751 Claims Processing Jobs - Page 22

Walk-In Drive on 7th June 2025 at Cotiviti -Pune for Healthcare Audit Walk-In Date: 7-June-2025 (Saturday) Time 9:00 Am 1:00 Pm Venue: Cotiviti India Pvt Ltd Plot C, Podium Floor, Binarius/Deepak Complex, Opposite Golf Course, Yerwada, Pune- 411006. We are hiring for the Healthcare Data Audit process at Cotiviti. Please refer to the information below and required skill set for the same. POSITION SUMMARY: Specialist Payment Accuracy position is an entry level position responsible for auditing client data and validating claim accuracy. Communicates audit recommendations and outcomes to supervisory auditor for evaluation, verification and continuous learning. POSITION REQUIREMENTS: Graduation mandatory. Excellent communication skills. US Healthcare experience is preferred. Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred Strong interest in working with large data sets and various databases Must be flexible working in fixed/rotational shifts Immediate joiners preferred Good energy and Positive attitude Long Term Career Orientation If the above profile interests you then please walk-in for the interview. Please refer to the above mentioned walk-in details. Please bring your updated Resume along with an ID Proof. Best regards, Atish Chintalwar Senior Executive Human Resource COTIVITI About Cotiviti: Cotiviti is a leading healthcare solutions and analytics company headquartered in the United States, with more than 10000 employees in offices across the U U.S., Canada, Australia, India, Nepal, Philippines & Mexico. Cotiviti has been in business for more than two decades (including predecessor companies), and our solutions have been well proven and tested. Our clients are primarily health insurance companies, including U.S. government payers, although healthcare providers, employers, and insurance brokers also use our solutions. In fact, we support almost every major health plan in the U.S. and more than 180 healthcare payers in total. We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and helping our clients discover ways they can improve efficiency and quality. In addition to healthcare, we support the largest and most influential retailers in the industry, including mass merchandisers, across the U.S., Canada, United Kingdom, Europe and Latin America. Our data management recovery audit services have helped them save hundreds of millions of dollars.

Level : SME Job Location : Chennai Shift : US Shift Experience : 6 Years for SME Notice : Immediate Joiner Qualification : Graduate (non tech) Notice : Immediate Joiner Excellent Communication Share resume on- archi.g@manningconsulting.in Contact-8302372009

