45 Adjudication Jobs

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing Claims Adjudication Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Role & responsibilities Candidates with 1-3 years of experience in Insurances process Knowledge of commercial administrative processes. Basic knowledge of Casualty loss exposures presented by Fortune 1000 customer base preferred. Working Knowledge of MS Office. High Level of commitment towards given deadlines. Self-motivated, discipline, good time management skills & demonstrates high levels of energy. Good problem solving and trouble shooting ability as well as flair for improvisation. Preferred candidate profile Perks and benefits

Perform setter activities such as setting up tools, fixtures & workpieces on the machine. Operate and tend induction machines to heat materials,components,or finished products Adjust and monitor temperature controls heating cycles other equipments Required Candidate profile Conduct routine checks, perform minor repairs , replace worn components and clean production equipments to ensure smooth operation •Knowledge of machine operation,calibration and basic maintenance

*Please share your resume before coming to the walk-in on 6th Saturday 11:00am - 4:30pm Role: Claims Adjudicators/Sr. Claims Adjudicators Location: Noida Key Skills: Knowledge of US Health Insurance domain, Claims Adjudication, Providers and Members Enrolment, MS Office and good keyboard skills. Experience: 3 + years in Claims Adjudication or in relevant field (Fresher dont apply) Job Description: We are seeking a detail-oriented and analytical Claims Adjudicator to review, evaluate, and process insurance claims in accordance with policy guidelines and regulatory standards. The ideal candidate will have a strong understanding of claims procedures, excellent decision-making skills, and a commitment to accuracy and compliance. Prior experience in claims processing or adjudication preferred. Familiarity with insurance policies and regulatory requirements. Strong attention to detail and organizational skills. Proficiency in claims management systems and MS Office. Candidate should be ready to work night shift (US Shift). Interested candidates may share their resumes @madhulika.sharma@4aisoft.com and Gargi.gupta@4aisoft.com

You are seeking a skilled Claims Associate with at least 12 months of experience in voice or semi-voice claims processing and adjudication, specifically in the realm of Property & Casualty (P&C) insurance. Your primary responsibility will be to manage claims processing and adjudication for Property & Casualty insurance, ensuring that claims are processed within the company's established standards. You will be expected to communicate effectively with customers to resolve claims and provide necessary updates, supporting global clients with the exception of China and Japan. To excel in this role, you must possess a thorough understanding of Property & Casualty claims and have a minimum of 12 months of voice or semi-voice claims experience. Additionally, only graduates are eligible to apply for this position. As a Claims Associate, you will have the opportunity to work in a dynamic team based in Bangalore. The role involves 24/7 rotational shifts with two rotational week offs. The company provides two-way cab transport within a 25 km radius, excluding any transport allowance. The salary offered is up to 4.5 LPA, along with a night shift allowance of 7,500. If you meet the specified requirements and are eager to enhance your career in the insurance sector, we encourage you to apply now. Join us to become a valuable part of our team and enjoy benefits such as health insurance, Provident Fund, and performance bonuses. Job Type: Full-time Work Location: In person Language: English (Preferred), Hindi (Preferred),

Greetings from NTT DATA, Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 3-8 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Interested Candidates please share me your resume to Ganga.Venkatasamy@nttdata.com

Key Responsibilities: Review and process insurance claims submitted by policyholders, providers, or third parties. Verify the accuracy and completeness of submitted claims and supporting documents. Investigate and validate claims using internal systems and guidelines. Coordinate with internal departments (e.g., underwriting, customer service) for clarification or additional information. Maintain accurate and organized records of all claims and transactions. Communicate claim decisions to stakeholders clearly and professionally. Escalate complex or disputed claims to senior team members or supervisors. Meet individual and team KPIs such as turnaround time, accuracy rate, and productivity. Ensure compliance with all legal, regulatory, and company standards during the claims process. 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 @firstsource.com email addresses.

