671 Claims Processing Jobs

Interacting with patients in a compassionate and empathetic manner, explaining the purpose of the sleep test, and providing clear instructions on how to use the device properly Setting up the sleep testing device at the patient's home, ensuring it is functioning correctly, and providing thorough instructions on how to operate it safely and effectively Troubleshooting and Repairs: Diagnose technical issues with medical devices, identify root causes, and implement timely repairs to minimize downtime

Oversee billing workflows, billing accuracy, compliance with payer and regulatory guidelines. SME in Practice Mgt (PM), Billing, PM software, payer portals, clearinghouses. POC & supports project mgt for billing onboarding for new practices in RCM

Good Knowledge in insurance cashless process in Hospital Exp : 2-4 yrs Qualification : Any Graduate Interested candidate please share your CV on hr1.jh@mmfhospitals.in Mrunalini.S 02041096690 / 8657171616

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Looking for voice process only. Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : kowsalya.k HR (8122343331)

Graduate 7-8 years of relevant exp Responsible for end-to-end claims adjustor Flexible with rotational shifts Excellent communication skills

Mandatory Skill : Facets and EDI- X12 transactions (837, 834 &835) , EDI transactions including enrolment, claims eligibility, health insurance process like claims & enrolment 3 + Years of Experience in Software testing in Health insurance domain Strong understanding of health insurance process like claims & enrolment Strong knowledge on Customer facing applications Develop test cases/scenarios for Facets and EDI- X12 transactions (837, 834 &835) X12 segment and Looping structure validations against the Healthcare standards including, HIPPA and SNIP level validations to be verified Perform Detailed testing on EDI transactions including enrolment, claims eligibility and provider data Validate Facets benefit plans, claims processing and pre/post adjudication rules. Work closely with Business analysts and developers to understand business requirements/user stories Proficiency in SQL for data validation Good to have Defect Management tools like JIRA/Rally/ADO Strong Analytical and problem solving Excellent Verbal and written communication skills Health care Certifications are added advantage

To be liaison between the patient, the hospital, and TPA, managing claim processing by coordinating with the TPA to facilitate timely claim settlements and patient billing, all while adhering to insurance guidelines and regulations.

Primary Responsibilities: Achievement of individual productivity and quality standards Contribute to working on Volumes when required and asked by the Management or Stakeholder Examining and identifying overpayments in claims, securing savings through recovery, and communicating effectively (in both written and spoken forms) to confirm and retrieve overpayments. Keeping recovery records updated with accurate information and documentation is also required Be able to learn and adapt to various claim system platforms and analyze claim payments for validation of potential other payor liability 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: 2+ years of experience using E&I & M&R claims platform 2+ years of health care experience working with claims data and / or medical codes 2+ years of experience with medical claims auditing and researching medical claims information 2+ years of experience working with processing and reviewing medical claims platforms Experience analyzing large data sets to determine trends or patterns Experience reading and interpreting clinical coding guidelines, provider contracts, fee schedules, and claim payment policies Experience within the UHC healthcare environment and systems Knowledge and understanding of medical claims terminology, CPT-4, J-codes, and ICD Diagnosis procedure codes Computer proficiency in Microsoft Office including Word (create documents), Excel (data entry) and Outlook (send email / calendar utilization) Proven ability to work under high production and quality standards 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. #njp #SSCorp

Hands on experience in at least one of the Guidewire products (Claim/Policy/Billing) Should have knowledge on Admin data loading. Good knowledge in Web services, XML, GxModel, Messaging, Batch implementation, Integrating with 3rd Party Systems and Document composition tools like Xpressions, Thunderhead Experience on any database Oracle / SQL Server and well versed in SQL Designed & modified existing workflows (required for Billing Integration) Experience in SCRUM Agile, prefer Certified Scrum Master (CSM) Good written and oral communication. Works in the area of Software Engineering, which encompasses the development, maintenance and optimization of software solutions/applications.1. Applies scientific methods to analyse and solve software engineering problems.2. He/she is responsible for the development and application of software engineering practice and knowledge, in research, design, development and maintenance.3. His/her work requires the exercise of original thought and judgement and the ability to supervise the technical and administrative work of other software engineers.4. The software engineer builds skills and expertise of his/her software engineering discipline to reach standard software engineer skills expectations for the applicable role, as defined in Professional Communities.5. The software engineer collaborates and acts as team player with other software engineers and stakeholders. Mandatory Skill Hands on experience in at least one of the Guidewire products (Claim/Policy/Billing) Should have knowledge on Admin data loading. Good knowledge in Web services, XML, GxModel, Messaging, Batch implementation, Integrating with 3rd Party Systems and Document composition tools like Xpressions, Thunderhead Skills (competencies) Verbal Communication JavaScript API integration Policy Development Critical Thinking