Ready to shape the future of work? At Genpact, we don't just adapt to change we drive it. AI and digital innovation are redefining industries and were leading the charge. Genpacts AI Gigafactory, our industry-first accelerator, is an example of how were scaling advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. From large-scale models to agentic AI, our breakthrough solutions tackle companies most complex challenges. If you thrive in a fast-moving, tech-driven environment, love solving real-world problems, and want to be part of a team that's shaping the future, this is your moment. Genpact (NYSE: G) is an advanced technology services and solutions company that delivers lasting value for leading enterprises globally. Through our deep business knowledge, operational excellence, and cutting-edge solutions we help companies across industries get ahead and stay ahead. Powered by curiosity, courage, and innovation , our teams implement data, technology, and AI to create tomorrow, today. Get to know us at genpact.com and on LinkedIn, X, YouTube, and Facebook Genpact is hiring | Underwriting | Noida | physical drive on 31st May Interview Location: Genpact Headstrong Office, Noida sector 59, D-4, D Block, Sector 59, Noida, Uttar Pradesh 201301, near to sector 59 Metro Station. Date: 31-MAy-25 Time: 11:00 Am to 2:00 PM Skill Sets - US Mortgage, Underwriting, US Brokerage, Insurance, Backend Ops, Insurance, Property and Casualty, P&C Insurance, In this role, you will be responsible for Provide expert advice on commercial insurance products, risk management strategies, and regulatory requirements. Your expertise will be required to ensure that team members receive the best possible advice and solutions tailored to their specific needs. You will be required to interact and work with the client partners for all process/business knowledge related documents are updated periodically and team is made aware of the same in a timely manner. Should be open to work in any shift as per the business requirement Your role will require you to utilize your experience in and knowledge of insurance/reinsurance and underwriting processes to process transactions for the Underwriting Support Teams and communicate with the Onsite Team. Responsibilities * Perform necessary activities to support broking teams in collaborating with account management to initiate a renewal, preparing and submitting marketing proposals to underwriters, processing endorsements and policy checking along with other requests * Identify and retrieve relevant compliance documentation necessary to process new policies and policy renewals, changes, additions, deletions and cancellations. * Calculating adjustments and premiums on policies and other insurance documents. * Ensure repository of record is accurate and current to ensure outputs and client deliverables will be produced according to guidelines and policy detail. * Communicating directly with underwriters/brokers/account executives to follow up or obtain additional information. * Monitor and attend to requests via client service platform that require action in a timely manner. * Help colleagues troubleshoot and resolve basic issues and perform other related duties as required. Qualifications we seek in you! Minimum Qualifications * Graduate with an excellent interpersonal, communication and presentation skills, both verbal and written * Relevant and meaningful years of experience of working in US P&C insurance lifecycle - pre-placement, placement, and post-placement activities (such as endorsements processing, policy administration, policy checking, policy issuance, quoting, renewal prep, submissions, surplus lines, licensing, agency admin, inspections and so on. * Demonstrate and cultivate customer focus, collaboration, accountability, initiative, and innovation. * Proficient in English language- both written (Email writing) and verbal * A strong attention to detail; analytical skills and the ability to multi-task are important Preferred Qualification and Experience * Relevant years of insurance experience and domain knowledge, especially P&C insurance * Candidate having Broker (US P&C insurance) experience would be an asset * Proficient with Microsoft Office (Word, PowerPoint, Excel, OneNote) * A strong attention to detail; analytical skills and the ability to multi-task are important * Should be a team player with previous work experience in an office environment required * Client focused with proven relationship building skills * Ability to work collaboratively as a key member of a team and independently with minimum supervision * Highly organized with a proven ability to prioritize competing requirements and deadlines under pressure Why join Genpact? Be a transformation leader Work at the cutting edge of AI, automation, and digital innovation Make an impact Drive change for global enterprises and solve business challenges that matter Accelerate your career Get hands-on experience, mentorship, and continuous learning opportunities Work with the best Join 140,000+ bold thinkers and problem-solvers who push boundaries every day Thrive in a values-driven culture Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress Come join the tech shapers and growth makers at Genpact and take your career in the only direction that matters: Up. Lets build tomorrow together. Genpact is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion or belief, sex, age, national origin, citizenship status, marital status, military/veteran status, genetic information, sexual orientation, gender identity, physical or mental disability or any other characteristic protected by applicable laws. Genpact is committed to creating a dynamic work environment that values respect and integrity, customer focus, and innovation. Furthermore, please do note that Genpact does not charge fees to process job applications and applicants are not required to pay to participate in our hiring process in any other way. Examples of such scams include purchasing a 'starter kit,' paying to apply, or purchasing equipment or training.