NTT DATA- Hiring for Asst. Manager (BPO Supervisor) - Healthcare & Insurance in Gurgaon- Permanent Role Interested candidates may share your CV on whatsapp @ 8881551615 Job Title Asst. Manager ( BPO Supervisor ) (45 Hours Per week) Job Type - Full-time Work Timings: Scheduled shifts: Monday - Friday, 9:00 p.m. - 7:00 a.m. IST Domain - Healthcare & Insurance Location - NTT Data, Gurgaon Role: Asst. Manager will be responsible for all business delivery & performance as per set SLA parameters of Disability claim process in healthcare & insurance domain. And must understand the business delivery, maintain & publish metrics with multiple stakeholders; brief and deliver all in-house process delivery & requirements, apart from coordinating with onshore partners as and when required. As a Asst. Manager, you will be the contact point for all team members, and will be responsible for supervising, managing and motivating team members daily basis. You should also be able to act proactively to ensure smooth team operations and effective collaboration. Purpose of the Post: The Asst. Manager role is to collaborate with the Director Operation / Manager to lead a core team of staff to process Disability management claims to achieve the defined productivity and quality as per the Service level Agreement by facilitating training, coaching and access to the process. The post holder will report to and work closely with the Director operation / Manager for the development and delivery of the service. He need to work with the staff team taking lead responsibility for the preparation, implementation and monitoring of all day-to-day activities and communicate to update all the stakeholders of status for the account. Key Responsibilities Ensure that the highest standard of service delivery in terms of productivity and quality as per the defined Service Level Agreement with Client. To provide leadership and support to the staff assigned in line with Policies. Contribute to the development of strategies for the implementation and improvement of the process. Coordinate with staff and ensure that duties, activities, and tasks allocated to staff are carried out efficiently. Verify and review all forms and documents of a case for errors, missing information, legibility; and request follow up information as required. Performs quality checks on all work to assure the accuracy. Will be responsible for maintaining up to date information on relevant databases and the monitoring and auditing of same for the account. Candidate Profile: Experience as asst. manager in healthcare processes, preferably in Indexing and Adjudication of claims. Excellent communication, team management, and customer management skills to maintain positive customer relations. Excellent analytical skills Good knowledge of client-specific process rules and regulatory requirements Interested candidates may share your CV whatsapp 8881551615

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills ..Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.

Level-SME Minimum exp-4 Years Skills Required-US Helathcare , claims adjudication Must have on papers SME or Assistant TL experience Location-Chennai / Bangalore US Shifts Work from office Immediate -30days Notice Share resume-archi.g@manningconsulting.in Contact- 8302372009

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills ..Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.

Role: Claims Adjudicators/Sr. Claims Adjudicators Location: Noida Key Skills: Knowledge of US Health Insurance domain, Claims Adjudication, Providers and Members Enrolment, MS Office and good keyboard skills. Experience: 3 + years in Claims Adjudication or in relevant field Job Description: We are seeking a detail-oriented and analytical Claims Adjudicator to review, evaluate, and process insurance claims in accordance with policy guidelines and regulatory standards. The ideal candidate will have a strong understanding of claims procedures, excellent decision-making skills, and a commitment to accuracy and compliance. Prior experience in claims processing or adjudication preferred. Familiarity with insurance policies and regulatory requirements. Strong attention to detail and organizational skills. Proficiency in claims management systems and MS Office. Candidate should be ready to work night shift (US Shift). Interested candidates may share their resumes @madhulika.sharma@4aisoft.com and Gargi.gupta@4aisoft.com

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-5 years of experience in processing Claims Adjudication Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Role & responsibilities Review and process incoming healthcare or insurance claims accurately and efficiently. Verify patient, provider, and policy details to ensure claims meet all requirements. Investigate discrepancies, missing information, or potential fraud indicators. Coordinate with internal departments or external providers for claim clarification. Maintain accurate records and ensure compliance with regulatory and company standards. Meet daily productivity and quality targets while maintaining confidentiality. Freshers are not eligible B.TECH ,B.E, B.Sc, Any Post Graduation fresher are not eligible. Anyone who attended interview before 30 days are not eligible to attend walk-in. 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 @firstsource.com email addresses.