Job description R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work Fo2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices 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. Responsibilities: Follow up with the payer to check on claim status. Responsible for calling insurance companies in USA on behalf of doctors/physicians and follow up on outstanding accounts receivables. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Candidates must be comfortable with calling on denied claims. Interview Details: Interview Mode: Face-to-Face Interview Walk-in Day : 28th June, Friday Walk in Timings : 1 PM to 4 PM Walk in Address: Candor Tech Space Tower No. 3, 6th Floor, Plot 20 & 21, Sector 135, Noida, Uttar Pradesh 201304 Contact Person-Nasar Arshi 926377969 We are hiring for RCM/US Healthcare experience only Desired Candidate Profile: Candidate must possess good communication skills. Only Immediate Joiners can apply & Candidate must be comfortable working for Gurgaon location. Provident Fund (PF) Deduction is mandatory from the organization worked. B. Tech/B.E/LLB/B.SC Biotech or Candidates Pursuing regular Graduation/Post Graduation aren't eligible for the Interview. Undergraduate (People who are not a graduate) should have Min. 12 Months Exp. Candidate should have at least 12 months of RCM experience. Benefits and Amenities: 5 days working. Both Side Transport Facility and Meal. Apart from development, and engagement programs, R1 offers transportation facility to all its employees. There is specific focus on female security who work round-the-clock, be it in office premises or transport/ cab services. There is 24x7 medical support available at all office locations and R1 provides Mediclaim insurance for you and your dependents. All R1 employees are covered under term-life insurance and personal accidental insurance.

As a Claim Adjudication AGM you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator.Role Supervise claim adjudication staff to ensure claims are processed efficiently and accurately. Review complex or escalated claims and make final decisions on approvals or denials. Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers). Monitor team performance using KPIs (turnaround time, accuracy rate, etc.). Collaborate with medical coding, billing, provider relations, and legal teams as needed. Handle audits, quality assurance, and process improvement initiatives . Open for WFO/ Noida Extension Location/ Night shifts. Please share CV at annu.misra@rsystems.com

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 Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Preferences for this role include: 1.5+ 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. 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. Both Under Graduates and Postgraduates 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.

RESPONSIBILITIES *Responding to Customers' Needs. ~Keeping an Eye on Trends and Monitoring Competition. *Communicating work and brand values with Marketing Team. *Developing a Growth Strategy.

Greetings from Access Healthcare Minimum 1year of experience required Should have Knowledge in payer or provider experience Candidate should have good communication skills Basic knowledge on Revenue cycle management Salary as per company norms Ready to work in night shift Location : Chennai Interested candidates can drop your resume through WhatsApp - 9944497268/9043315031

Key Responsibilities: Assist in developing and implementing sales and marketing strategies to drive business growth. Conduct market research to identify potential clients and market trends. Support the creation of promotional materials, including presentations and social media content. Engage with clients through various channels, understanding their needs and providing product information. Participate in sales meetings and contribute ideas for improving team performance. Maintain accurate records of sales activities and customer interactions. Collaborate with team members to achieve monthly and quarterly sales targets. Criteria :- Female Candidate only Age - 18-25 Immediate joinner Fresher will be preffered Location: Dombivli,Panvel,Karjat Contact no. - 9324483283