Ready to shape the future of work? At Genpact, we don't just adapt to change we drive it. AI and digital innovation are redefining industries and were leading the charge. Genpacts AI Gigafactory, our industry-first accelerator, is an example of how were scaling advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. From large-scale models to agentic AI, our breakthrough solutions tackle companies most complex challenges. If you thrive in a fast-moving, tech-driven environment, love solving real-world problems, and want to be part of a team thats shaping the future, this is your moment. Genpact (NYSE: G) is an advanced technology services and solutions company that delivers lasting value for leading enterprises globally. Through our deep business knowledge, operational excellence, and cutting-edge solutions we help companies across industries get ahead and stay ahead. Powered by curiosity, courage, and innovation , our teams implement data, technology, and AI to create tomorrow, today. Get to know us at genpact.com and on LinkedIn, X, YouTube, and Facebook Genpact Mega Walk-In drive for Insurance & Underwriting roles on 31st May 2025 (Saturday)_ Noida location *Walkin Date: 31-May-2025 (Saturday) *Walkin time: 12 PM - 1 PM *Venue details: Genpact Headstrong Office, Noida sector 59, D-4, D Block, Sector 59, Noida, Uttar Pradesh 201301 *Graduation: Any graduate is eligible except law *Work experience: 0 - 4 yrs (previous exp. in insurance is required) *Shift: US Only work from office Skill Sets - US Mortgage, Underwriting, US Brokerage, Insurance, Backend Ops, Insurance, Property and Casualty, P&C Insurance, In this role, you will be responsible for Provide expert advice on commercial insurance products, risk management strategies, and regulatory requirements. Your expertise will be required to ensure that team members receive the best possible advice and solutions tailored to their specific needs. You will be required to interact and work with the client partners for all process/business knowledge related documents are updated periodically and team is made aware of the same in a timely manner. Responsibilities Manage and resolve basic inquiries associated with all aspects of Client Services and service delivery (e.g. output delivery, basic broking inquiries, etc.). Communicating directly with underwriters/brokers/account executives to follow up or obtain additional information. Conduct training sessions for employees to enhance their understanding of commercial insurance principles and practices. Act as a liaison between clients and team members to ensure smooth communication related to updates, and inquiry responses received from client SMEs. Maintain accurate records of client interactions and knowledge material Conduct monthly knowledge assessment tests and TNI (training need identification) Ensure all controls are followed, existing exceptions are reviewed, and duplicate policies are reported before processing any transaction. Ability to handle varied volumes of workloads and to reach targets and deadlines on a timely basis. Lead by example by demonstrating and sharing knowledge with all lines of business the importance of best practices and acting as the subject matter expert to all operational and procedural activities for the Broking operations team Qualifications we seek in you! Minimum qualifications Graduate in any stream (except law) Relevant and meaningful years of experience of working in US P&C insurance lifecycle pre-placement, placement, and post-placement activities (such as endorsements processing, policy administration, policy checking, policy issuance, quoting, renewal prep, submissions, surplus lines, licensing, agency admin, inspections and so on. Demonstrate and cultivate customer focus, collaboration, accountability, initiative, and innovation. Proficient in English language- both written (Email writing) and verbal A strong attention to detail; analytical skills and the ability to multi-task are important Preferred Qualification and Experience An Insurance Certification would be an edge Awareness about Property & Casualty insurance regulation and anomalies will be preferred Relevant years of insurance experience and domain knowledge, especially P&C insurance Candidate having Broker (US P&C insurance) experience would be an asset Proficient with Microsoft Office (Word, PowerPoint, Excel, OneNote) A strong attention to detail; analytical skills and the ability to multi-task are important Should be a team player with previous work experience in an office environment required Client focused with proven relationship building skills Ability to work collaboratively as a key member of a team and independently with minimum supervision Highly organized with a proven ability to prioritize competing requirements and deadlines under pressure Why join Genpact? Be a transformation leader Work at the cutting edge of AI, automation, and digital innovation Make an impact Drive change for global enterprises and solve business challenges that matter Accelerate your career Get hands-on experience, mentorship, and continuous learning opportunities Work with the best Join 140,000+ bold thinkers and problem-solvers who push boundaries every day Thrive in a values-driven culture Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress Come join the tech shapers and growth makers at Genpact and take your career in the only direction that matters: Up. Lets build tomorrow together. Genpact is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion or belief, sex, age, national origin, citizenship status, marital status, military/veteran status, genetic information, sexual orientation, gender identity, physical or mental disability or any other characteristic protected by applicable laws. Genpact is committed to creating a dynamic work environment that values respect and integrity, customer focus, and innovation. Furthermore, please do note that Genpact does not charge fees to process job applications and applicants are not required to pay to participate in our hiring process in any other way. Examples of such scams include purchasing a 'starter kit,' paying to apply, or purchasing equipment or training.

Graduation is mandatory (any stream expect B.Tech & B.E). Shift Time:5:30 PM to 2:30 AM IST Fixed Saturday and Sunday Off. Basic computer proficiency. Excellent communication skill Work from office Location: Nagpur

Role & responsibilities Manage insurance claims from receipt to settlement, ensuring timely processing and resolution. Coordinate with TPAs (Third Party Administrators) for claim adjudication and settlement. Handle mediclaim claims, health insurance claims, and other types of general insurance policies. Ensure accurate billing and reconciliation of patient accounts. Maintain records of all interactions with patients, providers, and insurers. Preferred candidate profile 5-8 years of experience in insurance coordination or TPA coordination role. Strong knowledge of insurance billing, claims processing, and claims settlement procedures. Proficiency in handling multiple tasks simultaneously under tight deadlines. Excellent communication skills for effective interaction with customers (patients), providers (hospitals), and insurers. Perks and benefits As per industry