Key Responsibilities: Review and process incoming healthcare or insurance claims accurately and efficiently. Verify patient, provider, and policy details to ensure claims meet all requirements. Investigate discrepancies, missing information, or potential fraud indicators. Coordinate with internal departments or external providers for claim clarification. Maintain accurate records and ensure compliance with regulatory and company standards. Meet daily productivity and quality targets while maintaining confidentiality. B.TECH ,B.E, B.Sc, Any Post Graduation fresher are not eligible. Anyone who attended interview before 30 days are not eligible to attend walk-in. 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 @firstsource.com email addresses.

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing, and the corrected claims process Knowledge of healthcare insurance policy concepts, including in-network, out-of-network providers, deductible, coinsurance, co-pay, out-of-pocket, maximum inside limits, and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services, and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 1-3 years of experience in processing claims, adjudication, and the adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both undergraduates and postgraduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytical skills **Required schedule availability for this position is Monday-Friday 5.30 PM/3.30 AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to work overtime and on a weekend basis to meet business requirements.

Role & responsibilities Respond to inbound and outbound calls related to healthcare insurance, claims, billing, and eligibility. Assist US-based members and providers with accurate and timely information. Maintain a strong understanding of healthcare benefits, medical terminology, and insurance workflows. Accurately document customer interactions and transactions in the system. Meet and exceed key performance metrics including quality, customer satisfaction (CSAT), and Average Handling Time (AHT). Collaborate with internal teams for escalation resolution and process improvement. Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance Assist customers in navigating the member website, and other websites while encouraging and reassure them to become self-sufficient. Please connect with Neeraj Salariya@8285244315. Preferred candidate profile 0-3 years of experience in international voice process. Excellent verbal and written communication skills in English. Strong interpersonal skills with the ability to remain patient and empathetic. Comfortable working night shifts and rotational offs. Basic computer literacy and typing skills. Please connect with Neeraj Salariya@8285244315. Perks & Benefits Salary ranges from 3.2 to 3.43 LPA. Cab Facility or Transport Allowance Medical Insurance Life Insurance.

Role & responsibilities Respond to inbound and outbound calls related to healthcare insurance, claims, billing, and eligibility. Assist US-based members and providers with accurate and timely information. Maintain a strong understanding of healthcare benefits, medical terminology, and insurance workflows. Accurately document customer interactions and transactions in the system. Ensure HIPAA compliance and protect patient privacy at all times. Meet and exceed key performance metrics including quality, customer satisfaction (CSAT), and Average Handling Time (AHT). Collaborate with internal teams for escalation resolution and process improvement. Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance Assist customers in navigating the member website, and other websites while encouraging and reassure them to become self-sufficient. Please connect with Neeraj Salariya@8285244315. Preferred candidate profile Minimum 6 months to 3 years of experience in international voice process (preferably Healthcare & Welfare). Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design) Excellent verbal and written communication skills in English. Strong interpersonal skills with the ability to remain patient and empathetic. Comfortable working night shifts and rotational offs. Basic computer literacy and typing skills. Experience with international healthcare insurance processes (e.g., claims adjudication, EOB, authorizations). Knowledge of HIPAA regulations. Graduate in any stream (preferably Life Sciences, Healthcare, or related fields). Undergraduates with relevant BPO experience are eligible to apply Knowledge of billing practices and procedures preferred Proficiency with word processing and spreadsheet software and required. Please connect with Neeraj Salariya@8285244315. Perks & Benefits Salary ranges from 3 to 3.43 LPA. Cab Facility or Transport Allowance Medical Insurance Life Insurance.

