164 Claim Investigation Jobs - Page 6

Job description Roles and Responsibilities 1. Acts as an interface between the TPA, Insurance Company and the hospital. 2. Responsible for investigation of suspicious claims. 3. Effective usage of Fraud control measures. 4. Act as a backend support to the TPA. 5. Responsible for data mining and analytics related to Fraud and Investigation (IFD) 6. MIS reporting related to fraud control and all stakeholders. 7. Should be completely fine with doing field work (for Investigations) 8. Should have own vehicle (2 Wheeler) with license. 9. Team handling exp is must . Desired Candidate Profile Preferably with an experience(min.3yrs) from TPA or Insurance profile. If Interested share your resume to t...

Job Title : P&C Claims Management Qualification : Any Graduate and Above Relevant Experience : 1 to 5 years Must Have Skills : 1.Experience in P&C Claims Management, preferably with BPO/Insurance process exposure. 2.Strong experience handling FNOL (First Notice of Loss) or FROI (First Report of Injury) cases. 3.Knowledge of claims systems like Guidewire, Duck Creek, Majesco, or similar platforms. 4.Familiarity with ISO, NCCI, and WCIRB reporting requirements. 5.Proficient in MS Office (Excel, Word) and data entry with attention to detail. 6.Strong communication and interpersonal skills with a customer-centric approach. 7.Ability to multi-task in a fast-paced and compliance-driven environment...

Job Title: Insurance Desk Executive TPA Coordination / Claims Specialist Location Options: KIMS Hospital, Nashik Survey No. 571/1A/1, Plot No. 63, Mumbai Agra Highway, Nashik, Maharashtra – 422001 KIMS Hospital, Thane West – Queens St, near Brentford Cooperative Society, Hiranandani Estate, Thane West, Maharashtra – 400615 Organization: Ayu Health Hospitals Experience Required: 0–2 years (Freshers are welcome to apply) Preferred Gender: Male Candidates Preferred Location: Candidates residing near hospital locations will be given preference About Ayu Health: Ayu Health is one of India’s fastest-growing healthcare networks, dedicated to making high-quality healthcare accessible and affordable ...

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...

Role: Executive / Sr Executive - Account Management (CRM) Receive and check claim documents for completeness and advice employees regarding pending documents, if any. Track and control documents to ensure TAT of claims/cards as per SLA. Feedback from Insurers and Corporates. Additional revenue opportunities from existing Corporates. Non voice coordinator Respond to queries from the employees of the corporate through e-mails. Maintain weekly reports on claims and queries and the TAT of the same Escalate issues as per the escalation matrix. To attend to any other assignments assigned to you from time to time. Candidates must have TPA experience Interested candidates can reach out via email at ...

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-: 6m- 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 determinin...

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...

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Manager Qualifications: Any Graduation Years of Experience: 10 to 14 years Language - Ability: English(Domestic) - Advanced 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 wou...

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-: 6m- 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 determinin...

Urgent requirement for BHMS,BDS,BAMS -Rajasthan(Jaipur) Freshers/candidate with clinical or TPA experience. 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: BHMS,BDS,BAMS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also app...

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 model that can mee...

Responsibilities: * Manage health & motor claims from intake to settlement * Investigate claims, gather evidence & negotiate settlements * Ensure compliance with regulatory requirements

Handling TPA related all process from billing to co-ordinate with TPA companies. Maintaining & uploading patient's files on the portal. Handling billing Department, Implants bill updating & reconciliation.

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 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...

Hiring Clinical Investigator for Mohali location ! Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT Candidates with prior US Healthcare or Clinical experience will be preferred. 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 night shift. Job Location - Mohali Interested candidates can share resume - Jitendra.pandey@cotiviti.com Regards, Jitendra 7350534498

Hiring Clinical Doctors for Medical coding role in Mohali !! 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. (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 night shift. Job Location - Mohali Interested candidates can share resume - Jitendra.pandey@cotiviti.com Regards, Jitendra 7350534498

Urgent requirement for BDS/MBBS-Chennai( Kilpauk ) Freshers/candidate with clinical or TPA experience. 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 / BDS graduate. MBBS Candidate Should be MCI Registered BDS Candidate Should be DCI Registered Male candidate prefer. Good Medical & basic computer knowledge Should have completed intern...

Venue Walk-In Interview on 30-May-2025, Registration will End by 11:00AM Responsibilities: Applying medical knowledge in evaluating the medical claim files to ascertain the medical admissibility. Must understand the policy wordings including Terms & conditions to adjudicate the Admissibility/Rejection. Processing of claims as per regulatory guidelines. Adhering to the TATs in processing. Quality review of processed files. Grievance redressal, handling escalations and Identifying the fraudulent claims. Required understanding and evaluation criteria: Qualified MBBS, BAMS, BHMS having all certificates in hand Preferably from Insurance and TPA experience Clinical Acumen/knowledge in terms of hos...

Health Investigator Field Investigator Claim Investigator Medical Claim Investigator

Role & responsibilities Oversee and manage the end-to-end claims process, ensuring timely processing and adherence to internal policies Analyze claims data to identify trends, assess process gaps, and evaluate financial impact Prepare and present reports including claim status, pending settlements, and loss projections to senior management Collaborate with internal teams and external partners to resolve operational challenges and enhance efficiency Act as the primary point of contact for claim-related insights, fostering clear communication among stakeholders Identify and implement best practices to improve claim management accuracy and efficiency

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(International) - 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...

About Navi Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a Navi_ite : 1. Perseverance, Passion and Commitment Passionate about Navis mission and vision Demonstrates dedication, perseverance, and high ownership Goes above and beyond by taking on additional responsibilities 2. Obsession with ...

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 off...

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 model that can mee...

Role: Executive / Sr Executive - Account Management (CRM) Receive and check claim documents for completeness and advice employees regarding pending documents, if any. Track and control documents to ensure TAT of claims/cards as per SLA. Feedback from Insurers and Corporates. Additional revenue opportunities from existing Corporates. Non voice coordinator Respond to queries from the employees of the corporate through e-mails. Maintain weekly reports on claims and queries and the TAT of the same Escalate issues as per the escalation matrix. To attend to any other assignments assigned to you from time to time. Candidates must have TPA experience Interested candidates can reach out via email at ...