Quality specialist For claims adjudication with Sagility Sagality India

3.0 - 7.0 years

4 - 5 Lacs

indore, coimbatore, bengaluru

Work from Office

Urgent hiring for Specialist quality for claims adjudication from US Healthcare. Looking for immediate joiners or less than 30 days' notice period. Interested folks can reach out to below mentions contact persons. Quality Analyst Claims Adjudication (US Healthcare) Experience: 4 years Location: Indore, Coimbatore, Bangalore Department: Claims Operations Role Summary: A results-driven Quality Analyst with 4 years of experience in US healthcare claims adjudication. Proficient in conducting audits, ensuring compliance, and improving accuracy in claims processing. Skilled in applying 7 QC tools, Root Cause Analysis (RCA), Corrective & Preventive Actions (CAPA), and Six Sigma methodologies to drive process improvements, error reduction, and compliance adherence. Key Responsibilities: Conduct audits of adjudicated claims to ensure accuracy, compliance with client guidelines, and US healthcare standards. Utilize Six Sigma tools and methodologies for process optimization and efficiency improvement. Apply 7 QC tools to analyze defects, identify trends, and improve quality outcomes. Perform Root Cause Analysis (RCA) on recurring errors and implement CAPA to eliminate reoccurrence. Track and analyze quality performance metrics, prepare audit reports, and share insights with stakeholders. Collaborate with operations and training teams to close feedback loops and implement corrective measures. Ensure compliance with HIPAA and regulatory guidelines while handling sensitive member/provider data. Lead and support continuous process improvement initiatives to enhance accuracy, productivity, and customer satisfaction. Core Skills: Claims adjudication (Medical, Dental, Hospital & Pharmacy claims) Quality audits & compliance review Six Sigma (Green Belt preferred) & process improvements 7 QC tools, RCA & CAPA Error trend analysis and quality reporting Analytical thinking & problem-solving MS Excel, Quality monitoring tools, Workflow management Interested candidates can please reach out as below: For Coimbatore location please reach out to Anitha or whats app your resume on : 9597910418 For Bangalore location please reach out to Preetham - Please share your updated resume on preetham.hr@sagility.com For Indore location please reach out to Srikanth or whats app your resume on : 8309217838

Posted 5 days ago

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Senior Medical Officer Paramount health caee

5.0 - 9.0 years

0 Lacs

maharashtra

On-site

You will be responsible for conducting internal quality checks on claims processed by the Claim Team on a daily basis. Additionally, you will attend external audits conducted by different Insurers at PHS Mumbai premises and visit Insurer offices to discuss recoveries/queries raised. It will be part of your role to sensitize the team about various errors made during processing. The job is a full-time position located at A-442, Road No. 28, Ram Nagar, M.I.D.C. Industrial Area, Wagle Estate, Thane West, Pin Code - 400604. The work schedule is during day shifts, and the benefits include health insurance and Provident Fund.,

Posted 1 month ago

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