224 Claim Investigation Jobs - Page 7

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

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...

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 skill...

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. Ve...

*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 com...

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, Kart...

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. • Answeri...

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...

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 & 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 t...

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 attor...

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...