57 Adjudication Jobs - Page 2

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. Dis...

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...

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 R...

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 sele...

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 funda...

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 r...

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 ...

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...

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 deta...

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 perfor...

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 processi...

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. Maintai...

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the cl...

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical a...

Role & responsibilities Process cashless and reimbursment claims (Should have knowledge of processing retail policies of National/United/New India/Oriental insurance companies. Preferred candidate profile BAMS/BUMS/BHMS Fresher or max 2 years experience in the similar field. Ready to work in shifts

Roles and Responsibilities Design and deliver training programs for international voice process teams, focusing on soft skills, accent reduction, customer service, sales, and product knowledge. Develop and maintain relationships with clients to understand their requirements and preferences for training delivery. Collaborate with subject matter experts to create engaging and effective learning materials. Monitor the effectiveness of trained employees through evaluation metrics such as quality scores, call audits, and feedback from customers. For further information kindly connect with- Simran Rana - 9137514621

Greetings!!! Openings at Sagility for Process Trainer(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

Dear Applicant, Hiring for US Healthcare (SQL) - TM Level : TM Location - Hyderabad Work mode : WFO Shift : US shift Years of exp : 7 yrs CTC - Up to 15lpa Qualification : any Graduate Notice period : Immediate , 30 days Skills : US Health Care Domain Knowledge. E.g. Encounters, EDI, HIPAA, 837 Layout, insights into Medicare and Medicaid Markets etc. Facets or any other healthcare adjudication system knowledge will be added advantage. SQL Server SSIS and SSRS plus any Microsoft cloud technologies will be added advantage. Analytical and Query Writing Skills(SQL) SQL Procedure and Packages Debugging skills. Knowledge on any reporting tools or software e.g. Tableau or Power BI etc. PPT Presenta...

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the cl...

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

Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and controls. Creating the process for claim processing (Cashless and Reimbursement). Co-ordination between Network Hospitals/Preauthorization/Claims. Ensuring a high-q...

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

SUMMARY Job Title: Healthcare Claims Associate German Language Location: Powai, Mumbai Experience Level: 1 6 years Employment Type: Full-time Shift: UK shift Job Summary: We are looking for a detail-oriented and multilingual professional to join our healthcare operations team as a Healthcare Claims Associate with fluency in German . The ideal candidate will be responsible for processing, reviewing, and validating healthcare claims in accordance with company policies and healthcare regulations. Fluency in German is essential as the role involves interpreting and processing claims originating from German-speaking regions. Key Responsibilities: Review, verify, and process healthcare claims usin...

Job Location : Hyderabad Qualification - Graduate Work mode Work from office Shift timing 1:00 PM IST to 12:00 AM IST Team leader - 12 lpa Team Manager - 15 lpa Notice 0-60 days US Health Care Domain Knowledge. E.g. Encounters, EDI, HIPAA, 837 Layout, insights into Medicare and Medicaid Markets etc. Facets or any other healthcare adjudication system knowledge will be added advantage. SQL Server SSIS and SSRS plus any Microsoft cloud technologies will be added advantage. Analytical and Query Writing Skills(SQL) SQL Procedure and Packages Debugging skills. Knowledge on any reporting tools or software e.g. Tableau or Power BI etc. PPT Presentations with client. Should be good at communication s...