Skill required: Claims Services - Payer Claims Processing Designation: Health Admin Services New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.Business solutions that support the healthcare claim function, leveraging a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims. What are we looking for? Us shiftsQuick learner 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 Qualifications Any Graduation

Project Role : Business Architect Project Role Description : Define opportunities to create tangible business value for the client by leading current state assessments and identifying high level customer requirements, defining the business solutions and structures needed to realize these opportunities, and developing business case to achieve the vision. Must have skills : GuideWire ClaimCenter Good to have skills : NA Minimum 7.5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As a Business Architect, you will be responsible for leading current state assessments and identifying high-level customer requirements, defining the business solutions and structures needed to realize these opportunities, and developing a business case to achieve the vision. Your typical day will involve working with GuideWire ClaimCenter and collaborating with cross-functional teams to create tangible business value for the client. Roles & Responsibilities: Lead current state assessments and identify high-level customer requirements. Define the business solutions and structures needed to realize opportunities. Develop a business case to achieve the vision. Collaborate with cross-functional teams to create tangible business value for the client. Utilize expertise in GuideWire ClaimCenter to deliver impactful solutions. Work directly with the client gathering requirements to align technology with business strategy and goals GuideWire ClaimCenter ie FNOL, claim closure, exposures, reserves Good experience in Property and Casualty Working knowledge of SOAP / REST web service - Should be able to create/ consume the web services in Java - Understanding of XML, XSD Knowledge of messaging, pluginsProfessional & Technical Skills: Must To Have Skills:Expertise in GuideWire ClaimCenter. Good To Have Skills:Experience in business architecture and solution design. Strong understanding of business processes and requirements gathering. Experience in developing business cases and delivering impactful solutions. Excellent communication and collaboration skills. Good to have Guidewire Developer in Integration/ Configuration, GOSU scripting and Java Enterprise Edition Good to have Experts internally and externally for their deep functional or industry expertise, domain knowledge, or offering expertise Basic SQL and Database knowledge Additional Information: The candidate should have a minimum of 7.5 years of experience in business architecture and solution design. The ideal candidate will possess a strong educational background in business, technology, or a related field, along with a proven track record of delivering impactful solutions. This position is based at our Bengaluru office. Qualifications 15 years full time education

Skill required: Delivery - Warranty Management Designation: I&F Decision Sci Practitioner Sr Analyst Qualifications: Any Graduation Years of Experience: 5 to 8 years What would you do? Data & AIIn Warranty Management, you will be working on defining warranty offerings; run outsourced after-sales warranty support and entitlement programs; evaluate customer feedback and planned versus actual costs of warranty coverage; use warranty data analytics to reduce cost and improve product quality; increase recoveries from suppliers and design and deploy warranty solutions. The team also works on the verification and analysis of warranty claims based on available and external resources - a portal with supporting information. What are we looking for? Warranty/ Analytics/ Automobile Data Analysis Business Intelligence Reporting Scripting Adaptable and flexible Ability to work well in a team Commitment to quality Agility for quick learning Written and verbal communicationPython, SQL, ML Roles and Responsibilities: In this role you are required to do analysis and solving of increasingly complex problems Your day-to-day interactions are with peers within Accenture You are likely to have some interaction with clients and/or Accenture management You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments Decisions that are made by you impact your own work and may impact the work of others In this role you would be an individual contributor and/or oversee a small work effort and/or team Qualifications Any Graduation

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 If candidates are interested please drop your update resume/CV on my Mail ID - varsha.kumari@mediassist.in Thanks & Regards Varsha Kumari Email - varsha.kumari@mediassist.in

The Digital :Guidewire ClaimCenter, Guidewire :ClaimCenter - Domain role involves working with relevant technologies, ensuring smooth operations, and contributing to business objectives. Responsibilities include analysis, development, implementation, and troubleshooting within the Digital :Guidewire ClaimCenter, Guidewire :ClaimCenter - Domain domain.

