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3 - 7 years

5 - 10 Lacs

Thiruvananthapuram

Remote

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Job Summary The Insurance Verification Manager will be responsible for overseeing the insurance verification process, ensuring timely and accurate verification of patient insurance eligibility and benefits. This role involves managing a team, optimizing workflows, and leveraging advanced features to enhance operational efficiency and patient experience. Key Responsibilities: Supervise and mentor the insurance verification team, setting performance goals and conducting regular evaluations. Provide training and support to team members on insurance verification tools and best practices. Ensure timely verification of patient insurance eligibility, benefits, coverage levels, exclusions, and limitations. Monitor and manage the verification process, addressing any discrepancies or issues promptly. Utilize efficient scheduling and patient list management techniques to prioritize verification tasks. Implement and maintain insurance templates to streamline data entry and reduce errors. Coordinate with other departments to ensure seamless integration of insurance verification with scheduling, billing, and patient care. Communicate with insurance providers to resolve verification issues and stay updated on policy changes. Generate and analyze reports on verification metrics, claim statuses, and aging balances. Ensure compliance with HIPAA and other regulatory requirements in all insurance verification activities. Qualification Bachelors degree in Healthcare Administration, Business Administration, or a related field. Minimum of 5 years of experience in insurance verification or healthcare revenue cycle management, with at least 2 years in a managerial or supervisory role. In-depth knowledge of insurance policies, eligibility criteria, coverage details, and claims processes. Proficiency in using insurance verification software, practice management systems, or related healthcare management tools. Strong understanding of HIPAA regulations and other healthcare compliance requirements. Excellent leadership and team management skills. Strong analytical and problem-solving skills, with the ability to make data-driven decisions. Effective communication and interpersonal skills, with the ability to coordinate with cross-functional teams. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and experience with data analysis tools. Professional certifications in healthcare management or medical billing and coding (e.g., CPC, AAPC, CHAM) are a plus. Willing to work in night shifts

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1 - 3 years

0 - 3 Lacs

Coimbatore

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Roles and Responsibilities Role : Medical billing executive Shift : 6pm to 3am Location : Tidel park, cbe Responsibilities: * At least one year of medical billing experience is required. * Experience with AR follow up is required. * Candidates must have proven track record and hands-on working experience with CPT and ICD-10 codes, as well as modifiers. * Ability to constructively communicate and problem solve with Medicare and commercial insurance companies. * This includes the use of the respective insurance portals, as well as verbal and written communication. Medical billing certification is a plus. * Biller will have full responsibility for all billing aspects (posting charges, posting payments, insurance billing, appeals, insurance follow up, patient and practice communication, etc.) of several practices and specialties. * Candidates must demonstrate the ability to multitask and independently work well within a group environment. * Competitive Salary * Only Male candidates Preferred

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1 - 5 years

3 - 5 Lacs

Hyderabad/ Secunderabad

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Full Job Description Role Objective: To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities: Process 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 PowerPoint 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 have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors Fresh graduates are most Welcome.. Perks and Benefits Paid Time off and Holidays Long Service Recognition Mobile and Internet Allowance COVID Emergency Support Transportation Medical Facility on Premise Mediclaim Insurance - Self & Dependents Voluntary Top Up on Mediclaim Insurance Personal Accidental Insurance Life Insurance Maternity/ Paternity Leave Telemedicine services Day Care Program Provident Fund Employee Pension Scheme Provident Fund (Voluntary) Gratuity Professional Development Calendar Manager Development Programs Domain Knowledge Expertise Maternity/ Paternity Leave Maternity Leave As per ESIC/Maternity Benefit Act whichever is applicable. 5 Paternity leave granted to the father of a new-born. Day care Benefit Program : childcare facilities to all its female associates so that they are able to focus on their work and achieve their career aspirations without compromising on childcare. We provide near site day care facilities tie up information and a reimbursement of up to INR 8000/- per month per child for up to 2 children per family. Paid Time Off and Holidays Under the paid time off program associates are entitled for different types of paid leaves 30 leave (Earned Leave + Casual Leave) per calendar year. Leave accrues every month. Only earned leave up to a maximum of 30 can be carried forward to the next year. 10 Holidays every calendar year; published in the beginning Regards Amit Soni Call or what's App: 9560589907

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1 - 5 years

3 - 5 Lacs

Gurugram

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Job Description: We are seeking a detail-oriented and proactive AR Follow-up Executive to join our dynamic revenue cycle team. The ideal candidate will be responsible for timely follow-up on outstanding claims with insurance companies to ensure maximum reimbursement. Youll work closely with billing and coding teams to resolve denials, track claims, and reduce aging accounts. Key Responsibilities: Review and analyze unpaid or denied claims. Initiate calls or work on web portals to follow up with insurance companies. Resolve claim discrepancies and ensure proper documentation. Update systems with claim statuses and next action steps. Meet daily and weekly productivity and quality targets Requirements: 1+ year of AR follow-up experience in the US healthcare domain. Strong knowledge of insurance guidelines and denial management. Excellent communication and analytical skills. Familiarity with medical billing software and tools. To apply, call Miss Shahin - 9599818161

