45 Claim Adjudication Jobs

4+ Yrs of experience in US Healthcare claims adjudication. Responsible for training new hires and existing employees on US Healthcare claims adjudication processes, systems, and compliance requirements. Can reach me @9902419093(Geetha)

Greetings from Niva Bupa! Job Location- Noida Sector-59 Department- Customer Servicing 6 Days working Must be a BPT graduate. JOB SUMMARY: Answering customer who are disputing over claim rejection or claim related query, also able to provide relevant information to the customer, floor support for team for any query related medical documents, Walk-in customer for claims. KEY RESPONSIBILITIES: Handling of claim rejections/ claim related query over calls and emails Floor support Walk-in customers Interested candidate can share their CV on 7430802568 or consultant.anjalijha@nivabupa.com with a subject "CV for Claim Adjuticator"

As a TL-Ins Claims at our company, you will be a seasoned professional with 5 to 8 years of experience in the Data & Analytics Business. Your role will involve overseeing the claim investigation process, utilizing advanced Excel skills for data analysis, and collaborating with cross-functional teams to streamline claim processing. You are expected to ensure compliance with industry regulations, provide detailed analysis on claim trends, and develop strategies for enhancing claim adjudication processes. Moreover, you will monitor claim processing metrics, facilitate training sessions for team members, and maintain up-to-date knowledge of industry standards. Key Responsibilities: - Oversee the...

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak excellent English. CTC – Upto 3.5 LPA

Greetings from Firstsource !!! HR Spoc - Madhubala Looking for US Healthcare Professionals !! Experience : 1- 4 Years Process : Non Voice - Skill : Claims Adjudication!! US Healthcare experience. Work location : Navalur Chennai Required : Minimum 1year Experience in US Healthcare BPO. Claims Adjudication!! Education - Any Graduates and Diploma(10+3)can apply. Immediate Joiners preferred!! Willing to work in Night Shift. Interested folks can directly Walk-in to Location: 5th floor, 4th block, Sandhiya Infocity(Bayline Infocity), OMR Rajiv Gandhi Salai, Navalur, near to AGS Bus Stop, Chennai, Tamil Nadu 603103. Walk - in time: 11:00 Am - 2:00 Pm Walk - in date: Monday to Friday Note: Bring you...

Our Client is hiring for Claim Handler at Mumbai Location. Role type - Dedicated claims handler Work location - Work from office Mumbai, Vikhroli. Timings - 10 am - 7 pm. Monday to Saturday - Acko, Digit, Care TPA - Medi assist, Vidal Health, FHPL Required Candidate profile Preferred roles - Client Servicing, CRM, Claims handler, Customer support (If they understand claims terminology. Comms expectation - Interaction with Customers and Partners TPA/insurers

Our Client is hiring for Claim Handler at Mumbai Location. Role type - Dedicated claims handler Work location - Work from office Mumbai, Vikhroli. Timings - 10 am - 7 pm. Monday to Saturday - Acko, Digit, Care TPA - Medi assist, Vidal Health, FHPL Required Candidate profile Preferred roles - Client Servicing, CRM, Claims handler, Customer support (If they understand claims terminology. Comms expectation - Interaction with Customers and Partners TPA/insurers

Our Client is hiring for Claim Handler at Mumbai Location. Role type - Dedicated claims handler Work location - Work from office Mumbai, Vikhroli. Timings - 10 am - 7 pm. Monday to Saturday - Acko, Digit, Care TPA - Medi assist, Vidal Health, FHPL Required Candidate profile Preferred roles - Client Servicing, CRM, Claims handler, Customer support (If they understand claims terminology. Comms expectation - Interaction with Customers and Partners TPA/insurers

Our Client is hiring for Claim Handler at Mumbai Location. Role type - Dedicated claims handler Work location - Work from office Mumbai, Vikhroli. Timings - 10 am - 7 pm. Monday to Saturday - Acko, Digit, Care TPA - Medi assist, Vidal Health, FHPL Required Candidate profile Preferred roles - Client Servicing, CRM, Claims handler, Customer support (If they understand claims terminology. Comms expectation - Interaction with Customers and Partners TPA/insurers

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...

Job Descriptions: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of nonavailability of tariff. Approve or deny the cla...

