224 Claim Investigation Jobs

Roles and Responsibilities: 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 non-availability of tariff. Approve or d...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model t...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

Greetings From Scorelabs Inc ! Validate medical necessity and check eligibility Ensure accurate claim coding for inpatient, outpatient, and day-care procedures. Qua - BAMS , BHMS & MBBS Freshers Are also Welcome ( If they Interested in Claims) Required Candidate profile Handle claim resubmissions, rejections, and audits from insurance providers. Collaborate with physicians, billing teams, and insurance officers for clarification or denials. Hr Mounika - 8688334476

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

Roles and Responsibilities: 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 non-availability of tariff. Approve or d...

About the Role We are looking for experienced and detail-oriented professionals to join our Claims Case Management Team . The role involves reviewing and analyzing health insurance claims, ensuring accuracy, compliance, and cost-effectiveness while maintaining a strong customer-centric approach . You will collaborate closely with hospitals, TPAs, and internal teams to identify irregularities, prevent financial losses, and uphold the integrity of the claims process . Key Responsibilities 1. Claim Review & Analysis Assess claims for admissibility, medical necessity, and identify irregularities or overbilling. Conduct root-cause analysis using claims data, treatment records, and clinical guidel...

Responsibilities: * Conduct field investigations * Verify documents on site * Report findings accurately * Collaborate with claims team * Ensure timely completion Annual bonus

Manager / Assistant Manager Account Management - MediAssist Job Title: Manager / Account Management Company: Medi Assist Location: Bangalore CTC: 9 to 12 LPA Experience: 11 to 15 years Industry: Health Insurance / TPA / Healthcare Key Responsibilities:- Client Relationship & Strategy: Build and maintain long-term partnerships with insurers, corporate clients, and healthcare providers. Lead high-level review meetings and ensure strong relationship governance. Operations & Service Delivery: Oversee end-to-end account operations including claims, customer service, and issue resolution. Ensure compliance with TATs and SLAs. Performance Analysis & Reporting: Monitor KPIs, analyze client data, and...

Responsibilities: * Conduct field investigations for claims * Collaborate with legal team on case preparation * Gather evidence, interview witnesses, analyze data * Present findings clearly and concisely Annual bonus

Responsibilities: * Process claims accurately and efficiently * Communicate findings clearly via email * Input data into system with precision * Conduct thorough claim investigations * Meet deadlines consistently

Seeking a male candidate with TPA/investigation agency experience, expertise in Mediclaim investigation/verification, team handling, client communication, and TAT management. Focus on reimbursement and cashless claims. Strong leadership required.

Responsibilities: * Conduct field investigations to gather evidence and facts. * Verify claims through on-site inspections and interviews with witnesses. * Collaborate with legal team during litigation processes. Annual bonus

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(Domestic) - Intermediate Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and hum...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than ...

Job Summary: Manage and conduct in depth Mortality, Frauds, Misconduct investigations received from various sources Responsible for driving culture in the Zone through coordination with Zonal Distribution and HR leaders Responsible for driving FMU initiatives and managing FMU activities in Zone Role & Responsibilities: 1. Mortality Investigations Manage agencies and get in-depth investigations of Mortality cases with holistic, appropriate and precise completion within TAT Coordination with Claims and Mortality Control Team for reconciliation and closure of assigned cases Managing and ensuring timely and accurate billing of investigation agencies 2. Proactive analysis of business to identify ...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

Job Summary: We are seeking a qualified and experienced medical professional with a strong background in health insurance claim settlement and customer service . The ideal candidate will leverage their clinical knowledge to evaluate and process health insurance claims efficiently while ensuring a high level of customer satisfaction. This hybrid role bridges the gap between medical accuracy , regulatory compliance , and empathetic customer support . Key Responsibilities: Medical Review & Claims Adjudication: Assess and validate medical claims based on clinical documentation and policy coverage. Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility. Co...

Order Management/Claims Order Skill-Order Management,Sales Order,Order Claims,Order Fulfillment,ERP,S&F Exp-1-2Yrs In Order(PKG Upto-3.5LPA) Exp-2-5Yrs In Order(PKG Upto-5.50LPA) Loc-Pune NP-Imm-30Days Ritika-8587970773 ritikab.imaginators@gmail.com Required Candidate profile Skill-Order Management, Sales Order, Order Claims, Order Fulfillment, ERP, S&F, claim processing, creating claims/tickets, dealing with supplier, credit note, handling investigation, Supply chain

Responsibilities: * Conduct field investigations on claims * Gather evidence and interview witnesses * Maintain confidentiality at all times * Prepare detailed reports with findings * Collaborate with legal team as needed Annual bonus

Job description We Are Hiring for International Semi voice Process Profile -: Claim Processing associate ( Semi voice) Languages req: Excellent English communication Requirement -: Good Communication Skills Exp-:2yrs- 5 yrs in claims Shifts:Rotational Location : Bangalore Immediate joiners only *** Only 2 rounds of interview Job description Document claim file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate. exposure and complexity for Property and Content damage and Liability/Injury claims. Exercise judgement to determine policy verification and coverage determination by analysing applicable coverage for claims and determini...