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2 - 5 years

3 - 6 Lacs

Gurugram

Work from Office

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Job Summary: We are seeking a dedicated and detail-oriented professional to manage insurance claims on behalf of clients across various lines of business. The ideal candidate will ensure accurate documentation, effective coordination with insurers, and timely settlement of claims, while maintaining high standards of service and compliance. Key Responsibilities: Register and manage claims across multiple insurance segments (e.g., Health, Motor, Property, Marine, etc.) Liaise with clients and insurance companies to collect required claim documents and provide status updates Monitor and ensure timely follow-ups to drive claim resolution and settlements Maintain accurate claim records and prepare regular MIS reports for internal and client use Ensure adherence to regulatory requirements and internal company standards throughout the claims process Proactively follow up with insurers to expedite claim approvals and settlements Escalate delays, disputes, or complex claims to senior management or resolve through effective negotiation Candidate Requirements: Graduate degree (preferably in Commerce, Insurance, or a related field) 25 years of experience in claims handling within a broking firm or insurance company Strong knowledge of insurance products and end-to-end claim processes Effective communication and interpersonal skills, with a focus on client servicing and coordination High attention to detail and the ability to manage multiple claims simultaneously

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4 - 9 years

3 - 5 Lacs

Coimbatore

Work from Office

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Greetings!!! Openings at Sagility for Process Trainer-Enrollment(US Healthcare) Minimum of 4 years of experience as a Process Trainer in an International BPO. Excellent written and verbal communication skills, with strong interpersonal abilities. Proven experience as a Trainer in an International BPO environment. Strong presentation and Excel skills. Sound knowledge of basic training methodologies. Ability to work in US rotational shifts. Immediate joiners are mostly preferred. Interested candidates can share your resume to anitha.c@sagilityhealth.com

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1 - 4 years

2 - 5 Lacs

Gurugram

Work from Office

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Role Objective: Payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The cash/payment posting staff posts these payments immediately into the respective patient accounts, against that claim to reconcile them. Essential Duties and Responsibilities: Need to work on payment posting and denial batches. Must work on ERA discrepancies. Need to do bank reconciliation. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint 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 have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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2 - 5 years

5 - 9 Lacs

Gurugram

Work from Office

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Reports to (level of category) : Individual COA( Performance Management) 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.? Analysis data to identify process gaps, prepare reports and share findings for Metrics improvement. Able to interact independently with counterparts. Performance management First level of escalation Work in all shifts on a rotational basis WFO only Need to be cost efficient with regards to processes, resource utilization and overall constant cost management Must operate utilizing aggressive operating metrics. Qualifications Graduate in any discipline from a recognized educational institute (Except B.Pharma , M.Pharma , Regular MBA, MCA B.Tech Freshers') 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. Subject matter expert in AR follow up Demonstrated ability to exceed performance targets Ability to effectively prioritize individual and team responsibilities Communicates well in front of groups, both large and smal l.

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2 - 5 years

4 - 7 Lacs

Gurugram

Work from Office

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Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities: Process 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 PowerPoint 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 have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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2 - 5 years

3 - 7 Lacs

Noida

Work from Office

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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. Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and Responsibilities: Process 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 PowerPoint 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 have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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2 - 5 years

3 - 7 Lacs

Noida

Work from Office

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Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities: Process 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 PowerPoint 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 have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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4 - 8 years

6 - 10 Lacs

Hyderabad

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Designation : Operations Manager 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.

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4 - 8 years

4 - 9 Lacs

Gurugram

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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.

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3 - 7 years

2 - 3 Lacs

Chennai

Work from Office

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Greetings from ACP Billing Services! We are hiring for the following roles - Work from Office Charge Posting Payment Posting Experience & Requirements: Minimum 3+ years of experience in US Medical Billing. Strong verbal and written communication skills. Charge/Payment Posting candidates with good typing skills will have an added advantage. Competitive remuneration as per industry standards. Spot offers for selected candidates. Immediate joiners are preferred. Responsibilities: Process medical billing transactions with a 99% or higher accuracy rate. Understand and apply customer-provided business rules while ensuring compliance with turnaround time requirements. Work collaboratively in teams to achieve set targets. Utilize medical billing expertise to monitor and report customer KPIs. Actively participate in learning programs and compliance initiatives. Competencies & Skills: Strong interpersonal and analytical skills. Proficiency in MS Office (Word, Excel, PowerPoint). Adaptability, flexibility, and a proactive approach to tasks. Commitment to meeting productivity, quality, and attendance SLAs. Team-oriented mindset with a willingness to take initiative. Work Location : ACP Billing Services Pvt Ltd - NO.133, 2ND FLOOR, EJNS ARK, KP GARDEN STREET, MADHAVARAM HIGH ROAD, MADHAVARAM Chennai- 600 051. Land Mark : Next to ICICI Bank Madhavaram Branch. Share your CV to hr@acpbillingservices.com / WhatsApp 9841820311

