592 Claims Adjudication Jobs - Page 7

Looking for doctors who have experience in processing Cashless And Reimbursment Claims (Group or Retail) Experience - 2+ years in claim processing

Claims processing Doctor Job Description: Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance. With the medical expertise ,need to master the various products and to apply the same during claim processing. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. List of Responsibilities: To validate the authenticity and the credibility of the claims. To coordinate with various persons (Claimant, Treating Physician, Hospital insurance desk, Field Visit Drs, Investigation officers)for hassle-free claim processing . To expertise ,the process of negotiation when necessitated. The claim handler owes a duty of care to the patient, ensuring that their needs are being met and that they re receiving the treatment or medicine they need. Job Qualifications and Requirements: Required BDS, BHMS, BAMS, MD, Pharm D Graduates. Adapt and inbuilt the process of communication and coordination across the zones and the supporting verticals accordingly.

Primary Responsibilities: Lead a team of 25 – 30 certified coders. Maintains staff by orienting and training employees; maintains a safe, secure, and legal work environment Performance Management – Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies Drive employee engagement and retention activities by sharing company’s vision and goals, empowering employees on tasks as per their skill set, providing regular feedback etc. Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate in any discipline Certified coder from AAP/AHIMA 2+ years of experience as Team leader or Assistant Manager Experience in handling a team of minimum 15 Experience from medical coding background only Experience in performance management, coaching, supervision, quality management, results driven, foster teamwork, handles pressure, giving feedback Proven ability to use Microsoft Office Products (Excel, PowerPoint etc.) Proven ability to operate basic office equipment (copier and facsimile machine) At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone – of every race, gender, sexuality, age, location and income – deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission. #njp #SSCorp External Candidate Application Internal Employee Application

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. r1rcm.com Facebook

R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, Top 100 Best Companies for Women by Avtar & Seramount, and amongst Top 10 Best Workplaces in Health & Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by enabling efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 16,000+ strong in India with presence in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Designation Operations Manager Location: Hyderabad Reports to (level of category) Senior Operations Manager Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. a) Day-to-day operations b) People Management (Work Allocation, On job support, Feedback & Team building) c) Performance Management (Productivity, Quality, One-On-One sessions, KRA, PIP) d) Reports (Internal and Client performance reports) e) Work allocation strategy f) CMS 1500 & UB04 AR experience is mandatory. g) Span of control - 80 to 100 h) Thorough knowledge of all AR scenarios and Denials i) Expertise in both Federal and Commercial payor mix j) Excellent interpersonal skills h) Should be capable to interact with US clients and manage escalations Qualifications Graduate in any discipline from a recognized educational institute Good analytical skills and proficiency with MS Word, Excel and PowerPoint Good communication Skills (both written & verbal) Skill Set Candidate should be good in Denial Management Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials. Ability to interact positively with team members, peer group and seniors. Demonstrated ability to exceed performance targets. Ability to effectively prioritize individual and team responsibilities. Communicates well in front of groups, both large and small. r1rcm.com Facebook

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

: Job Title: Client On Boarding, NCT Location: Jaipur, India Corporate TitleNCT Role Description The Analyst will be responsible for completion of day-to-day activity as per standards and ensure accurate and timely delivery of assigned production duties. The role is required to verify account opening documents for PWM US client against the KYC. And also ensure correct FATCA reporting to comply with regulatory requirement. Candidate/Applicants would need to ensure adherence to all cut-off times and quality of processing as maintained in SLAs. What well offer you 100% reimbursement under childcare assistance benefit (gender neutral) Sponsorship for Industry relevant certifications and education Accident and Term life Insurance Your key responsibilities Ensure quality/quantity of processing is maintained as per the SLA. Should be capable to handle multiple deadlines Ensure to process and approve all cases in given TAT. Knowledge of AML and ABR procedure and roles. Knowledge of various Regulations like REG E, D, and Volker is required. Ensure timely completion of all request and adhere to ClientConfidentiality. Flexible with business hours respective to volume received. Update volumes in various spreadsheets/work logs accurately and on time. Ensure team work culture is practiced. Escalate all issues in time, to the appropriate level, to avoid any adverse impact on the business. Functional Skills Have fundamental knowledge of KYC, FATCA Account opening, Banking etc Have understanding of Business Information search for prospect clients. Understand important of transactions approval procedure to control risk of fraud and error. Knowledge on different client documentation across geographies. Knowledge of the life cycle of the on-boarding process. Your skills and experience In-depth knowledge of KYC, ABR, FATCA & COB. Needs to be a self-starter with significant ability to undertake initiatives. Should have Effective communication skills and fluency in Microsoft Office skills. Should be open to work in night shift. Education / Certification Graduates with good academic records with relevant experience. Needs to be a self-starter with significant ability to undertake initiatives. Should have Effective communication skills and fluency in Microsoft Office skills. Should be open to work in night shift. Knowledge of various banking products, KYC, AML, FATCA, equity market and their flow would be an added advantage. How well support you About us and our teams Please visit our company website for further information: https://www.db.com/company/company.htm We strive for a culture in which we are empowered to excel together every day. This includes acting responsibly, thinking commercially, taking initiative and working collaboratively. Together we share and celebrate the successes of our people. Together we are Deutsche Bank Group. We welcome applications from all people and promote a positive, fair and inclusive work environment.

Educational Bachelor of Engineering,BCA,BTech,MBA,MTech,MCA Service Line Application Development and Maintenance Responsibilities A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your teams towards developing optimized high quality code deliverables, continual knowledge management and adherence to the organizational guidelines and processes. You would be a key contributor to building efficient programs/ systems and if you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you!If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Technical and Professional : Domain experiencePayer core – claims/Membership/provider mgmt. Domain experienceProvider clinical/RCM, Pharmacy benefit management Healthcare Business Analysts - with Agile/Safe-Agile Business analysis experience Medicaid, Medicaid experienced Business Analysts FHIR, HL7 data analyst and interoperability consulting Healthcare digital transformation consultants with skills/experience of cloud data solutions design, Data analysis/analytics, RPA solution design KeywordsClaims, Provider, utilization management experience, Pricing,Agile, BA Preferred Skills: Domain-Healthcare-Healthcare - ALL Technology-Analytics - Functional-Business Analyst

Educational Bachelor of Engineering,BCA,BTech,MCA,MTech,MBA Service Line Application Development and Maintenance Responsibilities As a ‘Senior Product Manager’ you will be pivotal to creating roadmap, owning release plan for multiple capabilities that is futuristic and meets industry and client needs. You will be responsible for continuous backlog management, prioritizing the backlog considering the needs and objectives of every stakeholder. As a thought leader in your business domain, bring in industry best practices, learnings from client demos and interactions into designing. You will anchor business pursuit initiatives, sales demo. You will have the opportunity to shape the Infosys platform that enables payers and providers to deliver better care. Additional Responsibilities: Experience in market leading healthcare products (key emphasis). Proven track record of at least 8 years in software product management roles. Capability/Feature planning and design, manage the specifications of their development, and monitor their on-going operation to better understand customer experiences. Clearly communicating progress towards delivery, technical challenges that may occur. Act as a thought leader and subject matter expert in the assigned product area, develop essential product documentation including business case, business requirements and use cases. Own product backlog and collaborate closely with the platform engineering team. Create Journey Maps that re-imagine/re-define the healthcare problematic process areas. Understanding of trends affecting customer adoption. Experience of working with enterprise customers, both technical and business, and at all levels. Influence leaders in diverse functional areas Strong business acumen including experience in estimation and pricing, market research. Demonstrated ability to navigate ambiguity and adapt quickly to modern technology and processes. Strong analytical ability with exposure to data science and automation Teaming/Collaboration - Demonstrates exceptional leadership and team management skills, with a collaborative and empowering approach to achieve results through influence. Excellent communication, presentation, and interpersonal skills to develop lasting relationships with senior business or technical leaders with the highest levels of business acumen and technical expertise. Technical and Professional : Payer/ Provider/ PBM organizations Product Management/Product Engineering /Healthcare Operations Experience working with industry leading Enrollment, Claims, Billing or EHR systems. Managing product lifecycle in whole – from ideation, exploration, approval, development, implementation, measurement, and ongoing development. Expertise in US Government Program Line of Business - Medicare, Medicaid, Duals, Marketplace Plan Sponsor & Product, Enrollment & Billing, Provider Data Management, Provider Network Management, Claims, Encounters, Medicare, and Marketplace Risk Adjustment. Developing results-oriented strategies to solve complex and open-ended business problems. Market Analysis and Product fitment Communicating and facilitating architecture design discussions/decisions and impacts to key stakeholders. Customer success on managing customer engagements and requirements. Leading business pursuits and product demonstrations. Agile Product Development Methodology Preferred Skills: Domain-Healthcare-Healthcare - ALL

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

We are looking for a performance-driven Team Leader to lead our international voice support team. The ideal candidate should bring 5+ years of total experience in a voice-based BPO setup with at least 1-2 years of hands-on experience in team handling. The role is crucial in maintaining operational excellence improving CSAT scores and ensuring minimal attrition. Key Responsibilities : - Lead and manage a team of voice agents in delivering high-quality international customer support Drive and achieve targets for CSAT (Customer Satisfaction)" AHT (Average Handling Time) FCR (First Call Resolution) and Quality Scores Actively monitor and improve customer experience through coaching and root cause analysis Implement initiatives to manage and reduce team attrition while maintaining high team morale Ensure timely escalations are resolved and service recovery is handled effectively Conduct regular one-on-one meetings and team huddles to communicate updates performance feedback and development plans Work closely with Quality and Training teams to identify and close skill gaps Analyze reports and dashboards to monitor performance trends and take corrective actions Maintain compliance with company policies and client-specific KPIs Foster a culture of accountability collaboration and continuous improvement Skills & Attributes : - Strong understanding of customer experience metrics such as CSAT" NPS and Quality Scores Demonstrated ability to handle attrition and engage teams positively Proactive leadership style with experience in coaching and mentoring Excellent verbal and written communication skills Ability to work under pressure and in a target-oriented environment Competence in using CRM tools reporting dashboards and workforce management tools Contact Person : - Anusiya Contact Number : - 9840114871

Looking for an Accounting Receivable Specialist with 1+ year of U.S. medical billing experience, knowledge of EOBs, denials, CPT codes, and U.S. insurance. Must work U.S. shifts from Pune. Healthcare experience required. Provident fund

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims needs to be completed adhering to required TAT and quality SLA. Key Results Production, Quality Shift and Schedule adherence Process Knowledge Minimum Eligibility: Candidates should have minimum 1 year Experience in Claims Adjudication & Claims Adjustment or Claims Adjudication with Appeals & Grievances Shift Details: Night shift / Flexible to work in any shift and timingCab Boundary Limit: Up to 30 km (One way drop cab) Job Location: Firstsource Solution Limited,5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103.Landmark near Vivira Mall. Contact: Arun HR Phone: 6374232238 Email: arun.kumar9@firstsource.com If you are interested please share your updated CV to the arun.kumar9@firstsource.com or 6374232238 Join us to be part of a dynamic team with career growth opportunities. We look forward to seeing you at the interview! You can refer your friends as well! 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 arun.kumar9@firstsource.com