Caliber Organisation is a leading client servicing company, catering to esteemed organizations such as UNICEF, IndusInd Bank, Axis Bank, AU Small Finance Bank, and HDFC Bank. We are committed to nurturing talent and providing a platform for career growth. As a Business Leader , you will undergo comprehensive on-the-job training to gain in-depth knowledge of our organization and industry, with the opportunity to advance to higher positions based on performance. We are seeking highly motivated and ambitious FRESHERS to join our team as Marketing Team Leader. The role involves intensive training, exposure to various aspects of the organization, and the potential to lead a team based on individual performance. Designation: We are hiring for theTeam leader position. The trajectory of growth within the organization includes advancement into roles focused on Business Development and Business Management, offering ample opportunities for professional development and career progression. Location:Dombivli,Panvel

Here, the only person to stop you from succeeding is you As one of the most progressive sales and marketing companies we specialise in providing the clients we represent with an outsourced sales solution. With expanding demand comes expansion and we are currently opening 5 new offices around Mumbai in the coming 12 months and are recruiting for Business Management Officer Unlimited career growth Valuable skills that are highly transferable Weekly earnings and attractive incentives Be part of a high charged, motivated & fun environment Be part of a team-oriented and fun environment 1) Training and Developing team members to develop a high performance culture. 2) Training & imparting knowledge on sales and marketing techniques 3) Expanding Business across country 4) Customer Acquisition & Promotion: Acting as a point of contact on behalf of the client for promotion & brand development. 5) Expanding Business & mapping of new market segments in new territories across India. 6) Looking forward to people who have good command over English & local language. 7) To meet sales and performance expectations 8) Train and develop associates on regular basis Location: Thane,Mumbai,Navi Mumbai,Kalyan/Dombivli,MUMBAI ALL AREAS CONTACT ON: 9324483283

You will be handling the specific part of market which will be assigned by the company. You would have to meet the client at their work space and give corporate Presentation about the product, doing negotiation by communicating with patience and by solving their query. Having Strong interpersonal skill is must for dealing with the clients and need to be self motivated. Skills Required: Contributes to team effort by accomplishing related results as needed. Maintains quality service by establishing and enforcing organization standards. Identifies product improvements or new products by remaining current on industry trends, market activities, and competitors. Maintains relationships with clients by providing support, information, and guidance; researching and recommending new opportunities; recommending profit and service improvements. Sells products by establishing contact and developing relationships with clients. Criteria: Immediate joiner Age - 18 to 25 Location - Mumbai all areas, Mumbai Suburbs, kalyan,Dombivli,Panvel

We train and develop freshers at different level of BUSINESS giving them an exposure in marketing,management, team handling, client servicing, training & Development, Accounts and Finance. Job Role- * Working for business management and development profile for clients. * Training and developing people in business management and development * Managing clients and providing the best services * Doing B2B campaigns for business management and development * Organizing events, seminars and workshop at corporate level * Maintaining relationship with HNI Clients and customers * Handling a team of 20-25 associate Required Candidate profile *Graduates & post Graduates who aspires to build themselves as leaders in the industry *Dynamic & Hardworking *Ambitious & Positive Thinker * Freshers can Apply * Post Graduate/Graduate Freshers Location-Thane,Mumbai,Navi Mumbai,Mumbai All Areas, Kalyan/Dombivli

Required Candidate profile Caliber Organisation is a leading client servicing company, catering to esteemed organizations such as UNICEF, IndusInd Bank, Axis Bank, AU Small Finance Bank, and HDFC Bank. We are committed to nurturing talent and providing a platform for career growth. As a Management Trainee, you will undergo comprehensive on-the-job training to gain in-depth knowledge of our organization and industry, with the opportunity to advance to higher positions based on performance. Location- Thane,Navi Mumbai,Mumbai,Dombivli,Panvel,Karjat,mumbai all areas, MUMBAI SUBURBS, kalyan Desired Candidate Profile *Dynamic & Hardworking *Freshers *Excellent Interpersonal and Communication skills *Graduate & Post Graduate Freshers *Freshers willing to get trained in all the areas of management.