Job Descriptions: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of nonavailability of tariff. Approve or deny the cla...

Job Descriptions: Check the medical admissibility of claims by confirming the diagnosis and treatment details. Verify the required documents for processing claims and raise an information. Request a case of an insufficiency. Approve or Deny claims as per T&C witihin TAT. Required Qualification : BAMS, BHMS and MBBS(with indian registration Work from Office only Interested candidates can share there profiles to disha.raman@mediassist.in or WhatsApp to 8904968911.

Configure Benefits for new/existing health plans. Able to understand claim Adjudication. Apply MS-Excel skills to write macros and apply formulas wherever required. Working hand in hand with onshore team to understand requirements. Testing benefits to ensure that all the products are delivered error free. Co-ordination and reporting with onshore. Maintain weekly and monthly metrics. Requirements for this role include: Manual Testing experience US Healthcare domain experience in claim adjudication Excellent excel skills able to create reports using Macros and able to use all formulas. Basic knowledge of SQL/PLSQL Exceptional customer service and follow-up communication.

Genpact (NYSE: G) is a global professional services and solutions firm delivering outcomes that shape the future. Our 125,000+ people across 30+ countries are driven by our innate curiosity, entrepreneurial agility, and desire to create lasting value for clients. Powered by our purpose the relentless pursuit of a world that works better for people we serve and transform leading enterprises, including the Fortune Global 500, with our deep business and industry knowledge, digital operations services, and expertise in data, technology, and AI. Inviting applications for the role of Process Associate P&C Claims roles for Bengaluru location Responsibilities: Ability to draw accurate data selection...

Job Descriptions: Check the medical admissibility of claims by confirming the diagnosis and treatment details. Verify the required documents for processing claims and raise an information. Request a case of an insufficiency. Approve or Deny claims as per T&C witihin TAT. Required Qualification : BAMS, BHMS, B.Sc. Nursing, Msc Nursing, Work from Office only Interested candidates can share there profiles to disha.raman@mediassist.in or WhatsApp to 8904968911.

You are a highly experienced and dynamic Project Manager with 10-12 years of relevant experience in Client Facing roles in Healthcare Services, preferably in the role of a Medical Billing/Claims Manager. You possess an Engineering Degree / Masters Degree / Bachelors Degree. The job location for this role is in Vizag & Shillong, and you should be willing to travel between iMerit offices up to 25%. As a Project Manager, you will be responsible for overseeing a team of Operators and Reviewers, focusing on optimizing operational efficiency and maintaining high standards of accuracy and quality for one of the significant healthcare clients. Collaboration with cross-functional teams, monitoring pe...

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...

Government Panel Knowledge like CGHS, ESI, ECHS Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Preparing split bills/ Doctor charges etc. Handling all TPA Portals.

Female Candidates can apply. Must have Min 1+yrs exp as a Team Leader from International Healthcare or Insurance Process BPO. Must know KPI's and Team Leading Skills. US Shifts Fluent English Call 8447780697 send CV monu@creativeindians.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...

Description The Claim Analysis role involves evaluating and processing insurance claims to ensure accurate and fair assessments, contributing to the overall efficiency of the claims department. Responsibilities Analyze and assess insurance claims to determine validity and coverage based on policy terms. Investigate claims by gathering relevant information, interviewing claimants, and consulting with medical professionals when necessary. Prepare detailed reports documenting findings and recommendations for claim resolution. Collaborate with underwriting and legal teams to ensure compliance with policies and regulations. Communicate effectively with clients, claimants, and colleagues to provid...

Job Responsibilities: ***ONLY BHMS GRADUATES CAN APPLY.*** Having experience (at least 5 yrs) in TPA claim processing. Having a Good relationship with Hospitals under the East Zone. Financial Contribute to renewal portfolio expansion through relationship building with the insurance companies and surveyors to ensure optimum claim settlement in minimum time During processing of claim analyse the following and communicate to underwriters: adequacy of sum insured anomalies in the policy scope of additional policies other related information Control expenses Business Process Facilitate proper settlement of the claim in the shortest possible time to the satisfaction of the client by ensuring the f...

Looking Immediate joiners 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 perfo...

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...