591 Claims Adjudication Jobs - Page 4

Hiring for US Healthcare (B2B) Voice / Blended Process Graduate with 1 year customer service exp can apply Salary upto 3.30 LPA Location- Uppal 5 Days working Both side cab Fixed shifts (6:30 pm - 3:30 am) Contact Vanshita- 9910807579 Required Candidate profile Candidate must have good communication Skills. Candidate should have good typing speed. Candidate should be comfortable to work in fixed night shifts. Perks and benefits Incentives

Prepare ILAs, Final Survey Reports, and requirement letters Maintain updated records of claim intimation, surveyor visits, document status, and report submissions Follow up with insured parties to minimize TAT Enter claims info in CMS software Health insurance Provident fund

Experience in BPO Industry- International Voice only Team Leader - Health and welfare process voice (MUST) Health and welfare - Medicare Hippa Cobra Excellent Comms

We are looking for a highly skilled and experienced PDI Associate to join our team at Ekya Schools. The ideal candidate will have 2-5 years of experience in the field. Roles and Responsibility Collaborate with cross-functional teams to design and implement effective learning solutions. Develop and maintain high-quality educational content and materials. Provide training and support to teachers and staff on new technologies and methodologies. Evaluate student progress and provide feedback to improve outcomes. Participate in professional development opportunities to stay current with best practices. Foster positive relationships with students, parents, and community members. Job Requirements Strong understanding of IT Services & Consulting industry trends and technologies. Excellent communication and interpersonal skills. Ability to work effectively in a fast-paced environment and prioritize tasks. Strong problem-solving and analytical skills. Experience with project management tools and techniques. Familiarity with educational software and technology platforms. A graduate degree is required for this position. About Company Ekya Schools is a leading provider of innovative education solutions, committed to delivering high-quality education experiences to students. We focus on creating engaging and interactive learning environments that promote student growth and development.

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, a business of Marsh McLennan (NYSE: MMC), is the world s top insurance broker and risk advisor. Marsh McLennan is a global leader in risk, strategy and people, advising clients in 130 countries across four businesses: Marsh, Guy Carpenter, Mercer and Oliver Wyman. With annual revenue of $24 billion and more than 90,000 colleagues, Marsh McLennan helps build the confidence to thrive through the power of perspective. For more information, visit marsh.com, or follow on LinkedIn and X.

Desired Candidate profile Good communication skills Fresh Nursing Graduates Analyze and process US medical claims and billing records Basic computer literacy Flexible with shift timings Benefits

We are looking for a skilled Payment Posting and Charge Entry - Rcm Executive to join our team at Prodat IT Solutions, with 1-6 years of experience in the field. Roles and Responsibility Manage payment posting and charge entry processes for accurate and timely payments. Coordinate with clients and internal teams to resolve payment-related issues. Develop and implement process improvements to increase efficiency and reduce errors. Analyze data to identify trends and areas for improvement in payment posting and charge entry. Collaborate with cross-functional teams to achieve business objectives. Ensure compliance with company policies and procedures. Job Requirements Strong knowledge of payment posting and charge entry processes. Experience working with RCM systems is required. Excellent analytical and problem-solving skills. Ability to work effectively in a team environment. Strong communication and interpersonal skills. Familiarity with industry standards and regulations.

Looking to onboard a highly motivated and detail-oriented AR Associate with 0-1 years of experience to join our team in Bengaluru. The ideal candidate will have excellent communication skills and the ability to work effectively in a fast-paced environment. Roles and Responsibility Manage accounts receivable, including processing payments and resolving billing issues. Coordinate with clients to ensure timely payment and resolve any discrepancies. Maintain accurate records of all transactions and reports. Collaborate with internal teams to resolve account-related issues. Develop and implement effective strategies to improve cash flow. Analyze data to identify trends and areas for improvement. Job Strong understanding of accounting principles and practices. Excellent communication and interpersonal skills. Ability to work effectively in a team environment. Proficient in using computer software applications. Strong analytical and problem-solving skills. Ability to meet deadlines and work under pressure. Experience working in a CRM/IT Enabled Services/BPO industry is preferred. Omega Healthcare Management Services Private Limited is a leading healthcare management services company committed to providing high-quality patient care and services to its clients. We are a dynamic and growing company with a strong presence in the healthcare industry.