About the Team The Claims team at Navi is responsible for delivering a fast, transparent, and customer-first claims experience. From initial intimation to final settlement, whether cashless or reimbursement, they manage the end-to-end process with a strong focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and use data-driven insights and process automation to improve claim resolution speed and customer satisfaction. About the Role The role involves end-to-end medical claims adjudication, including reviewing treatment records, verifying eligibility, identifying potential fraud, and making informed claim decisions. It requires coordination with providers, customers, and internal stakeholders to ensure TAT and SLA adherence. The Medical Officer is also expected to support cost negotiations and assist in claim analytics. Strong communication, regulatory knowledge, and problem-solving skills are essential, along with a background in medicine. What We Expect From You Reviewing and evaluating medical claims to determine their eligibility for payment Investigating medical claims to identify fraud Communicating with claimants, providers, and other parties involved in the claim Making decisions about medical claims, such as whether to approve or deny a claim Negotiate with the treating doctor/ hospital to reduce the unjustified hospitalization cost Automate the system and bring in improvements to claims processes Monitoring systems and processes to ensure sustained levels of performance Liaison with internal stakeholders to ensure the deadlines of TATs and SLAs & Work towards the designated Tasks Tracking of customer communication for effective grievance resolution within TAT & SLAs Knowledge of products, regulations, and guidelines is a must to ensure process compliance. Claim Analytics- Periodical claim analysis to identify fraud and monitor claim performance metrics. Informing the customer about the rejection of their claim through a call Team Management- Build and manage a team of processing doctors supporting the function Must Haves Ability to handle independent assignments & having the acumen to draw logical conclusions He/she 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 Ability to anticipate potential problems and take appropriate corrective action Knowledge of health regulations, IRDA circulars is a must. Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Candidates having data analytics experience would be an added advantage. Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Inside Navi We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal & Home Loans to UPI, Insurance, Mutual Funds, and Gold, we are building tech-first solutions that work at scale, with a strong customer-first approach. Founded by Sachin Bansal & Ankit Agarwal in 2018, we are one of India's fastest-growing financial services organisations. But we are just getting started! ` Our Culture The Navi DNA Ambition. Perseverance. Self-awareness. Ownership. Integrity. We are looking for people who dream big when it comes to innovation. At Navi, you'll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you're driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each otherand that starts with every one of us. Why You'll Thrive at Navi At Navi, it's about how you think, build, and grow. You'll thrive here if: Youre impact-driven : You take ownership, build boldly, and care about making a real difference. You strive for excellence : Good isn’t good enough. You bring focus, precision, and a passion for quality. You embrace change : You adapt quickly, move fast, and always put the customer first.

Job Summary Join our dynamic team as a Claims Processing Specialist where you will play a crucial role in ensuring the accuracy and efficiency of claims adjudication. With a focus on Medicare and Medicaid claims you will contribute to the seamless processing of claims enhancing our service delivery. This hybrid role offers the flexibility of working both remotely and on-site during night shifts. Responsibilities Process claims with precision ensuring adherence to Medicare and Medicaid guidelines. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Utilize claims adjudication software to enhance processing efficiency. Provide feedback on process improvements to enhance service delivery. Maintain up-to-date knowledge of industry regulations and compliance standards. Communicate effectively with stakeholders to ensure clarity and resolution of claims issues. Document claims processing activities accurately for audit and reporting purposes. Support the team in achieving departmental goals and objectives. Participate in training sessions to stay informed about the latest claims processing techniques. Ensure confidentiality and security of sensitive claims information. Contribute to a positive work environment by supporting colleagues and fostering teamwork. Adapt to changing priorities and work effectively under pressure. Qualifications Demonstrate proficiency in claims adjudication processes and software. Possess strong analytical skills to identify and resolve claims discrepancies. Exhibit excellent communication skills for effective stakeholder interaction. Show a keen understanding of Medicare and Medicaid claims requirements. Display attention to detail in processing and documenting claims activities. Have the ability to work independently and collaboratively in a hybrid work model. Certifications Required Not required

The ideal candidate for this position should have experience working as a Team Leader or Designated Team Leader for at least a year. Additionally, they should possess a minimum of 5+ years of experience in Adjudication, Adjustments, or Provider Maintenance within the US Healthcare industry. The candidate must be open to working in any shift provided and should have a strong understanding of US Healthcare practices. It is essential for the candidate to have a comprehensive knowledge of CPT Codes, Diagnosis Codes, and the Authorization Process. They should also be familiar with the pre-adjudication and post-adjudication processes of the Claim Life Cycle. Proficiency in English comprehension is required, along with the ability to work independently and communicate effectively with various stakeholders. The candidate should be willing to adapt to different shift timings and should be capable of conducting sessions and providing On-the-Job Training support. In terms of responsibilities, the selected candidate will be required to assist team members with their queries and take ownership of their targets and goals. They will be responsible for managing a team of 10-15 associates and ensuring adherence to norms related to attendance, punctuality, reporting, and completion of work.,

