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2.0 - 7.0 years
3 - 7 Lacs
Gurugram
Work from Office
About the work - Member Services for Seniors: Medicare and Retiree programs serve a vulnerable demographic, seniors who often have complex health conditions, limited digital literacy, and require extra care and patience over the phone. Segments we will support (Phase 1) : Medicare Advantage (Part C) : End-to-end plans covering hospitalization, medical services, and prescriptions. Group Retiree Plans : Tailored benefits for retired employees of corporations, government, or unions, often with layered entitlements and detailed queries. D-SNP (Dual-Eligible) : For members eligible for both Medicare and Medicaid. These are low-income or disabled seniors, requiring high sensitivity and multi-agency coordination. Call types expected : Plan eligibility, enrollment, and disenrollment Co-pay and deductible clarifications Benefit explanations (vision, dental, OTC) Provider and PCP changes Claims, EOBs, and billing support Pharmacy exceptions and drug tier clarifications Appeals, grievances, and service denials Hospice and long-term care coordination Medicaid coordination Skill requirements : Deep understanding of CMS (Centers for Medicare & Medicaid Services) guidelines Familiarity with Medicaid programs by state Strong listening and verbal communication Patience and empathy for cognitive or hearing impairments Proficiency in navigating multiple systems and tools Why this matters : Customer satisfaction directly impacts Medicare Star Ratings, which drive UHGs CMS reimbursements First 90-day retention is critical to reduce member churn Supporting D-SNP and retiree populations reinforces UHG’s mission of healthcare equity and access This is a defining opportunity, let’s come together to exceed expectations, build client trust, and establish ourselves as a long-term strategic partner for UHG. Looking forward to your thoughts and functional readiness in our upcoming working session. Regards Trapti Singh 9911397154
Posted 1 week ago
1.0 - 2.0 years
1 - 2 Lacs
Hyderabad
Work from Office
Job Title: Associate Payment Posting Years of Experience: 1-2 years Location: Hyderabad, Telangana Mode of interview: In-person. Mode of operation: Work from office Shift Timings: 9:00 a.m.6:00 p.m Job Description Functional Expertise: Should be able to post ERAs and Manual posting, patient-cash, check and CC payments. Should have strong understanding of medical billing terms, such as co-pays, coinsurances, deductibles allowable amount, contractual adjustments, out-of network and in-network processing, retractions/recoupments, capitation payments, Collection agency payments, MVA and WC payments, Correspondence and Zero claims. Should be able to access websites to retrieve, process and upload the EOBs. Should be able to identify line item denials for non-covered services, inclusive services, credentialing, medical necessity, non-par, no-auth denials, COB Denials and associated denial reason codes. Medicare claims processing-sequestration, interest payment, reporting codes, Modifiers Should be able to understand Payer specific guidelines, process secondary and Tertiary claims and patient statements. Process Insurance and patient refunds. Should be capable of interpreting and processing the EOBs, research, correct and re-file denied claims. Reconciliation and balancing the payment batches. Operational Duties: Comply to daily productivity and Accuracy standards. Submit daily production reports to team lead. Stay in constant communication with team lead /operations manager Professional & behavior is expected Receive feedback from QA on errors and follow updated protocol. Additional Comments Having NG application knowledge will be advantage Contact Info: Shivani:8341128389
Posted 1 month ago
1.0 - 2.0 years
2 - 4 Lacs
Noida
Work from Office
Role & responsibilities Follow up with the Insurance company to check on claim status. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Insurance Collection Insurance Ageing. Will be involved in various AR reports preparation such as Aging reports, Collection reports etc. Analyzing Claims. Initiate telephone calls to insurance companies requesting status of claim in queue regarding past due invoices and establishment payment arrangements. Meet Quality and productivity standards. Processing the Health insurance claims. Contact insurance companies for further explanation of denials & underpayments. Take appropriate action on claims to guarantee resolution. Auditing the claims Ensure accurate & timely follow up where required. Review denials to determine necessary steps for Claim review Respond to client inquiries via phone and email regarding account or software issues. NOTE : It's available only for Noida/Ghaziabad/Mayur Vihar/New Ashok Nagar/Laxmi Nagar/Vinod Nagar/Ghazipur/Khora candidates. Perks and benefits
Posted 1 month ago
0.0 - 1.0 years
1 - 2 Lacs
Noida
Work from Office
Role & responsibilities Follow up with the Insurance company to check on claim status. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Insurance Collection Insurance Ageing. Will be involved in various AR reports preparation such as Aging reports, Collection reports etc. Analyzing Claims. Initiate telephone calls to insurance companies requesting status of claim in queue regarding past due invoices and establishment payment arrangements. Meet Quality and productivity standards. Processing the Health insurance claims. Contact insurance companies for further explanation of denials & underpayments. Take appropriate action on claims to guarantee resolution. Auditing the claims Ensure accurate & timely follow up where required. Review denials to determine necessary steps for Claim review Respond to client inquiries via phone and email regarding account or software issues. NOTE : Fact to Face Interview will be conducted in office premises. It's temporary WFH and is available only for Noida/Ghaziabad/Mayur Vihar/New Ashok Nagar/Laxmi Nagar/Vinod Nagar/Ghazipur/Khora candidates. Perks and benefits
Posted 1 month ago
1.0 - 4.0 years
3 - 5 Lacs
Hyderabad
Work from Office
Job Title: Charge Entry Specialist Job Description: We are seeking a detail-oriented Charge Entry Specialist to join our healthcare team. The ideal candidate will be responsible for accurately entering and verifying patient treatment codes, maintaining records, and assisting with billing inquiries. This role is crucial for ensuring the accuracy of medical billing and coding, which directly impacts the financial health of our organization. . Responsibilities: Enter medical treatment codes into billing software accurately. Verify all patient demographic data and insurance information. Review and correct claims that have been denied or rejected due to incorrect coding. Ensure all required documentation is available for billing. Maintain confidentiality of all patient information in accordance with HIPAA guidelines. Resolve discrepancies in billing data. Work closely with the billing team to ensure accurate billing and reduce denials. Stay updated with changes in billing codes and medical terminology. Qualifications: Strong understanding of medical terminology, billing codes, and revenue cycle management. Excellent attention to detail and accuracy. Ability to maintain high levels of accuracy under pressure. Proficiency in using billing software and other relevant tools. Strong communication skills to interact with healthcare providers and insurance companies. Experience in medical billing or a related field is preferred. Education: Graduation mandatory experience matters more! Contact: please share your resume to below Contact HR- Aakshya - 8072294017 HR- Aravind - 7286960006 walk- in Location: Sutherland global Services DivyaSree TechRidge, Block P2, (North Wing) 7th Floor, Manikonda, Hyderabad 500089, Write Name on your top of your Resume - Akshaya / Aravind
Posted 2 months ago
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