Cashless Executive, TPA Executive, Insurance Executive Responsibilities: Patient Eligibility Verification: Claim Processing: Pre-authorization and Approvals: Coordination: Status Tracking and Follow-up: Cashless Admission Facilitation:

Vidal is hiring for claim Processor Designation: Executive-Claims Location: Gurgaon, Key Responsibilities: Review and validate claim documents submitted by hospitals or insured members Scrutinize medical records and bills for completeness and accuracy Apply policy terms, conditions, and exclusions to adjudicate claims Perform ICD and procedure coding as per ailment and treatment Coordinate with medical officers for clinical opinion when required Maintain claim logs and update CRM systems with claim status Ensure adherence to defined SLAs and minimize processing errors Flag suspicious or potentially fraudulent claims for investigation Communicate with stakeholders for clarifications or missing documents Support audit and compliance teams with documentation and reports Shortfalls & Queries Required Skills & Competencies: Strong understanding of health insurance policies and TPA workflows Familiarity with medical terminology and coding (ICD, CPT) Attention to detail and analytical thinking Proficiency in claims processing software and MS Office tools Good written and verbal communication skills Ability to manage high volumes under pressure Commitment to confidentiality and data protection norms Qualifications & Experience: Graduate in any discipline (preferably life sciences or healthcare) 1-3 years of experience in claims processing within a TPA or insurer

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through data-driven decision-making Collaborate with cross functional teams for complex claim resolutions Timely and accurate claim settlements to avoid interest penalties Detection and prevention of fraudulent claims to reduce financial loss Accurate payout calculations aligned with policy terms Reduction in claim rework or overpayments Minimal customer complaints or escalations Timely and empathetic communication with beneficiaries Clear guidance provided throughout the claim process Claims processed within defined turnaround time (TAT) 100% compliance with regulatory and internal audit standard Effective coordination with legal and other departments Accurate and complete documentation for each claim Contributions to process improvement initiatives

Job Title: Business Analyst (Candidate must have experience in to US Healthcare Domain Adjudication System) Job Summary: We are seeking a motivated and detail-oriented Business Analyst with 3+ years of experience, preferably in the US healthcare domain , to join our dynamic team in Pune. This is a full-time, on-site position ideal for someone who thrives in a collaborative environment and is passionate about driving process improvement and delivering value through data-driven insights. The ideal candidate will work closely with cross-functional teams including operations, technology, and client stakeholders to understand business needs, analyze processes, and contribute to high-impact healthcare solutions. Key Responsibilities: Collaborate with stakeholders to gather, analyze, and document business requirements. Translate business needs into functional specifications for technical teams. Analyze healthcare claims, eligibility, and enrollment data to identify patterns and opportunities. Support project delivery by coordinating with development QA and configuration teams. Participate in client meetings, requirement walkthroughs, and status updates. Develop and maintain process documentation, user stories, workflow diagrams etc. Assist in UAT planning, execution, and issue tracking. Continuously monitor industry trends and regulatory changes in US healthcare. Mandatory Requirements: 3+ years of experience as a Business Analyst, with a strong understanding of US healthcare processes . Hands-on experience working with claims, eligibility, EDI 837/835/270/271 or other healthcare-related data sets. Experience in requirement elicitation , documentation , and business process mapping . Proven ability to work independently and in a team environment. Willingness to work from the Pune office on a full-time basis. Required Skills: Strong analytical and problem-solving skills. Proficiency in tools such as MS Excel, Visio , MS Word or similar. Excellent written and verbal communication skills. Attention to detail with strong organizational skills. Understanding of Agile/Scrum methodologies . Preferred Qualifications: Bachelor's degree in Computer science, IT, Healthcare Management, Information Systems, or a related field. Experience with HIPAA regulations , healthcare compliance, or payer-provider workflows. Exposure to reporting tools is a plus. Certification in Business Analysis (e.g., CBAP, CCBA) or Healthcare IT (e.g., CPHIMS) is a plus.