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1 - 6 years

1 - 3 Lacs

Chennai

Work from Office

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Designation - Claim Support Consultant Location - Teynampet Education - Any Graduate Experience - Advanced Excel & Team Handling Contact - Priskila -7825845773

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12 - 19 years

22 - 37 Lacs

Hyderabad, Chennai, Bengaluru

Hybrid

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Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Summary: As a Business Analyst, you will analyze an organization and design its processes and systems, assessing the business model and its integration with technology. You will assess the current state, identify customer requirements, and define the future state and/or business solution. Research, gather, and synthesize information to contribute to key decisions and solutions. Roles & Responsibilities: - Expected to be an SME, collaborate and manage the team to perform. - Responsible for team decisions. - Engage with multiple teams and contribute on key decisions. - Expected to provide solutions to problems that apply across multiple teams. - Lead process improvement initiatives to enhance efficiency. - Conduct stakeholder interviews to gather requirements effectively. Location: Pan India

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1 - 5 years

4 - 7 Lacs

Kolkata

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Job TitleINSURANCE EXECUTIVE Job Code HREQ2017/12/66 --> Job Location Kolkata Experience 1YR -5YRS Gender Male/ Female Job Details URGENTLY LOOKING FOR A CANDIDATE WHO HAVE KNOWLEDGE ABOUT Quotation and issuence of general insurance, claim processing. ELIGIBILITY CRITERIA- ANY GRADUATE. Salary Per Year 1-2.5 LPA Apply Now

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1 - 4 years

0 - 1 Lacs

Chennai

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Urgentvacancyforexpcandidates Worklocation@omr Qualification-DiplomainAutomobile/Mechanical Expcandidatesmust ExpinAutomobile/InternshipexpinAutomobilemust GoodengwithHindi/Telugu/Malayalamismandatory FordetailspingHRSwetha-9952798409(call/watsapp)

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7 - 12 years

3 - 7 Lacs

Mumbai

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Role: Closed file review & audit 1-Handling closed / open file review for third party administrator & inhouse claims 2-Recoveries from third party administrator for claims processed with errors 3-Highlight areas of improvement 4-Monthly reports to be published Candidate must have: 1-In-depth knowledge of medical cases with exposure to ailment treatments, policy coverages for OPD/hospitalization/personal accident/ travel claims 2-Good interpersonal skills 3-Must be proactive & effective learner 4- Must have previous experience of Audit 5- Good Analytical, Communication and Negotiation skills 6- Familiar with Basic Microsoft Excel and regulatory changes 7- Minimum 7 years of experience in general insurance Accident & Health claims Qualifications Degree in medicine (BHMS/BAMS/MBBS) At Liberty General Insurance , we create an inspired, collaborative environment, where people can take ownership of their work; push breakthrough ideas; and feel confident that their contributions will be valued, and their growth championed. We have an employee strength of 1200+ spread over a network of 116+ offices in 95+ cities, across 29 states. Our partner network consists of about 5000+ hospitals and more than 4000+ auto service centers. We believe and live by our values every day - Act Responsibly, Be Open, Keep it Simple, Make things better and Put People First. For learning about our key USPs, you can go visit our website. Working with Liberty also provides you an opportunity to experience One Liberty Experience . We create the One Liberty experience through Providing Global exposure to employees by including them in cross country projects that gives them opportunities to work with diverse teams within & outside India. Fosters Diversity, Equity & Inclusion (DEI) to create equitable career opportunities Flexi Working arrangements. If you aspire to grow & build your capabilities to work in a global environment, Liberty is the place for you!

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3 - 5 years

2 - 6 Lacs

Bengaluru

Work from Office

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Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years Language - Ability: English(International) - Intermediate 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? Property and Casualty Insurance Ability to establish strong client relationship Ability to meet deadlines Ability to perform under pressure Ability to work well in a team Prioritization of workload Claims Processing Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems Your day to day interaction is with peers within Accenture before updating supervisors In this role you may have limited exposure with clients and/or Accenture management You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments The decisions you make impact your own work and may impact the work of others You will be an individual contributor as a part of a team, with a focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

