiles data. Identifies and resolves routine and recurring problems. Skills Required Ability to analyze and process transactions based on rules. Able to integrate knowledge as a skilled specialist. Possess strong domain knowledge in Healthcare and Insurance domain.

Company: Marsh Description: Ensures timely and accurate production/processing of complex documents/information (includes report preparation) Maintains a basic understanding of the core aspects of relevant Insurance and related legislation (customer awareness) and strengthen established relationships Adheres to Company policies and performance standards Contributes to the achievement of Operations team Service Level Agreements (SLA) , Key Performance Indicators (KPI) and business objectives Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age, background, caste, disability, ethnic origin, family duties, gender orientation or expression, gender reassignment, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law. Marsh McLennan is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one anchor day per week on which their full team will be together in person.

Company: Marsh Description: Position Overview: We are seeking a dedicated and detail-oriented Claim Servicing Executive to join our Employee Benefits team in Marsh India. The ideal candidate will be responsible for managing and servicing claims related to employee benefits, ensuring a seamless experience for our clients and their employees. This role requires strong communication skills, a customer-centric approach, and the ability to work collaboratively within a team. Key Responsibilities: Claims Management: Process and manage employee benefits claims efficiently and accurately. Review and assess claims documentation to ensure compliance with policy terms and conditions. Liaise with clients, insurance providers, and internal teams to resolve claims-related inquiries and issues. Client Communication: Serve as the primary point of contact for clients regarding claims inquiries and updates. Provide timely and clear communication to clients about the status of their claims. Educate clients on the claims process and employee benefits policies. Documentation and Reporting: Maintain accurate records of all claims transactions and communications. Prepare and submit reports on claims activity and trends to management. Ensure all documentation is compliant with regulatory requirements and company policies. Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age, background, caste, disability, ethnic origin, family duties, gender orientation or expression, gender reassignment, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law. Marsh McLennan is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one anchor day per week on which their full team will be together in person.

The Billing Head will be responsible for overseeing the billing operations of Manipal Hospitals, ensuring efficient and accurate billing processes. This role involves managing a team of billing professionals, developing billing policies and procedures, and ensuring compliance with healthcare regulations. The Billing Head will also collaborate with various departments to improve billing practices, reduce discrepancies, and enhance revenue cycle management. Key responsibilities include analyzing billing data, identifying areas for improvement, and implementing strategies to optimize revenue collection. Roles and Responsibilities About the Role: - Lead the billing and revenue cycle management for Manipal Hospitals. - Oversee the development and implementation of billing policies and procedures. - Ensure compliance with healthcare regulations and industry standards. About the Team: - Work alongside a team of billing specialists, financial analysts, and support staff. - Collaborate with various departments, including finance, administration, and clinical teams. - Foster a culture of continuous improvement and high performance within the team. You are Responsible for: - Managing end-to-end billing processes, from charge capture to claim submission. - Analyzing billing data to improve revenue cycle efficiency and reduce denials. - Training and mentoring team members to enhance their skills and knowledge. To succeed in this role – you should have the following: - Proven experience in healthcare billing and revenue cycle management. - Strong analytical and problem-solving skills, with attention to detail. - Excellent communication and leadership abilities to effectively manage a diverse team.

Role & responsibilities Good knowledge in Claims Adjudication - US healthcare With Basic Competency Level: 1. Excellent interpersonal skills 2. Ability to understand and interpret policy provisions. 3. Product knowledge 4. Typing Skills 5. Problem Solving Skills Education, Experience and Flexibility: Under-Graduate or Any Graduate Minimum of 1 2 years of Customer Service experience. Flexible to work in US Shifts with rotational week offs. Preferred candidate profile pls share your CV to nishidha.kumar@sagilityhealth.com

You are a fresher who will be gaining experience in Health Claims by undergoing a few days of training. Your main responsibility will be to accurately process and adjudicate medical claims in compliance with company policies, industry regulations, and contractual agreements. In this role, you will review and analyze medical claims submitted by healthcare providers to ensure accuracy, completeness, and adherence to insurance policies and regulatory requirements. You will also verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement. Assigning appropriate medical codes such as ICD-10 and CPT to diagnoses, procedures, and services according to industry standards will be a crucial part of your job. Additionally, you will adjudicate claims based on established criteria like medical necessity and coverage limitations to ensure fair and accurate reimbursement. It will be your responsibility to process claims promptly and accurately using designated platforms. You will investigate and resolve discrepancies, coding errors, and claims denials through effective communication with healthcare providers, insurers, and internal teams. Collaboration with billing, audit, and other staff to address complex claims issues and ensure proper documentation and justification for claim adjudication will be essential. To excel in this role, you should maintain up-to-date knowledge of healthcare regulations, coding guidelines, and industry trends to ensure compliance and best practices in claims processing. Providing courteous and professional customer service to policyholders, healthcare providers, and other stakeholders regarding claim status, inquiries, and appeals is also expected. Documenting all claims processing activities, decisions, and communications accurately and comprehensively in designated systems or databases is a key part of the job. Participation in training programs, team meetings, and quality improvement initiatives to enhance skills, productivity, and overall performance is encouraged. Ideally, you should have a Masters/Bachelors degree in Nursing, B.Pharma, M.Pharma, BPT, MPT, or a related field. Excellent analytical skills with attention to detail, accuracy in data entry, and claims adjudication are essential. Effective communication and interpersonal skills, the ability to collaborate across multidisciplinary teams, and interact professionally with external stakeholders are required. You should possess a problem-solving mindset with the ability to identify issues, propose solutions, and escalate complex problems as needed. A commitment to continuous learning and professional development in the field of healthcare claims processing is crucial for success in this role.,