TPA Empanelment's Claim Processing Corporate Tie- ups

Job Title: Pega Senior System Architect (SSA) with SCE Experience Experience: 5 + yrs Key Responsibilities: Pega Application Development: Assist in the design and development of Pega applications for claims processing, ensuring alignment with business requirements and best practices. Configure and customize Pega applications using Pega BPM and case management capabilities, working under the guidance of senior architects. Smart Claims Engine (SCE) Integration: Support the integration of Pega applications with Smart Claims Engine (SCE) and other third-party healthcare systems. Participate in the design and implementation of workflows and decision rules within the claims management lifecycle. Technical Problem Solving: Troubleshoot issues within Pega applications and SCE integrations, identifying root causes and proposing effective solutions. Participate in debugging and resolving defects in the claims processing workflow. Collaboration with Teams: Collaborate with business analysts, developers, and testers to ensure the successful delivery of features related to SCE. Work closely with senior architects to design technical solutions that meet project requirements and ensure system scalability and reliability. Code Quality & Best Practices: Adhere to coding standards and best practices set by senior architects and the development team. Participate in code reviews and contribute to the development of reusable components and frameworks. Agile Development: Participate in Agile ceremonies, including sprint planning, daily stand-ups, and retrospectives, to ensure timely delivery of product features. Documentation: Assist in the creation and maintenance of technical documentation, including design specifications, user stories, and test cases. Document system changes, configurations, and enhancements to ensure transparency and ease of knowledge transfer. Qualifications: Experience: Minimum of 6 years of experience in Pega development, with a focus on case management and business process management (BPM). Experience with Smart Claims Engine (SCE) or similar healthcare claims management systems is highly preferred. Technical Skills: Hands-on experience with Pega 8.x or later, including configuration and customization of Pega applications. Knowledge of integrating Pega applications with third-party systems, including healthcare data exchange standards (e.g., HL7, FHIR). Experience with decision rules, user interface design, and business logic in Pega. Strong problem-solving skills and experience debugging Pega applications. Soft Skills: Ability to collaborate effectively with cross-functional teams and communicate complex technical issues to non-technical stakeholders. Strong analytical skills, attention to detail, and ability to adapt to changing requirements. Willingness to learn and grow within the Pega platform and healthcare domain. Healthcare Knowledge: Familiarity with healthcare claims processing, payer systems, and industry regulations (e.g., HIPAA) is a plus. Certifications: Pega Certified Senior System Architect (SSA) or equivalent certification is a plus Preferred Skills: Experience with Agile methodologies (e.g., Scrum, Kanban). Familiarity with Pega integration frameworks and tools (e.g., Pega REST API, SOAP services). Experience with SQL and relational databases (e.g., Oracle, MySQL).

The Guide Wire Policy Center role involves working with relevant technologies, ensuring smooth operations, and contributing to business objectives. Responsibilities include analysis, development, implementation, and troubleshooting within the Guide Wire Policy Center domain.

Role Description Overview: The AR Associate / Associate - RCM (AR) is accountable to manage day to day activities of Denials Processing/ Claims follow-up/ Customer Service Responsibility Areas: To review emails for any updates Call Insurance carrier document the notes in software and spreadsheet and take appropriate action Identify issues and escalate the same to the immediate supervisor Update Production logs Required Qualification: Any Graduates / Non-Graduates (Graduation Not Mandatory) / 10th (SSLC) + 12th (HSC) / 10th (SSLC) + Diploma (3 years) can apply Note: Students with backlogs in UG can also apply. College dropouts can also apply. Desired Profile: Understand the client requirements and specifications of the project Meet the productivity targets of clients within the stipulated time. Ensure that the deliverable to the client adhere to the quality standards. Ensure follow up on pending claims. Prepare and Maintain status reports Should be comfortable to work in night shifts Skills Required: Excellent Communication Skills Basic Computer Skills RCM Knowledge (PB/HB) Greetings from CorroHealth !! We have huge openings for Experienced Charge Entry Candidates. (1 - 5 Years). Interview Process : Walk-In Experience : 1 year to 5 years (Should have relevant experience in Charge Entry) Salary: Best In Industry Responsibility Areas : To review emails for any updates Correcting Claims and Charges. Required Qualification : Any Graduates / Non-Graduates (Graduation Not Mandatory) / 10th (SSLC) + 12th (HSC) / 10th (SSLC) + Diploma (3 years) can apply Note: Students with backlogs in UG can also apply. College dropouts can also apply. Desired Profile: Understand the client requirements and specifications of the project Meet the productivity targets of clients within the stipulated time. Ensure that the deliverable to the client adhere to the quality standards. Must have experience with Charge Entry Role. Skills Required: Good Communication Skills Basic Computer Skills RCM Knowledge *If Interested kindly reach out to us : HR Sama Parveen- Sama.Parveen@corrohealth.com HR Atul Kumar Singh- Atulkumar.Singh@corrohealth.com/ 9150095046

About Us At CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities, and shareholders every day. One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We are devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being. CIGNA Healthcare believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization. Working at CIGNA Healthcare will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us! Process Overview* International insurance claims processing for Member claims. * Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles. Responsibilities- Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. Monitor and highlight high-cost claims and ensure relevant parties are aware. Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable. Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. Interface effectively with internal and external customers to resolve customer issues. Identify potential process improvements and make recommendations to team senior. Actively support other team members and provide resource to enable all team goals to be achieved. Work across International business in line with service needs. Carry out other ad hoc tasks as required in meeting business needs. Work cohesively in a team environment. Adhere to policies and practices, training, and certification requirements. Requirements*: Working knowledge of the insurance industry and relevant federal and state regulations. Good English language communication skills, both verbal and written. Computer literate and proficient in MS Office. Excellent critical thinking and decision-making skills. Ability to meet/exceed targets and manage multiple priorities. Must possess excellent attention to detail, with a high level of accuracy. Strong interpersonal skills. Strong customer focus with ability to identify and solve problems. Ability to work under own initiative and proactive in recommending and implementing process improvements. Ability to organise, prioritise and manage workflow to meet individual and team requirements. Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential. Education* Graduate (Any) - medical, Paramedical, Pharmacy or Nursing. Experience Range* Minimum 1 year of experience in healthcare services or processing of healthcare insurance claims. Foundational Skills* - Expertise in international insurance claims processing Work Timings* 7:30 am- 16:30 pm IST Job Location* Bengaluru (Bangalore) About The Cigna Group Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Coordinating and communicating with the stakeholders, which may include suppliers, and internal teams members. Closely following up, monitoring, updating the progress of activities, and identifying the areas of improvement to take necessary steps in order to achieve the targets, in the defined timeline. Solving the various queries and/or doubts received from stakeholders (predominantly suppliers), and providing them all the necessary required supports. Working on internal necessary applications associated with the activities. Preparing accurate summary of the latest status of the activities on daily and/or weekly and/or monthly basis. Qualifications Bachelors degree (B.A., B.Sc. BCA etc.) from an accredited college or university or Equivalent Should have two or more years of experience in relevant or equivalent field. Having the knowledge of the apparel industry (experience in production or quality audits background will be a plus) Basic knowledge of Microsoft applications including Word, Excel, PowerPoint etc Additional Information Focused and self-driven personality. Delivers commitment towards work, department, and theorganization. Personality with Honesty & Integrity. Flexibility and ability to work closely on timelines. Excellent planner and Organizer. Effective Communicator in English with convincing abilities.

: Preferred Knowledge/ Skills: Demonstrates extensive abilities and/or a proven record of executing the following areas: Guidewire PolicyCenter, development experience; Knowledge of P&C Insurance domain (Policy, Claims, and Billing applications as per product requirements); Designing, developing, modifying, and deploying software, including object-oriented programming concepts with using design standards and best practices; Planning, designing, developing, modifying, testing, debugging, and maintaining GOSU language application code within Guidewire Policy Center Configuring screen layouts, including creation of new screens (PCFs); Configuring operational and administration related parameters such as roles and permissions, user attributes regions, and activity patterns; Resolving issues identified during testing of the configuration requirements; Handling the responsibility of organizing code merges and environment management tasks; Performing minor and major Guidewire software upgrades; Developing GUnit/Junit tests for testing business logic; Managing projects, programs, and teams of various sizes; Architecting and creating solution designs and effectively presenting solution architecture with various options and estimates; Assisting in GOSU code reviews, code cleanups and helping to perform sprint demos; 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. - Grade Specific Technology: HTML. CSS,React.js, Guidewire Portal, Edge Framework, Jutro Framework, GOSU, API Certification(s) Preferred: Guidewire Certifications in PolicyCenter, Skills (competencies) Verbal Communication

