38 Claim Investigation Jobs - Page 2

1. Reviewing the cases processed by medical adjudicator 2. Analysing financial error occurring at medical level 3. Auditing the queries and requirements raised in cashless and reimbursement cases 4. Feedback sharing and training for the frequent errors happening at processing level 6 Week offs in a month. Normal shift(9-6/10-7) Education- Doctors(BHMS/BUMS/BAMS/BPT) Experience- Min 1-2 years of Non-clinical experience Budget- 3.5 LPA to 5.5 LPA

Job Profile - To Analyze the risk-based performance and strategize the premium flow to the Insurers with a goal to meet the desired bottom line of the organization. Role & responsibilities Claim ratio calculation, monitoring and publishing the claim ratio dashboard. Holding primary discussions with key stakeholders (internally) along with Insurers, Reinsurers and Brokers for sharing findings, way ahead for programs/policies and settlement. Providing insights on loss ratios, risk dynamics and their impact on business performance. Calculating in depth analysis of any anomalies observed in claim/loss ratios trends. Providing key findings for product/category in terms of data requirement from risk. Discussions with insurers/Reinsurers and brokers for regular renewal management and placement of new business. Preparing Program notes for Insurers to quote. Maintaining cordial relationships with Insurers, Reinsurers, and brokers To drive tech enabled automations with an intent for process excellence. Education & Experience Graduation required & MBA will be an added advantage 8-10 years of experience in Claims/ Underwriting. Should be working for a general insurance company or Insurance broker Skills, Abilities and Competencies Ability to engage with Employees across levels Ability to handle conflicts and grievance handling Effective Negotiation skills High level of empathy with good listening skills Strong people skills to assess behavioral & values alignment Highly skilled in process management with eye for detailing Behavioral Attributes Go-Getter, self starter Bias for action, Execution & speed Open to ideas and eager to experiment Collaborative approach with ease in dealing with multiple stakeholders and teams Task focused with Interested can share CV on given id sangeeta.rajput@techguard.in

We are currently hiring Medical Officers to handle the processing of cashless requests and health insurance claims for TPAs/Insurance companies and Manage volumes effectively & efficiently to maintain Turnaround time of processing cases.

Process Improvement: Develop and implement strategies to improve claims processing efficiency and customer satisfaction. Monitor service provider KPIs and ensure adherence to company policies. Assist with process reviews and improvements. Team Management: Supervise and mentor a team of claims adjusters, providing guidance on complex claims. Conduct regular training sessions to enhance team skills and knowledge. Conduct employee performance reviews. Claims Management: Handle commercial claims of various sizes, from intimation to settlement. Ensure timely and accurate processing of claims, adhering to turnaround times. Conduct regular claims reviews and identify areas for improvement. Coordinate with salvage/investigation teams and accounts for high-value claims. Analyze commercial line claims data (intimated, paid, closed, repudiated, outstanding). Stakeholder Management: Develop and maintain strong relationships with brokers, insureds, and service providers. Provide regular updates and feedback on claims activity and trends to underwriters/risk assessors. Address employee and customer concerns. Interested candidates can mail their resume- mitashi.gupta4@universalsompo.com Education & Experience: Bachelors degree in Business, Marketing, Insurance, or a related field. 2-3 years of experience in commercial claims. Compensation & Benefits: Competitive salary with performance-based incentives. Opportunities for career growth within the organization. Health insurance and other employee benefits. Training and development programs.

Role & responsibilities Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Preferred candidate profile Preferably 6 Months - 1 year of experience in investigation Health Insurance, TPA, Hospitals, Healthcare

We are Hiring for Claims Handler !! Qualification :Grad (Min 6m exp in claims) Location: Bangalore Salary:Upto 4.2L Shifts :rotational Virtual interview !! Email: Careers@glympsehr.com Call Manya @ 6364803282 /9606557106 / 6364822002 Required Candidate profile Fixed weekend off Communication skills. Service reps should be pleasant and empathetic while they're interacting with customers. Competent technical knowledge. Ability to multitask.

