86 Claim Investigation Jobs - Page 2

Hiring for MNC 5 days working Rotational offs/shifts Grad with 1 year exp in Dispute Handling Salary upto 6.50 LPA Swati : 9354911204 Yashraj Anand 9910986621 Pooja 9821396721 Riya 9810963162

Role & responsibilities - manage risk across claims and underwriting processes. This leadership role requires close collaboration with multiple internal teams, including Claims, FWA, Retail Underwriting, Sales and Actuarial departments, to drive business performance, ensure regulatory compliance, and maintain effective governance. Monitor overall claims and underwriting portfolio performance by analyzing trends throughout Channels. Collaborate with Channel Heads and ground teams to define actionable plans for addressing unproductive or loss-making claims segments, fraud identification and prevention; etc. Lead initiatives to reduce claims costs, mitigate losses in unprofitable cohorts, and improve customer experience Conduct process reviews to identify and control processing errors, transaction outliers, and implementation risks. Develop and execute risk mitigation strategies to ensure smooth adoption of new processes and strategies. Manage audits and resolve findings related to Claims and Underwriting, including IRDA, internal, statutory, and other audits. Lead quality checks for processed claims (in-house and TPA) through concurrent/retrospective audits and system validation. Conduct audits of NEFT/Payment processes and clinical coding to ensure accurate system adjudication and effective data analytics. Enhance documentation and reporting accuracy within the Claims function. Oversee governance within the Claims and Underwriting teams to align with company objectives.

Roles and Responsibilities Manage a team responsible for investigating fraudulent activities related to health claims. Conduct thorough investigations into suspected cases of insurance fraud, gathering evidence and interviewing witnesses as needed. Develop and implement effective strategies to prevent future instances of fraud through risk control measures. Collaborate with other teams within the organization to ensure seamless communication and coordination during investigations. Ensure compliance with regulatory requirements and company policies throughout all aspects of claim investigation.

POSITION: MEDICAL OFFICER/CONSULTANT 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 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 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. • • • Responsibilities 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 deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

Looking for an Accounting Receivable Specialist with 1+ year of U.S. medical billing experience, knowledge of EOBs, denials, CPT codes, and U.S. insurance. Must work U.S. shifts from Pune. Healthcare experience required. Provident fund

Hiring for Disputes profile Loc- Gurgaon 5 days working Rotational offs/shifts Grad with 1 year exp in Dispute Handling Salary upto 6.50 LPA Call/whatsapp Divya- 9910810424 Shradha-9810359155 Vishu-9810359162 Alok-9810964095 Required Candidate profile Candidates should be ok with the night shifts. Candidates should have a good communication skills. Perks and benefits Both side cabs Cab allowances upto 4k

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 Medical Officer Claims PA/RI Approver Reporting to Location Assistant Manager Claims Noida Educational Qualification BHMS, , BAMS Shift 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 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. • • • Responsibilities 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 deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

POSITION: MEDICAL OFFICER/CONSULTANT 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 Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 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 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. • • • Responsibilities 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 deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies

Hiring for Dispute/Fraud claims Good communication skills Required Grad/UG with 1yr in Dispute/Fraud claims Salary upto 6.5LPA 5Days working Rotational shift/Off Cab/cab allowances Call & WhatsApp Zam 9910972518 Snehal 9625998099 Lakshita 8595954721

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture 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 120 countries. Visit us at www.accenture.com 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 dataDevelop and deliver 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 establish strong client relationshipAbility to handle disputesAbility to manage multiple stakeholdersAbility to meet deadlinesAbility to perform under pressure- 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 Qualification Any Graduation

Responsibilities: * Manage patient care in emergencies * Conduct claim investigations * Process health claims * Adjudicate claims fairly * Collaborate with TPAs on case resolution

Walk-in Drive || Clinical Doctors || Cotiviti Pune || IPDRG || Fresher & Experienced || Walk-in Date : 12th Jul 25 Walk-in Time : 10 AM to 2 PM Job Location : Pune Venue : COTIVITI INDIA PRIVATE LIMITED - Plot C Binarius Building 190 / 192 Plot C, Deepak Complex, National Games Road Off Golf Course, Shastrinagar, Yerawada, Pune, Maharashtra 411006 Eligibility : Fresher Eligibility Criteria : Medical Degree (MBBS or BAMS or BHMS or BPT) with Clinical experience or US Healthcare experience Strong analytical, critical thinking and problem solving skills Should have general knowledge on Medical Procedures, Conditions, illness & Treatment Practices Excellent verbal and written communication skills Should be ready to work in night shifts during training time Experience Eligibility Criteria : Any graduates with IP DRG Experience (Min of 1+ years) Active credentials through CIC & CCS is mandatory Excellent verbal and written communication skills Should be ready to work in night shifts during training time Interested candidates can share resume - abdul.rahuman@cotiviti.com or contact the below number Regards, Abdul Rahuman | Sr HR Executive 9080276094

Job Overview: We are looking for an experienced Claims Manager to handle non-motor insurance claims (such as Fire, Marine, Liability, Engineering, and other commercial policies ) for our SME clients. The ideal candidate should have a strong technical understanding of policy wordings, loss assessment, and claims lifecycle management, with the ability to coordinate effectively with surveyors, insurers, and internal stakeholders. Location : Ahmedabad Key Responsibilities: End-to-End Claims Management for non-motor SME policies including Fire, Marine, Liability, Engineering, etc. Coordinate with Insurers and Surveyors for timely claim registration, survey appointments, and assessment updates. Verify claim documents and assist clients in claim documentation and submission. Ensure timely follow-up and track the status of pending and approved claims. Resolve claim-related queries or disputes raised by the clients or insurers. Liaise with internal teams (Sales, Operations, etc.) to ensure seamless customer experience. Maintain and update MIS for claims on a regular basis. Analyze claim trends, recommend process improvements, and reduce TAT. Ensure compliance with IRDAI regulations and company protocols. Interested candidates please share your resume on disha.doshi@probusinsurance.com

*2-4 years exp. in Indian Insurance end-to-end group medical claims, *Resolved queries via Freshchat/Freshdesk (Customer Support) *Policy Document assessments *Stakeholders Mgmt., Collaboration & led escalations *Email/WhatsApp comms. Required Candidate profile *2-4 years exp. in Indian Insurance claims processing, CRM/Servicing/Claims handler roles in Insurer /TPA. *Graduate in healthcare, insurance *Verbal proficiency in English & Hindi must.

We are hiring for Automobile claim settlement process. - Helping customer through email and voice for settlement of claim - Skills Required: Knowledge of warranty claim process in automobile industry / Service Advisor in workshop. HR - 75488 27248 Required Candidate profile Qualification: Diploma in Automobile / Diploma in Mechanical Experience: Experience in Automobile / Internship experience in Automobile Language - Tamil or Hindi or Telugu and English Day shift

Hiring Alert Medical Officer (Claims) | Contract Role Location: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Company: Medi Assist Insurance TPA Private Limited Timing: 9:30 AM 6:00 PM | MonFri (Rotational Saturdays working) Eligibility: BAMS or BHMS graduates only 03 years experience (freshers welcome!) Role Overview: You will scrutinize and process insurance claims based on policy terms, verify treatment/diagnosis, raise queries for incomplete documents, and ensure accurate and timely closure of claims. Key Skills: Strong medical understanding Basic computer & typing skills Good communication Send your resume to: kishan.dwivedi@mediassist.in

Hiring Clinical Doctors for Medical coding role in Mohali !! Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT, MPT,BUMS Candidates with prior US Healthcare or Clinical experience will be preferred. Fresher Physicians can also apply with good clinical knowledge. Noncertified Physicians can apply however should be ready to complete the same within specified timeline. (CPC/CIC) Good communication skills. Candidates with corporate experience will be preferred. Immediate joiners preferred. Should be ready to work from office. Should be ready to work in rotational shift (Including night). Job Location - Mohali Interested candidates can share resume - karthickumar.sekar@cotiviti.com Regards, Karthick 8754142459

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. Note : Bike is Mandatory for travelling. Kindly share your Resume on ta4@mdindia.com

Urgent requirement for MBBS-Chennai( Kilpauk ) Freshers. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: MBBS graduate. MBBS Candidate Should be MCI Registered Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Only Male Candidates Required Venue details: MDIndia Health Insurance TPA Pvt. Ltd. No: 226 , OM Sakthi Towers Kilpauk Garden road, Kilpauk, Chennai-600010.

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture 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 120 countries. Visit us at www.accenture.com 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 dataDevelop and deliver 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 Claims ProcessingProperty and Casualty Insurance 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 Qualification Any Graduation

Role & responsibilities Provides professional medical, technical, consulting advice, and recommendations in support of claims evaluation, investigation, and assessment for various claims-related departments, while managing assigned caseload of complex case applying specialized training and knowledge to the assessment of cases and acting as a resource on clinical and technical issues. Conducts complex research, review and analysis of medical records, treatment plans and claim information. Provides recommendations regarding claimants current potential functional abilities and develops goal-focused return-to-work plans. Assess training needs and creates, authors, and presents medical training to claim and business partner associates. Engages claimants, healthcare providers, employers, and customers to ensure strict adherence in determining functional abilities. Engages claimants, health care providers and employers in return to work potential and planning while coaching claim specialists on identifying and acting upon return-to-work potential. Creates effective requests for medical information which focus on clarifying medical restrictions and limitations and their impact on work functionality. Performs other related duties as assigned or required Preferred candidate profile Education: Bachelor's degree (Medical) or diploma with a minimum of 15 years of education. Required Current RN licensure 4+ years of experience as an RN with Clinical/Ops Experience Preferred 7+ years Disability claims and/or clinical experience. Disability claims experience Preferred designations CCM (certified case management) and/or CDMS (certified disability management specialist). Shift Timing: 5:30 pm to 2:30 am Mon to Fri 5 day's work from office Note: This is an individual contributor role for a blended process.

Greetings from Access Healthcare Minimum 1year of experience required Should have Knowledge in payer or provider experience Candidate should have good communication skills Basic knowledge on Revenue cycle management Salary as per company norms Ready to work in night shift Location : Chennai Interested candidates can drop your resume through WhatsApp - 9944497268/9043315031

Long Term Disability Claim Manager Role Overview: The LTD Claim Manager will manage an assigned caseload of Long Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners in order to gather the information that is most relevant to each claim. It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate customer eligibility and interact with internal and external customers including, but not limited to, customers, employers, physicians, internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim. What You'll Do: Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach. Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information Execute on all client performance guarantees Respond to all communications within customer service protocols in a clear, concise and timely manner Make fair, accurate, timely, and quality claim decisions Adhere to standard timeframes for processing mail, tasks and outliers Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.) Clearly articulate claim decisions both verbally and in written communications Understand Corporate Compliance, Policies and Procedures and best practices Stay abreast of ongoing trainings associated with role and business unit objectives What You'll Bring: High School Diploma or GED required. Bachelor's degree strongly preferred. Long Term Disability Claims experience preferred. Experience in hospital administration, medical office management, financial services and/ or business operations is a (+) Comfortable talking with customers and having thorough phone conversations. Excellent organizational and time management skills. Strong critical thinker. Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously. Ability to focus and excel at quality production Proficiency with MS Office applications is required (Word, Outlook, Excel). Strong written and verbal skills demonstrated in previous work experience. Specific experience with collaborative negotiations. Proven skills in positive and effective interaction with customers. Experience in effectively meeting/exceeding personal professional expectations and team goals. Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset. Comfortable giving and receiving feedback. Flexible to change. Demonstrated analytical and math skills. Critical Competencies: Decision Quality Communicate Effectively Action Oriented Manages Ambiguity Customer Focus

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 About Accenture 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 120 countries. Visit us at www.accenture.com 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 dataDevelop and deliver 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 perform under pressureAbility to work well in a teamAdaptable and flexibleCommitment to qualityAccount Management 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 Qualification Any Graduation

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile – Executive If interested kindly share your resume to recruitment1@mdindia.com