224 Claim Investigation Jobs - Page 3

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

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 tri...

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 tri...

About the Role: As a Chief Risk officer, you will define and lead the Enterprise Risk Management (ERM) framework, encompassing strategic, financial, operational, cyber, and fraud risks. Youll bring sharp insights, emerging risk intelligence, and actionable governance to the table. Your core focus will be P ayments & Transaction Risk — ensuring secure, scalable, and compliant experiences across UPI, wallets, BBPS, cards and merchant flows. Role & responsibilities 1. Enterprise Risk & Governance Define and lead the Enterprise Risk Management (ERM) Framework covering strategic, financial, operational, compliance, fraud, and cyber risks. Establish and maintain risk appetite and tolerance levels ...

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...

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...

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...

Role & responsibilities Play as an intermediate role Between the Insurance co. and Hospital and We Assist Team. Adjudicating cashless and Reimbursement claims with claim documents provided by help desk executive. Should be able to do claim tabulation to bifurcate payable and non-payable items as per the terms and conditions laid out in the insurance policy. Evaluating claims and posting remarks in whats app group and updating in CRM. Monitoring billing as per the Tariff. Managing claims escalations from hospitals. Responsible to handling queries raised by insurance company / TPAs Provide technical assistance and conduct training sessions for new processors on various health insurance policie...

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...

Role & responsibilities: Outline the day-to-day responsibilities for this role. JOB DESCRIPTION HOSPITAL RELATIONS MANAGER Job Title: Assistant Manager/Deputy Manager, Hospital Relations Manager Department: Hospital Relations Location: Multiple (within Maharashtra) – Nagpur, Solapur, Satara, Kolhapur, Pune, Aurangabad, Nashik, Ahmednagar Job Type: Full-Time Job Summary: The Hospital Relations Manager will be responsible for managing and optimizing the relationship between the organization and hospital partners. This role involves overseeing pricing strategies, negotiating claims, resolving pending issues, and ensuring smooth coordination with internal stakeholders. The position also requires...

Open Positions (US Healthcare – Claims Adjudication Process_ Team Leader – Operations Quality Specialist Subject Matter Expert (SME) Quality Team Leader Process Trainer Assistant Manager Experience : 4 Years into US Health care Location : Coimbatore

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...

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 Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

Role & responsibilities We are looking for an accomplished Doctors with significant ICU experience and a strong ability to manage both clinical and non-clinical responsibilities. The ideal candidate will excel in patient care, clinical documentation, and possess in-depth knowledge of medical documentation essential for insurance claims processing. Key Responsibilities: Patient Documentation: Manage patient medical history and progress notes with precision. Claims Processing: Handle preauthorization and reimbursement claims, including validation and processing. Clinical Records: Maintain accurate clinical documentation in compliance with healthcare standards. Collaboration: Work closely with ...

Responsibilities: * Conduct field investigations for claims * Meet deadlines for report submission * Maintain confidentiality at all times * Gather evidence and interview witnesses * Prepare detailed investigation reports Annual bonus

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

ROLE & RESPONSIBILITIES Preauthorization claim processing Manage the Turnaround time. Quality adjudication with Errorless Rotational basis shift (8 AM to 10:30 PM) WFO only QUALIFICATION & EXPERIENCE: BHMS/BAMS/BUMS/BDS/BPT 1-2 years Experience Knowledge of insurance field Strong medical knowledge Fresher also can apply KEY COMPETENCIES & SKILLS REQUIRED MS office Communication Medical knowledge/disease knowledge Note- Interested candidates can share their resume at vishali.massey@nivabupa.com

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

Hiring for charge back and dispute handling profile 5 days working 2 offs Rotational shifts Grad with 1 year exp in Dispute & Charge back profile banking exp is preffered. Salary upto 6.50 LPA Only immediate joiners preffered Swati : 9354911204

Position: Medical Officer (Doctor) - TPA for Insurance and Risk Analysis Location: Gurgaon Job Type: Full-time About Policybazaar For Business Policybazaar, the flagship platform of PB Fintech Ltd., is Indias largest online insurance marketplace, acclaimed by Frost & Sullivan. Established in 2008, Policybazaar has revolutionized insurance with unmatched awareness, choice, and transparency. Introducing Policybazaar for Business, a dedicated service designed to meet the unique insurance needs of enterprises. Launched in 2021, it offers a robust portfolio of 15+ business insurance products tailored to diverse sectors, scales, and risk profiles. Policybazaar for Business aims to fortify Indias f...

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 - 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 envi...

Job Description: 1. Conduct insurance claim & valuation surveys of industrial, commercial & residential properties, prepare reports, handle correspondence, and assess losses as per policy coverage. Education: B.Tech (Civil/Mech/Elec), Freshers. Health insurance Provident fund