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 - 1 Year 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 that can meet the unique needs of each market segment.Claim processing team collects end-end data dataYou will be responsible for developing and delivering business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Property and Casualty InsuranceWriten & Verbal Communication Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

Role: Investigation Manager and have to manage daily work load of 15 to 20 claims end to end Triaging of claims from larger pool. Conduct ground inquiry with respect to brief of the case to understand the authenticity of the submitted cashless/ reimbursement/ death/ disability claim. Claim Assistance officer need to meet related person/ entity like insured/ claimant, vicinity check, hospital visit to collect claim relevant documents, meet treating doctor/ pathologist/ radiologist/ pharmacist and collect statement and relevant information which can help in adjudication of the claim. Officer needs to work on system to update the field work done on the case on regular basis and close the cases in system within stipulated TAT. Allocating claims to internal and external resources Taking regular and timely follow-up of allocated claims with internal and external resources. Carry out audit on the closure provided by internal and external resources. Have as strong hold on allocated claims and get the desired result by involving in to real time discussion with external resources. Maintain TAT and success ration as per the standard regional. Have to be ready to go down on ground as and when required to investigate health claims. Have to be open to travel across the state in hospitals.

We are looking for a female candidate. The Role includes Investigate/resolves claims, conduct phone calls, pursue recoveries, process claims, review medical history, monitor large claims, ensure compliance, assist with projects/reporting. Required Candidate profile Medical degree (BHMS, BAMS, etc.) or BSc Nursing/BDS. 0.5-3 yrs exp. Attention to detail, analytical skills. Pref: claims processing, health insurance, US healthcare, coding & medical record exp.

Job Description (IFD) Communicating with clients and understanding the investigation requirements. • Meeting with clients to discuss the nature of the investigation. • Conducting field investigations on appointed cases, insurance claims, or client requests. • Conducting in-depth research on various appointed cases. • Decide the extent and validity of a claim, and in so doing, prevent fraudulent claims by determining the claim's authenticity. • Gathering and analyzing evidence reports. • Conducting photographic and audio surveillance to gather evidence • Reviewing and solving cases by authenticating insurance claims. • Coordinating with agents to understand insurance claims matters. • Answering to specific trigger in reports. • Manage multiple cases with confidence and accuracy and respond well to working to meet targets and tight deadlines. • Prepare reports, maintain records and keep track of evidence trails. Address - MDIndia Health Insurance TPA Pvt. Ltd. First Floor, Lakhami Enclave, 41, Hosur Rd, near Forum Mall, Nanjappa Layout, Adugodi, Bengaluru, Karnataka 560030. Contact Number - 7030949730 ( Neha Nanoti )

We looking for candidates with minimum 1 year experience in Medical Insurance/TPA with good communication and email writing skills with good medical knowledge in Claims Adjudication. Current open positions: 4 vacancies Profile requirements: Qualification: Strictly from BAMS, BHMS, BSMS and MBBS. Candidates who can join us immediately to max 15 days. Role & responsibilities Cost control, Negotiations with hospitals, Bill revision, Savings update, and reprocessing Knowledge and Skill Requirements Technical Competencies Claims processing - Preauthorization, Medical adjudication, Billing experience GIPSA / MA package / SOC / Tariff deviations Identifying Bill inflations - Insurance Corporate billing Revenue Leakage, Cost control and Negotiations Audit on bundling / Unbundling of procedures Knowledge of surgeries, Advanced treatment, and cost of procedures Reasonable Customary clause Behavioral Competencies : Communication, Teamwork, Time management Interested candidates please reach out to us in whats app - 9880752060 or catherine.xavier@mediassist.in directly for the further interview process.

Dear Candidates, We are currently hiring Insurance Claim Associates for Ranchi Location. Interested candidate may send their CV to hrfirst@firstadvisorsinsurance.com

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 - Intermediate 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 that can meet the unique needs of each market segment.Claim processing team collects end-end data dataYou will be responsible for developing and delivering business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Ability to manage multiple stakeholders,Ability to perform under pressure,Agility for quick learning,Collaboration and interpersonal skills,Commitment to qualityAbility to manage multiple stakeholders,Ability to perform under pressure,Agility for quick learning,Collaboration and interpersonal skills,Commitment to quality Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation