164 Claim Investigation Jobs - Page 4

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, ...

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, ...

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, ...

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 expe...

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...

As a Claims Officer, your primary responsibility will be to efficiently handle and process insurance claims. You will be tasked with receiving and registering claims from policyholders or their representatives in a timely and professional manner. This includes collecting all necessary claim forms and documents to initiate the process. In addition, you will be required to meticulously collect and verify information related to the claims. This may involve gathering supplementary documents such as police reports, medical records, and any other relevant information essential for a thorough assessment of the claim. A crucial aspect of your role will be conducting detailed investigations into the ...

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through d...

Hiring Clinical Doctors for Medical coding role in Mohali !! Job Location - Mohali Role : Auditor I (IPDRG) Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT 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. (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 night shift. Interested candidates can share resume - abdul.rahuman@cotiviti.com Regards, Abdul Rahuman 9080276...

We are seeking a dynamic and detail-oriented Insurance Professional for the Legal Department to manage end-to-end insurance policy administration, claims processing, and risk management across multiple sites. The ideal candidate will have experience in insurance handling, preferably in the solar sector, and the ability to manage and coordinate across teams and insurance partners. COMPENSATION & BENEFITS: Medical Insurance Performance Incentives Cool Work Environment Travel Reimbursement (as per company policy) Exposure to challenging legal and insurance portfolios Supportive team and professional development ABOUT SADBHAV FUTURETECH LIMITED: Company Size - ~100 employees Headquarters - Gurga...

Prepare ILAs, Final Survey Reports, and requirement letters. Maintain records of claim intimation, surveyor visits, document status, and report. Follow up with insured and internal teams to minimize TAT Update data in CMS software Health insurance Provident fund

Job Summary We are seeking a highly skilled and experienced Team Lead for our RTR-Reinsurance domain. The ideal candidate will have 7 to 10 years of experience in customer service within the insurance domain. The role requires a strong understanding of claim investigation and property & casualty insurance. This is a hybrid work model with rotational shifts. Responsibilities Lead a team of customer service representatives in the P&C division to ensure high-quality service delivery. Oversee daily operations and ensure adherence to company policies and procedures. Provide guidance and support to team members to resolve complex customer issues. Monitor team performance and implement strategies t...

Responsible for overseeing and managing the claims process and ensures all claims are handled efficiently. Act as the main point of contact for customer inquiries,work to resolve issues promptly and Prepare regular reports on claims status.

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 ...

Description: JD for Investigations Manager, Claims Job Position Manager, Investigation - Claims based out of Corporate Office, Mumbai Job Brief Manager to oversee investigations for claims (Legal-TP Claims/ WC claims/ OD claims, PA Claims, Theft Claims & Health Claims, Commercial claims) of our GI business. The successful candidate will effectively ensure investigation conformity and minimize probability of exposure Academic Qualification Must be a graduate from a recognized institution or university. Law Graduate (LLB or LLM) + III pass out will be the first choice Required Experience / Key responsibilities Candidate must be experienced with 5 to 7 yrs in General Insurance Industry - specia...

Role & responsibilities Graduate Medical background, MR (B pharma), BHMS, BAMS/ MBA in Hospital Adminstration 2+ Years working experience in health insurance/health insurance TPA at Hospital handling/audit Candidate must have excellent knowledge of health insurance / Health TPA domain. Candidate must have excellent bill/medical negotiation skills & customer handling skills. Good communication skills in Hindi/English and regional language of the state/region. Ready to relocate himself/herself at location within India as may be required according to the job requirement Candidate must own vehicle to travel in various hospital assigned to him Candidate must be computer literate and shall possess...

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

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 i...

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 ...

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 d...

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 ...

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