Key Roles : Ensure accurate documentation and timely claim settlement Follow up with TPA and Govt. bodies for approvals/payments Strong knowledge of Govt. healthcare panels (ECHS, CGHS, ESIC, etc.) Experience in hospital billing & claim processing Annual bonus Provident fund Health insurance

Managing CGHS, ECHS, CAPF and Ayushman Bharat Government Portals: Claim Processing Audit Uploading Query Management Reconciliation and Recovery Management. Annual bonus Provident fund Health insurance

Hiring for US Healthcare (B2B) Voice / Blended Process Graduate with 1 year customer service exp can apply Salary upto 3.30 LPA (23k in hand) Location- Uppal 5 Days working Both side cab facility Fixed Sat-Sun off Fixed shifts (6:30 pm - 3:30 am) Required Candidate profile Candidate must have good communication Skills. Candidate should have good typing speed. Candidate should be comfortable to work in fixed night shifts. Perks and benefits Incentives Meal facility

Role & responsibilities Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication. Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial. Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information. Utilize claims processing systems and software to enter, update, and retrieve claims information accurately. Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse. Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy. Collaborate with team members to improve claims adjudication processes and contribute to departmental goals. Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development. Preferred candidate profile 0 to 3 years of experience in healthcare claims adjudication or a related field. Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Proficiency in using claims processing systems and software. Ready to work at night shift

Positions, General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. **Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Requirements for this role include: Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.

Job Description Experienced in AR calling, Denial Management, checking eligibility and Authorization verification. Must be familiar with MDLand and Athena . Calling Insurance companies on behalf of physicians and carryout further examination on outstanding Accounts Receivables. Prioritize unpaid claims for calling according to the length of time it has been outstanding. Call insurance companies directly and convince them to pay the outstanding claims. Check the relevance of insurance info offered by the patient. Evaluate unpaid insurance claims. Call insurance companies and check on the status of claims and verifying authorization. Transfer the outstanding balance to the patient of he/she doesnt have adequate insurance coverage. If the claim has already been paid, ask the insurance company for Explanation of Benefits (EOB). Make corrections to the claim based on inputs from the insurance company. Good organizational skills to implement timely follow-up. Willingness to work in night shifts and weekends. Excellent verbal and written communication skills. Strong reporting skills. Ability to follow established work schedule. Ability to follow instructions precisely.

Business Analyst The Business Analyst will work closely with Salesforce and Sales Operations team. You will be responsible for providing operational and strategic level analytical support to various Business Units at Zeta Global. The successful applicant will be able to demonstrate excellent judgement, work well under pressure, prioritize effectively, and work collaboratively with stakeholders across the company. Primary Job Duties & Responsibilities Update Financials Models that bring together: Closed Won sales to Income Statement Revenue and other sales driven metrics to understand the trends in the sales organization Ability to interpret data and turn it into insights for the business (trending, forward looking, metrics) Preparing reports and presenting to Sales Management, Business Unit Leaders and Finance Leadership Determine and recommend data to include in analytical projects and provide insights to business partners Create and present data visualization techniques to help support data exploration Lead the operationalizing and automation of complex data (more systems, data sets and streams, size of data sets more substantial) products into business Present and translate information in relevant business terms Understands and supports data models across multiple lines of business Understands how sales information is interrelated based on how the business and sales runs Reconciling data and loading information into Salesforce and other data models Ability to partner and work with various business partners Education, Work Experience, & Knowledge Undergraduate in Finance, Business, Accounting or Analytics preferred, or equivalent degree or certification 2-4 years of experience with data analysis, modeling and analytics Understands how to reconcile data and analyze it for trends Experience with using Salesforce preferred Advanced skills in using various technologies to assist in data analysis, including: Tableau (beginner), Excel (pivot tables, V-Lookup) Ensures the business meaning behind the data is clear to end users, and addresses any needed clarifications in a timely manner Understands functional use cases and readily extrapolates them into data requirements Understands how business data can change overtime to ensure this is considered in functional use cases, development, and testing Ensures historical data considerations are discussed when the team delivers new capabilities

What this job involves: Responsibilities: Daily Cash Application. Handle mailbox for request and query management Perform daily transactions as per standard operating procedures Allocating work to the team and ensuring service delivery as agreed norms and SLAs Creation of Statement of Accounts and Refund Packets Update process documents and capture the exceptions while processing as and when required Provide support during internal/ external audits Provide new hire orientation and process training Ability to multi-task and work in a dynamic and fast paced environment Team player and yet able to work independently Perform other duties assigned as and when required i.e. process improvement initiatives, system implementation and ad-hoc projects Sounds like you To apply, you need to have: Requirements: Ability Degree in Accounting or relevant professional accountancy qualification. Shift timings: 5:30 pm IST 02:00 am IST. Minimum 18 months of experience at current role within JLL. Preferably, 3-5 years of working experience in AR in MNC. Good knowledge of Accounts Receivable is an added advantage. Ability to multi-task and work in a dynamic and fast paced environment Team player and yet able to work independently On-site Gurugram, HR Scheduled Weekly Hours: 40