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.

Job Summary Join our dynamic team as a PE-Ins Claims specialist where you will leverage your expertise in the Life and Annuity domain to process and manage insurance claims efficiently. With a focus on accuracy and customer satisfaction you will play a crucial role in ensuring smooth operations and contributing to the companys success. This position requires working from the office during night shifts providing an opportunity to collaborate closely with team members and enhance your skills in a supporti Responsibilities Process insurance claims with precision and ensure compliance with company policies and regulations. Analyze claim documents and assess the validity of claims based on Life and Annuity domain knowledge. Collaborate with cross-functional teams to resolve complex claim issues and provide timely resolutions. Maintain accurate records of all claims processed and update the system with relevant information. Communicate effectively with clients to gather necessary information and provide updates on claim status. Identify potential areas of improvement in claim processing and suggest actionable solutions. Ensure high levels of customer satisfaction by addressing inquiries and resolving issues promptly. Monitor claim trends and provide insights to management for strategic decision-making. Adhere to company guidelines and industry standards while handling sensitive client information. Participate in training sessions to stay updated on industry changes and enhance domain expertise. Support team members by sharing knowledge and best practices in claim management. Contribute to the development of efficient workflows and processes to optimize claim handling. Utilize technical skills to streamline claim processing and improve overall efficiency. Qualifications Possess strong Life and Annuity domain knowledge with a focus on insurance claims. Demonstrate excellent analytical skills to evaluate and process claims accurately. Exhibit effective communication skills to interact with clients and team members. Show proficiency in using claim management software and related tools. Have a keen eye for detail to ensure accuracy in claim documentation. Display a proactive approach to identifying and solving claim-related issues. Certifications Required Certified Insurance Claims Professional (CICP) or equivalent certification preferred.

Job Summary Join our dynamic team as a PE-Ins Claims specialist where you will leverage your expertise in the Life and Annuity domain to enhance our claims processing efficiency. With 1 to 3 years of experience you will work from our office during night shifts contributing to the seamless operation of our insurance services. Your role will be pivotal in ensuring accurate and timely claims management directly impacting customer satisfaction and company success. Responsibilities Analyze and process insurance claims within the Life and Annuity domain to ensure accuracy and compliance with company policies. Collaborate with team members to identify and resolve discrepancies in claims documentation enhancing overall process efficiency. Utilize domain knowledge to assess claims and determine appropriate resolutions minimizing risk and maximizing customer satisfaction. Maintain detailed records of claims activities ensuring transparency and accountability in all transactions. Communicate effectively with internal and external stakeholders to facilitate smooth claims processing and address any inquiries. Implement best practices in claims management to streamline operations and reduce processing times. Provide insights and recommendations for process improvements based on data analysis and industry trends. Ensure adherence to regulatory requirements and company standards in all claims-related activities. Support the development and implementation of new claims processing tools and technologies. Participate in training sessions and workshops to stay updated on industry developments and enhance professional skills. Contribute to team meetings and discussions sharing knowledge and experiences to foster a collaborative work environment. Monitor and report on claims processing metrics identifying areas for improvement and implementing corrective actions. Assist in the preparation of reports and presentations for management review highlighting key performance indicators and achievements. Qualifications Demonstrate strong analytical skills with a focus on accuracy and attention to detail. Exhibit excellent communication and interpersonal skills to effectively interact with stakeholders. Possess a solid understanding of Life and Annuity insurance products and processes. Show proficiency in claims management software and related technologies. Display the ability to work independently and as part of a team in a fast-paced environment. Have a proactive approach to problem-solving and decision-making. Demonstrate a commitment to continuous learning and professional development. Certifications Required Certified Insurance Claims Specialist (CICS) or equivalent certification in Life and Annuity domain.