As a Claims Processing & Adjudication professional, you will be responsible for evaluating and processing medical/health insurance claims in accordance with policy terms, SOPs, and quality benchmarks. Your role will involve validating coverage, exclusions, sub-limits, and waiting periods against policy documents to ensure accurate claim processing. Ensuring documentation accuracy and compliance is crucial in this role. You will be required to maintain complete and compliant claim files that adhere to IRDAI guidelines and internal policies. Participation in quality control reviews and corrective actions will be necessary to uphold production and quality standards. Additionally, preparing detailed claim notes, summaries, and system entries with zero data discrepancies will be part of your routine tasks. Effective customer communication is key in this position. Handling inbound/outbound calls and emails to explain policy terms and conditions, claim decisions, and necessary documents to customers is essential. Providing timely status updates and resolving customer queries in a professional manner will be a significant aspect of your daily responsibilities. You will also be responsible for fraud detection and investigation. Identifying suspicious patterns, inconsistencies, or potential fraud and escalating for further investigation when necessary will be part of your duties. Conducting basic fact-finding activities such as doctor/hospital verification and requesting additional documents to support validity checks will also be required. In the realm of issue resolution and coordination, you will play a vital role in liaising with hospitals, TPAs, and internal teams to resolve mismatches, billing errors, and document gaps efficiently. Adaptability and continuous improvement are essential in this role. You will need to be able to work across multiple product lines and processes, supporting your peers during peak workloads. Additionally, suggesting process improvements to enhance turnaround time, accuracy, and customer experience will be encouraged. Participation in refresher trainings and staying updated on regulatory changes will also be expected. Keeping track of daily productivity, pending queues, and exceptions, and reporting them to the team lead/manager will be part of your responsibilities. Maintaining secure records and ensuring the confidentiality of customer data at all times is of utmost importance. If you are looking to embark on a full-time career in the field of Claims Processing & Adjudication and are eager to contribute to a dynamic team, we encourage you to apply now at btwgroup.co/careers. Job Types: Full-time, Fresher Work Location: In person For further inquiries, please contact the employer at +91 9503776369.,

Greetings from NTT DATA, Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 3-8 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Positions, General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. **Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Requirements for this role include: Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.

Job Summary Join our dynamic team as a PE-Claims HC specialist where you will play a crucial role in processing and adjudicating claims with precision and efficiency. This hybrid role requires a keen understanding of Medicare and Medicaid claims ensuring compliance and accuracy. With a focus on night shifts you will contribute to our mission of delivering exceptional healthcare solutions without the need for travel. Responsibilities Process claims with a high degree of accuracy ensuring compliance with Medicare and Medicaid regulations. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Maintain up-to-date knowledge of industry standards and regulatory changes. Utilize technical skills to enhance claims processing efficiency. Communicate effectively with stakeholders to ensure clarity and understanding of claims processes. Implement best practices to improve overall claims management. Monitor claims processing metrics to ensure timely and accurate adjudication. Provide feedback and suggestions for process improvements. Support the team in achieving departmental goals and objectives. Ensure all claims are processed within established timelines. Assist in the development of training materials for new team members. Contribute to a positive work environment by fostering collaboration and teamwork. Qualifications Possess strong analytical skills to assess and adjudicate claims accurately. Demonstrate proficiency in claims adjudication processes and tools. Exhibit a solid understanding of Medicare and Medicaid claims requirements. Show excellent communication skills to interact with various stakeholders. Have the ability to work effectively in a hybrid work model. Display a keen attention to detail to ensure compliance and accuracy. Certifications Required N / A