Role & responsibilities Shift timings (01:30 PM - 10 PM ) Hybrid Mode- Work from office. Looking for Immediate joiner. What will you do? Review complex claims and estimates for completeness and follow processes for incomplete information on claims Assess and adjudicate complex claims and estimates Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision Meet production and quality standards set for individuals, teams and department (timeliness, quality and service) Handle external and internal inquiries via written correspondence, e-mails and telephone as required Participate in departmental projects as required. Work in conjunction with the Dental Consultant on contentious cases, and with other departments/offices within the company in order to meet customer expectations Key Qualifications and experience: Diploma in Dental Hygiene (CEGEP/College or University Experience working in a dental clinic Strong knowledge of Group Insurance - Dental claims Customer service oriented Excellent communication skills both verbal and written Excellent problem solving skills Self motivated Team Oriented Ability to work in a changing environment Decision-maker Open to retroaction and giving feedback Bilingualism (French and English, verbal and written) nice to have Your scope of work / key responsibilities: Review complex claims and estimates for completeness and follow processes for incomplete information on claims Assess and adjudicate complex claims and estimates Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision Meet production and quality standards set for individuals, teams and department (timeliness, quality and service) Handle external and internal inquiries via written correspondence, e-mails and telephone as required Interested candidate can share their resumes at V.vaibhav@sunlife.com Preferred candidate profile

Create the future of e-health together with us by becoming a Manager Credentialing. As one of the Best in KLAS RCM organization in the industry we offer a full scope of RCM services as well as BPO services, our organization gives our team members the training and solutions to learn and grow across variety of technologies and processes. As an innovator and leader in the e-health services we offer unparalleled growth opportunities in the industry. What you can expect from us: A safe digital application and a structured and streamlined onboarding process. An extensive group health and accidental insurance program. Our progressive transportation model allows you to choose: You can either receive a self-transport allowance, or we can pick you up and drop you off on your way from or to the office. Subsidized meal facility. Fun at Work. Various career growth opportunities as well as a lucrative merit increment policy in a work environment where we promote Diversity, Equity, and Inclusion. Best HR practices along with an open-door policy to ensure a very employee friendly environment. A recession proof and secured workplace for our entire workforce. Ample scope of reward and recognitions along with perks. What you can do for us: Compiles and maintains current and accurate data for all providers. Completes provider enrollment credentialing and re-credentialing applications; monitors applications and follows-up as needed. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. Build knowledge base for payer requirements and forms for multiple states Track license and certification expirations for all providers to ensure timely renewals. Prepare meeting agendas and minutes for client calls. Train credentialing specialist (if applicable). Audit work completed by other departments (delegation/CAQH/Data Entry/Group & provider set up). Provide monthly invoicing data. Generate and send sign pages/application to client. Report to management any detected problems, errors, and/or changes in provider enrollment requirements upon discovery. Your Qualifications: Education: Bachelor's degree preferred. Minimum 5 years of relevant experience in Credentialing in US Healthcare (RCM. Understanding and knowledge of the credentialing and provider enrollment process. Must be able to organize and prioritize work and manage multiple priorities. Excellent verbal and written communication skills including, letters, memos and emails. Excellent attention to detail. Ability for research and analyze data. Ability to work independently with minimal supervision. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization. Convinced? Submit your persuasive application now (including desired salary and earliest possible starting date).

Career Club Consultancy and Management Services is looking for Customer Service Representative- Only For Nashik Candidates Freshers to join our dynamic team and embark on a rewarding career journeyResponsible for handling customer inquiries and complaints, providing information and resolving issues in a prompt and friendly manner. Act as the first point of contact for customers and play a critical role in building and maintaining customer loyalty. The primary duties of a CSR include answering phone calls, responding to emails and chat requests, troubleshooting problems, and processing orders or returns. Good communication, interpersonal, and problem-solving skills are essential for this role.

Analyst Claims- Review and process property insurance claims, including analyzing policies, assessing damage, and determining coverage and settlements. Work with insurance adjusters, clients, and third-Frty vendors to gather necessary information and documentation for claims processing. Collation of data and information of claims for reporting purposes Investigate and evaluate claims to ensure accuracy and completeness. Prepare and present reports and recommendations to management regarding claims status, trends, and outcomes. Involvement in subrogation requests and required follow-ups. Communicate with clients and stakeholders regarding claims status and resolution. Provide support to other departments and teams as needed. What You Bring To The Role Bachelor's degree in business, finance, or related field. At least 3 years of experience in property insurance claims analysis. Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Detail-oriented with the ability to manage multiple tasks simultaneously. Proficient in Microsoft Office Suite and other relevant software programs. Knowledge of property insurance policies, procedures, and regulations. Other skills: Ability to work independently as well as be a team player. Able to take direction and ask questions. Strong organizational skills. Eye for detail. Resourcefulness. Excellent communication skills Mandatory Skills: Institutional_Finance_Buy_Side_Others. Experience1-3 Years.