Design, develop, and configure Policy Center, Claim Center, and Billing Center applications in Guidewire. Customize Guidewire applications to meet specific business needs, including creating and modifying workflows, rules, and integrations. Develop and maintain integrations between Guidewire applications and other systems using APIs and web services. Develop and execute test plans, perform unit testing, and ensure the quality of the solutions delivered. Provide ongoing support and troubleshooting for Guidewire applications, addressing any issues that arise in production. Create and maintain technical documentation, including design specifications, user guides, and process flows. Work closely with business analysts, project managers, and other stakeholders to gather requirements and ensure alignment with business objectives. 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. - Grade Specific Extensive experience with configuring and improving Policy Center, including workflows, rules, and integration points. Proficiency in developing and configuring Claim Center, including claim processing and integration with external systems. Strong background in Billing Center configuration and customization, including payment processing and billing rules. Expertise in using Guidewire Studio for application development and debugging. Basic project management skills to manage tasks and deliverables effectively. Strong verbal and written communication skills for collaboration with team members and stakeholders. Excellent problem-solving skills with the ability to think critically and troubleshoot issues efficiently. Skills (competencies) Verbal Communication

Job description Team Executive - Payment Integrity Location : Bangalore Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 9 years of experience in Claims Adjudication(Payment Integrity,PrePay audit,Postpay audit) . With over 1 year of experience as a Team leader Proven track record in managing processes, streamlining workflows and excellent people management skills. Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals. Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Adhering to various regulatory and compliance practices. Maintaining and Ownership of reports both internal as well as for the clients. Presenting the data and provide deep insights about the process to the clients as well as Internal Management. Managing and co - ordinating training programs. Excellent in Coaching and providing feedback to the team. Take necessary HR actions as part of the Performance Improvement Process Key Performance Indicators Ensuring that the key Service Level Agreements are met consistently without any exceptions. Leverage all Operational metrices to ensure that the Revenue and Profitability targets are met and exceeded . Work in tandem with all Business functions to ensure smooth business process. Retention of key team members 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.rrr@firstsource.com

Grow Your Career With AR Caller In US Healthcare (KPO) NO SALES ! NOTARGET ! #Shift: US Shift #5days working #Salary: UPTO30K CTC #Location: Ahmedabad, Gujarat #Cab facilities available #Apply-Fresher & Experience >> Fluent English Required <

Job Description: Medical Record Retrieval and Release of Information Specialist Position Overview: We are seeking dedicated and detail-oriented Medical Record Retrieval and Release of Information (ROI) Specialists to join our healthcare team. The position is responsible for efficiently and accurately retrieving, processing, and releasing medical records in accordance with healthcare regulations and policies. This is a hybrid role with both calling and non-calling responsibilities. Key Responsibilities: Retrieve medical records from healthcare facilities, ensuring accuracy and completeness of records. Ensure compliance with HIPAA and other regulatory standards regarding the privacy and security of medical records. Process release of information requests for authorized parties such as patients, legal entities, insurance companies, and other healthcare providers. Organize and maintain medical records in both paper and electronic formats, ensuring they are accessible and easily retrievable. Coordinate with other departments (e.g., billing, insurance) to provide requested information while safeguarding patient confidentiality. Review and verify records for completeness and accuracy before releasing them. Perform audits of medical records to ensure accuracy and compliance with regulatory standards. Skills & Qualifications: Experience in healthcare administration or medical records management (preferred). Knowledge of HIPAA regulations and patient confidentiality. Strong communication skills (for calling positions). Excellent attention to detail and organizational skills. Ability to work efficiently and accurately in a fast-paced environment. Experience with medical records systems and software (e.g., Epic, Cerner, etc.) preferred. Ability to handle sensitive information with professionalism and discretion. Comfortable with night shift. Salary & Benefits: Competitive salary based on experience Health and Accidental insurance ( Call or Whatsapp -9650506346) Sufiya