Management freshers into sales marketing PR -Brand awareness/ customer acquisition -Developing team and providiing and providing effective trainiing -mentoring & managing team to achieve desired performance -understanding financial aspects REQUIRED CANDIDATE PROFILE -Creative & positive -well groomed -GOOD ETIQUETTE -willingness to learn -training provided -has a smile & great leadership qualities *Age 18-27 *Freshers can apply *Immediate joiner Locations : thane, navi mumbai, mumbai all areas, MUMBAI SUBURBS, MUMBAI, kalyan, dombivli, panvel,

: JD Our values define the working environment we strive to create diverse, supportive and welcoming of different views. We embrace a culture reflecting a variety of perspectives, insights and backgrounds to drive innovation. We build talented and diverse teams to drive business results and encourage our people to develop to their full potential. Talk to us about flexible work arrangements and other initiatives we offer. We promote good working relationships and encourage high standards of conduct and work performance. We welcome applications from talented people from all cultures, countries, races, genders, sexual orientations, disabilities, beliefs and generations and are committed to providing a working environment free from harassment, discrimination and retaliation. Visit Inside Deutsche Bankto discover more about the culture of Deutsche Bank including Diversity, Equity & Inclusion, Leadership, Learning, Future of Work and more besides.

Job description Quality Auditor - Claims Adjudication Location : Navalur,Chennai Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 3-8 years of excellent knowledge on client specifics and experience in all types of Claims Adjudication. Good experience in Quality team handling. Perform quality review of claims based on the documentation provided by client to ensure claim output meets all customer specifications Collects all findings during the audits and perform effective root cause analysis along with examiners & ops supervisors Generate multiple level of analysis from the audit findings and identify opportunities to improve overall process Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Conduct 1-0-1 coaching / feedback on specific error scenarios Provide suggestions to Trainer and Ops on the slow performers who needs additional coaching / re-training on specific areas Tracks all feedback from client and provide constructive information to agents during daily quality team huddle Participates in client knowledge calibration exercise Understanding Client P&Ps and auditing documents / claims based on instruction guidelines. Record audit findings and prepare audit reports and circulate quality dashboard Organize ILP review meeting and quality briefings to update associates on any quality issues Analyze internal/client feedback and respond with details Handling Feedback sessions efficiently. Interested Candidates share your CV - deepalakshmi.rrr@firstsource.com / 8637451071 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 deepalakshmi@firstsource.com email addresses.

Responsibilities: • Analyze and evaluate workers's compensation claim payments using client proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state workers compensation fee schedule and/or PPO contract. Research, request and acquire all pertinent medical records, implant manufacturers invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement. Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement. Prepare correct Workers Comp initial bill packet or appeal letter using Client systems tools and submit with all necessary supporting documentation to insurance companies. Other duties as required. Education: Diploma / Bachelors Degree in any discipline. Experience: • Experience working for a US based BPO OR US healthcare insurance industry experience OR a similar experience recommended. • Competent in MS Office Suite and Windows applications. Skills and Prerequisites: • Strong verbal communication skills. • Fast and accurate typing skills while maintaining a conversation. • Multitasking of data entry while conversing with Client contacts and insurance companies. • Ability to professionally and confidently communicate to outside parties via phone, email and fax. • Ability to handle large volumes of work while maintaining attention to detail. • Ability to work in a fast-paced environment. • Work under limited supervision, manage multiple tasks and prioritize assignments within limited time constraints. • Effectively communicate issues/problems and results that impact timelines for project completion. • Ability to interact professionally at multiple levels within the organization. • Timely and regular attendance.

1) Preparing and submitting billing data and medical claims to insurance companies 2) Generate revenue by making payment arrangements, collecting accounts and monitoring and pursuing delinquent accounts 3) Collect delinquent accounts by establishing payment arrangements with patients, monitoring payments and following up with patients when payment lapses occur 4) Utilize collection agencies and small claims courts to collect accounts by evaluating and selecting collection agencies, determining the appropriateness of pursuing legal remedies and testifying in court cases, when necessary 5) Ensuring each patients medical information is accurate and up-to-date 6) Preparing bills and invoices and document amounts due to medical procedures and services 7) Good expertise in AR Aging 8) Doing charge and Payment Posting 9) All the End to End process of Medical Billing Please share your updated CV with the Acknowledgement Role & responsibilities Benefits 5 Days Working Medical + Accident Insurance On-site Yoga, Gym, Sports, and Bhagwat Geeta Session Excellent Work-life balance Annual one-day Trip All festival Celebration US Shift (Timings is 5:30 PM to 3:00 AM)