Eurofins Assurance India Pvt Ltd is a leading certification body providing Audit & Certification , Inspections , and other services covering the broad spectrum of sustainable supply chain. Eurofins will help the customers to mitigate risks in their supply chain and to ensure the benchmarking performance with operations, processes, systems, people or capabilities. Whether you are in Food, Cosmetics, Consumer products or Health care sector, our global auditor and technical expert network will help to mitigate/eliminate your risks against supply chain and distribution flows: Regulatory and Industrial standards . We have accreditations for a number of different industry standards/memberships to ensure we service the entire supply chain. TC application review "¢ Preparation of draft manual transaction certificate "¢ Issuing TC or rejecting TC "¢ Client Coordination related to the TC application. "¢ Compile the GMO related data for GOTS and TE using applicable templates. "¢ Compile the monthly TC data for TE. Qualifications Any graduate can apply.

Eurofins Assurance India Pvt Ltd is a leading certification body providing Audit & Certification , Inspections , and other services covering the broad spectrum of sustainable supply chain. Eurofins will help the customers to mitigate risks in their supply chain and to ensure the benchmarking performance with operations, processes, systems, people or capabilities. Whether you are in Food, Cosmetics, Consumer products or Health care sector, our global auditor and technical expert network will help to mitigate/eliminate your risks against supply chain and distribution flows: Regulatory and Industrial standards . We have accreditations for a number of different industry standards/memberships to ensure we service the entire supply chain. Responsible for local sales for assurance business for products like (SMETA, BSCI, HIGG "“ FEM, SLCP, WRAP, GOTS, etc.) "¢ Responsible for achieving targeted revenue for North region as defined by Eurofins Management. "¢ Prepare and present sales quotations and proposals to current and prospective clients. "¢ Maintain accurate customer and sales information in CRM. "¢ Provide Monthly Sales reports to Management. "¢ Responsible for supporting marketing activities in region. "¢ Assist in payment collection for region. "¢ Assist in Scheduling the audit. "¢ Commitment to providing a consistently high standard of customer service. "¢ Demonstrable record of success in sales, product or service marketing and sales management Additional Information Good written and verbal communication skills Operational Excellence and demonstrated ability to deliver results in multiple challenging situations. Team-focused with the ability to achieve or exceed objectives while working collaboratively with other team members to achieve mutual success. Good at Presentations High leadership and supervisory skills Result oriented Problem solving Good at Retention

Key Responsibilities : Lead Generation & Sales: Proactively identify and engage potential members through various channels, including walk-ins, inbound inquiries, and outbound outreach Membership Sales & Conversions: Present and sell membership options, upsell additional services such as personal training, and close sales to meet or exceed monthly targets Customer Engagement & Retention: Provide personalized tours, address member inquiries, and ensure a welcoming environment to enhance member satisfaction and retention CRM Management: Utilize CRM tools to track leads, manage follow-ups, and update member records to maintain accurate and up-to-date information Community Outreach: Build relationships with local businesses, organizations, and influencers to drive group memberships and increase brand visibility Event Management: Organize and participate in events to engage the community and generate interest in membership offerings

Aster Medcity is looking for Deputy Manager Revenue Cycle Managementto join our dynamic team and embark on a rewarding career journey Developing and implementing revenue cycle management policies and procedures that ensure accurate billing, timely collections, and compliance with regulatory requirements Monitoring and analyzing revenue cycle data to identify areas for improvement and implement process improvements Collaborating with other departments to ensure that revenue cycle activities are aligned with organizational goals and objectives Managing the accounts receivable to ensure timely and accurate billing and collections Ensuring compliance with regulatory requirements related to revenue cycle management Managing relationships with payers and negotiating contracts and reimbursement rates Developing and maintaining relationships with key stakeholders, including patients, providers, and payers Managing budgets and financial performance for revenue cycle management and preparing reports and presentations to senior management on revenue cycle performance Excellent leadership and communication skills, with the ability to motivate and manage teams effectively Strong analytical and problem-solving skills

Prepare ILAs, Final Survey Reports, and requirement letters. Maintain records of claim intimation, surveyor visits, document status, and report. Follow up with insured and internal teams to minimize TAT Update data in CMS software Health insurance Provident fund