Introduction A career in IBM Consulting embraces long-term relationships and close collaboration with clients across the globe. In this role, you will work for IBM BPO, part of Consulting that, accelerates digital transformation using agile methodologies, process mining, and AI-powered workflows. Youll work with visionaries across multiple industries to improve the hybrid cloud and AI journey for the most innovative and valuable companies in the world. Your ability to accelerate impact and make meaningful change for your clients is enabled by our strategic partner ecosystem and our robust technology platforms across the IBM portfolio, including IBM Software and Red Hat. Curiosity and a constant quest for knowledge serve as the foundation to success in IBM Consulting. In your role, youll be supported by mentors and coaches who will encourage you to challenge the norm, investigate ideas outside of your role, and come up with creative solutions resulting in groundbreaking impact for a wide network of clients. Our culture of evolution and empathy centers on long-term career growth and learning opportunities in an environment that embraces your unique skills and experience. About Business Unit: Spartan Technology Services and Solutions Private Limited, a subsidiary of IBM, operates globally across 170 countries. Its a crucial part of IBM Business Process Operations, offering end-to-end services for policy renewal and query resolution in the insurance industry, with a strong commitment to data security and quality. Your role and responsibilities As a Process Associate - Insurance (Claims), you will be involved in the Processing of Life and Annuity Insurance, Claims processing. You should be flexible to work in shifts. Your primary responsibilities include: Handling claims investigation, processing, and payments Claims document validation, calculating benefit amount, and releasing same to the beneficiary Meet productivity and quality targets on a daily, weekly, and monthly basis Required education Bachelors Degree Preferred education Masters Degree Required technical and professional expertise Graduate (except B.Tech/Technical Graduation/Law) with a minimum of 1.5 years of experience in Life/Annuities products in Claims Good Communication skills - English (both written & verbal) Proactive and high analytical skills should foresee issues and suggest solutions, with impactful data Basic Computer knowledge along with typing speed of 35 words/minute Preferred technical and professional experience Proficient in MS Office applications Self-directed and ambitious achiever Meeting targets effectively Demonstrated ability to analyze complex data, complemented by strong interpersonal and organizational skills

EDUCATIONAL QUALIFICATION: MBBS graduate (No experience required) BHMS/BAMS graduate (Minimum 2 years of experience with Claims Processing in the Insurance sector). Role & responsibilities Analyzing and summarizing medical records for pre and postsettlement projects. Interpreting clinical data in terms of medical terminology and diagnosis. Adhering to company policies/ARCHER principles and hence taking good care of Archer culture. Adhere to Health Insurance Portability and Accountability Act (HIPPA) all the time. Daily reporting to Medical team lead for productivity & quality Preferred candidate profile Technical Skills: Knowledge of basic level of health care data analysis and clinical review. Sound knowledge of medical terminology, assessments, patient evaluation, and clinical medicine. Ability to work proficiently with Microsoft Word, Adobe, and Excel. Interpersonal Skills: Ability to perform well in a team environment, with staff at all levels, to achieve business goals. Ability to function under pressure and with deadline-oriented project demands as well as manage multiple initiatives. Team player and motivated self-starter. Detail-oriented, organized, able to multi-task. Effective communication skills.

Claims Executive- EB website Link: www.dishainsurance.com Job Summary: We are seeking a qualified Claims executive to help our clients in claims and any other query solution through their own skills. Our ideal Claims executive has to have in-depth knowledge of and experience with the Claim process, Policy terms and conditions, relationship building and MIS management. We are seeking a quick learner with strong communication skills, and someone with a track record of success who can inspire the same in others Roles & Responsibilities: One stop solution for all client queries and requirements Represent our company, with a comprehensive understanding of our services in the area of claim process and policy terms and conditions. Providing the timely help to clients in claim settlements in both cashless and reimbursements claims. Co-ordinating with Insurance Company in updating endorsements, CD Balance and claims reports. Co-ordinating with TPA in claim settlements, in solving the issues due to any calculation error and any data error with the MIS reports. Co-ordinating with clients, HR Head and Finance Head in resolving any issues. Maintaining MIS reports. Co-ordinating with the Retention team. Visiting clients to understand if they have any concerns and help them in fixing the issues. Visiting the TPA and Insurance Company to maintain good relationship with the customer relation team. Desired Profile/ Who should join: Should have 3 to 6 years of experience in a general insurance company/ insurance broker / surveyor Proficient in Microsoft Excel and MS office Fair knowledge about the Insurance processes Good communication skills Problem solving attitude Flexibility with calls and mails