Primary Responsibilities: Be able to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines Be able to review and analyze medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation Be able to extract and code various screening CPT codes and HCPCS codes from the documentation Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved in a timeframe that will assure compliance with regulatory and client guidelines Adherence with confidentiality and maintains security of systems Compliance with HIPAA policies and procedures for confidentiality of all patient records Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate Certified coder through AAPC or AHIMA Certifications accepted include CPC, CCS, CIC and COC Anyone Current coding certifications and must provide proof of certification with valid certification identification number during interview or Offer process Fresher & 7+ months of experience in Medical coding Sound knowledge in Medical Terminology, Human Anatomy and Physiology Knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems Proficient in ICD-10-CM, CPT, and HCPCS guidelines At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.

About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, and India. Our rightshore delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies Job Title: CSA and Senior CSA Grade: H1/H2 Job Category: Associate Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) Processing and data entry for routine types of physician and contract linkage transactions such as: Load new physician demographics and contract linkage using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Perform physician demographics and contract linkage data using the appropriate loading instruction guidelines (i.e. Managed Care Forms, Provider Data Loading Templates, etc.) Responsible for ensuring all data elements necessary to complete the request are provided and responds to the submitter with a detailed outline if additional information is needed Use desk-top macros whenever possible to ensure data loading accuracy and efficiency Send large requests capable of being automated as defined by management to the AST Provide excellent customer service to customers (physician, health plans, affiliates, delegates, insured, and all associated business partners) by: Quickly and accurately identifying and assessing customer needs and taking appropriate action steps to satisfy those needs Solve problems systematically using sound business judgment and following through on commitments using an automated approach whenever possible Respond to customers in a polite and professional manner Complete assigned work within established TAT and Quality metrics while remaining within downtime parameters to ensure customer satisfaction Key Results Production, Quality Shift and Schedule adherence Process Knowledge Role Holder Profile Preferred educational qualifications: Graduation (Any discipline - 3 years) without arrears. B. Preferred work experience: Minimum 6 months to 1 year of experience in Provided Data Management C. Skills and Competencies Mandatory knowledge in health care industry and PDM Working knowledge of systems platforms preferred PC skills (Power Point, Word, Excel, Access, Lotus Notes, Intranet) preferred Strong customer service orientation required i. Functional / Technical: ii. Behavioral: Shift Adherence Floor Decorum Interpersonal skills Team Player Interested candidates can walk-in directly and write HR Name Geethika or Ilyas on top of your resume.

POSITION: MEDICAL OFFICER/CONSULTANT 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 Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 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

We are hiring medical officers for cashless claims processing. Ideal candidates have 0-2 years in TPA/insurance with BAMS/BHMS. Strong medical knowledge and understanding of health policy terms are required.

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 year 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.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skills. Written and verbal communication. Collaboration and interpersonal skills. Ability to meet deadlines. Process-orientation Roles and Responsibilities: Your expected interactions are within your own team and direct supervisor. You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments. The decisions that you make would impact your own work. You will be an individual contributor as a part of a team, with a predetermined, focused scope of work. Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 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.Team prepares a case studyGroup disability coverage is tied to employment. If change or loss of job, the coverage is not portable. The cost of group coverage can also change from year to year. It is a sort of insurance that pays out if a policyholder is unable to work and earn an income due to a disability. What are we looking for Problem-solving skillsWritten and verbal communicationCollaboration and interpersonal skillsAbility to meet deadlinesProcess-orientation Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

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 Ability to establish strong client relationshipAbility to handle disputesAbility to manage multiple stakeholdersAbility to meet deadlinesAbility to perform under pressure- 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

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS, B.sc Nursing, BPT mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in