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5 - 9 years

0 - 0 Lacs

Bengaluru

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Job Title: Guidewire Portal Business Analyst Experience : 5 to 8 Years Location : Pan India (UST Locations) Employment Type : Full-time Job Description: We are looking for a skilled Guidewire Portal Business Analyst with 5-8 years of experience to join our team. The ideal candidate should have a strong understanding of the Guidewire Digital Portal suite and proven expertise in analyzing and translating business requirements for insurance-based platforms. This role involves collaborating with cross-functional teams and clients to ensure the successful implementation of Guidewire solutions. Key Responsibilities: Gather, analyze, and document business requirements for Guidewire Portal (Digital) implementations. Collaborate with product owners, UX designers, developers, and QA teams to translate business needs into functional requirements. Create detailed user stories, process flows, use cases, and functional specifications. Conduct gap analysis between current and proposed processes. Work closely with development and QA teams to ensure alignment of solutions with business needs. Support UAT, triage issues, and provide production support during go-lives. Act as a liaison between business users and technical teams. Required Skills: 5-8 years of experience as a Business Analyst , with strong exposure to Guidewire Digital Portal (CustomerEngage, ProducerEngage, etc.) In-depth understanding of P&C insurance domains , especially PolicyCenter/ClaimCenter/BillingCenter is an advantage Experience working in Agile/Scrum environments Proficient in writing user stories, acceptance criteria, BRD, FSD Strong communication and stakeholder management skills Hands-on experience with tools like JIRA, Confluence, Visio Nice to Have: Guidewire certification (Portal or BA) Understanding of web technologies (HTML/CSS/JavaScript) is a plus Experience working with offshore/onshore delivery models Required Skills Guidewire,Business Analysis,Property & Casualty

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5 - 8 years

4 - 7 Lacs

Gurugram

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Skill required: Delivery - Financial Management Designation: I&F Decision Sci Practitioner Sr Analyst Qualifications: Bachelor's in actuarial science/Master's in actuarial science Years of Experience: 5 to 8 years What would you do? Data & AIDesign and implement the org structure, responsibilities, procedures and supporting technology to ensure finance and accounting operations run effectively and efficiently. Ability to perform day-to-day management of financial accounts, provide financial assistance for decision making in timely manner, apply accounting principles, prepare accurate and timely financial management reports and statements and ensure accurate recording and analysis of revenues and expenses. What are we looking for? Insurance Claims Financial Reporting Ability to work well in a team Adaptable and flexible Agility for quick learning Commitment to quality Ability to manage multiple stakeholders 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 Qualification Bachelor’s in actuarial science,Master’s in actuarial science

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5 - 10 years

14 - 19 Lacs

Bengaluru

Work from Office

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About Navi Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a Navi ite : 1. Perseverance, Passion and Commitment Passionate about Navis mission and vision Demonstrates dedication, perseverance, and high ownership Goes above and beyond by taking on additional responsibilities 2. Obsession with high-quality results Consistently creates value for the customers and stakeholders through high-quality outcomes Ensuring excellence in all aspects of work Efficiently manages time, prioritizes tasks, and achieves higher standards 3. Resilience and Adaptability Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility Key Responsibilities: Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations. Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities Recommend actions based on findings, such as denying, reducing, or adjusting claims Communicate audit results and findings to management and external stakeholders Suggest process improvements to enhance the efficiency and accuracy of the claims audit process. Stay updated with industry trends, regulations, and changes in healthcare policies that may impact claims auditing Provide guidance and training to claims team members or other related stakeholders Investigating medical claims to identify fraud Automate system and bring in improvements on claims processes Team Management- Build and manage the team of doctors supporting the function The role involves identifying discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements What are some of the good to have skills for this role? Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Experience in handling audit Background in claims processing with clinical experience in a hospital setting Data analytics experience would be an added advantage Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Knowledge of health insurance policies and regulations, IRDAI circulars is must Strong analytical and problem-solving skills. Excellent attention to detail and ability to spot discrepancies Ability to anticipate potential problems and take appropriate corrective action Effective communication skills for working with different stakeholders Time management skills to meet deadlines. Should have a broad understanding of Claims Practice Sharp business acumen to understand health insurance claim servicing needs Excellent communication skills, including writing reports and presentations

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5 - 8 years

4 - 8 Lacs

Bengaluru

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Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Senior Analyst Qualifications: Any Graduation Years of Experience: 5 to 8 years Language - Ability: English(International) - Intermediate 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? Property and Casualty Insurance Ability to establish strong client relationship Ability to manage multiple stakeholders Ability to perform under pressure Process-orientation Written and verbal communication Payment Processing Operations 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 Please note that this role may require you to work in rotational shifts Qualification Any Graduation

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- 1 years

1 - 5 Lacs

Bengaluru

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Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(International) - Intermediate 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? Property and Casualty Insurance Ability to establish strong client relationship Ability to meet deadlines Ability to perform under pressure Ability to work well in a team Prioritization of workload Claims Processing 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

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