76 Claim Processing Jobs

As a Senior Business Analyst / Lead Business Analyst at the company, your role will involve: - Having a minimum of 5 - 8 years of experience in EDI healthcare transactions. - Demonstrating strong knowledge of EDI standards and formats, especially related to 837, 835, 270/271, 276/277, and other healthcare-specific transactions. - Utilizing hands-on experience working with EDI translation tools such as Gentran, Sterling Integrator, or similar platforms. - Ensuring compliance with HIPAA regulations and understanding healthcare industry standards. - Having familiarity with HL7 and FHIR standards would be considered a plus. - Proficiency in mapping tools like Altair, Mirth Connect, or other EDI ...

Qualification: MSC, B.Pharma, M.Pharma Key Responsibilities: Good communication skill. Knowledge in computers like MS office. Good medical knowledge. Independently process Post hospitalization claims; process complex claims with minimal assistance Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information Suggest operational policies, workflows and process improvement initiatives Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same. Applying medical and surgical aspects to scrutinize the patient repor...

Qualification and Experience: Education: BDS/ BAMS/ BHMS/ BMBS Experience: 4+ Year of experience in claim processing, quality assurance or audit in a health insurance or TPA setup. Job Summary: The Medical Officer Revenue Assurance is responsible for ensuring accuracy, compliance, and efficiency in the insurance claim process through structured quality audits, SOP implementation, and continuous process improvement. The role is to lead the successful implementation of revenue cycle solutions ensuring that the system supports front-end, mid-cycle, and back-end processes across healthcare organizations. You act as a bridge between clinical, financial, and technical teams, leveraging deep domain...

Denial Management Perform pre-call analysis & check status by calling the payer/ using IVR / web portal services for Hospital billing Record after-call actions & perform post call analysis for the claim follow-up. Resolve enquiries, complaints Required Candidate profile Qualification: HSC/ 12th/ Under Graduates/Graduates Experience: 01 to 4yrs Good exposure to the US Healthcare Industry, Various Reports & Denial Management. Open for night shifts

You have a PG/MBA in HR (Full time MBA) with 5-6 years of relevant experience in handling HR Compliance and liaising with Statutory Authorities independently. You possess excellent people management skills, are target-oriented, positive, and proactive. Your experience includes a sound understanding and exposure in EPF, ESIC, Professional Tax, Gratuity related matters, Compliance, and other labour laws. Additionally, you have experience in liaising with external Insurance vendors for claim processing and settlement of Employee Claims. **Key Responsibilities:** - Handling HR Compliance and liaising with Statutory Authorities independently - Managing people effectively with a target-oriented ap...

Qualification and Experience: Education: BDS/ BAMS/ BHMS/ BMBS Experience: 4+ Year of experience in claim processing, quality assurance or audit in a health insurance or TPA setup. Job Summary: The Medical Officer Revenue Assurance is responsible for ensuring accuracy, compliance, and efficiency in the insurance claim process through structured quality audits, SOP implementation, and continuous process improvement. The role is to lead the successful implementation of revenue cycle solutions ensuring that the system supports front-end, mid-cycle, and back-end processes across healthcare organizations. You act as a bridge between clinical, financial, and technical teams, leveraging deep domain...

* Updating records and files in portal * Knowledge in computers like MS office. * Usage of company platform for patients data updation. * Database management. * Good interpersonal skill. * Coordination with other team members and internal department of the hospital * Share daily activity report to the reporting manager Note: Apply only if fine to work at hospital and location

As a Senior Manager Health Claims at Tata AIG General Insurance Company Limited, you will play a crucial role in building and maintaining strong relationships with key customers. Your responsibilities will include: - Serving as a point of contact for client inquiries and escalations. - Applying medical knowledge to resolve queries and provide guidance. - Handling grievance redressal, managing escalations, and identifying fraudulent claims. - Responding to customer inquiries via phone calls and emails, resolving complaints, and addressing concerns. - Assisting clients in understanding and navigating the claims process. - Collecting and verifying claim documents, and coordinating with internal...

Role Overview: As an Insurance Executive at Naruvi Hospitals, your primary responsibility will be to manage all aspects of hospital insurance operations. Your role will involve ensuring seamless coordination between patients, insurance providers, and internal departments to facilitate the insurance processes efficiently. Key Responsibilities: - Coordinate with patients, consultants, and insurance companies for pre-authorization, approvals, and claim processing. - Verify insurance coverage, policy limits, and eligibility of patients. - Prepare and submit pre-authorization requests and discharge intimations. - Follow up on pending approvals and claims to ensure timely settlements. - Maintain a...

Team Management Participate in recruitment process to identify the right talent within the function. Guide and direct the team in efficiently achieving their targets. Establish individual performance expectations and regularly review individual performance of the team. Identify and create development opportunities for team members to enhance functional knowledge. Non Motor Claims and Network Management Implement Claims SOP within the team and service network and ensure adherence of the same. Claims forecasting and workload distribution within the team and service providers based on claims volume, seasonality and ASP skill sets Claim processing an monitoring day to day claims activities and e...

Job Title:Associate Vice President Operations Department : Accounts Receivable Work Location:Navi Mumbai, India Reports To:Vice President Operations Work from Office Role Overview TheAssociate Vice President ARwill lead large-scale operations in the US Healthcare RCM domain, managing teams of 800+ employees across multiple accounts. This role requires strong leadership, client relationship management, operational excellence, and strategic vision to ensure process efficiency, profitability, and superior client satisfaction. Key Responsibilities People Leadership Provide strategic leadership to project teams, ensuring productivity, quality, and performance. Mentor and guide Team Leaders, SMEs,...

As a Motor Operation Sr, you will play a crucial role in supporting motor claims and underwriting operations. Your responsibilities will include assisting in processing motor insurance claims and documentation, coordinating with surveyors, garages, and policyholders for claim assessment, supporting the underwriting team in issuing and renewing motor policies, performing field visits if required, and maintaining accurate records while ensuring timely updates in the system. **Key Responsibilities:** - Assist in processing motor insurance claims and documentation - Coordinate with surveyors, garages, and policyholders for claim assessment - Support the underwriting team in issuing and renewing ...

As a Claims Processing Executive at the company, your primary responsibility will be managing and processing Medicare, Medicaid, and Commercial claims. Your proficiency in MS Excel will be crucial for ensuring operational efficiency and accuracy, especially during night shifts. Your role is essential for contributing to impactful healthcare solutions through data analysis, collaboration with team members, and ensuring compliance with healthcare regulations and policies. Key Responsibilities: - Utilize MS Excel for analyzing and managing claim data to enhance operational efficiency - Collaborate with team members to resolve claim discrepancies and improve processing workflows - Maintain knowl...

Job Description : Team Management Participate in recruitment process to identify the right talent within the function. Guide and direct the team in efficiently achieving their targets. Establish individual performance expectations and regularly review individual performance of the team. Identify and create development opportunities for team members to enhance functional knowledge. 2. Non Motor Claims and Network Management Implement Claims SOP within the team and service network and ensure adherence of the same. Claims forecasting and workload distribution within the team and service providers based on claims volume, seasonality and ASP skill sets Claim processing an monitoring day to day cl...

Description We are seeking a detail-oriented Radiology Coder with 2-5 years of experience to join our healthcare team. The ideal candidate will be responsible for reviewing and coding radiology services accurately, ensuring compliance with industry standards. This role requires a strong understanding of medical coding systems and the ability to work collaboratively with medical staff. Responsibilities Review and analyze medical records and diagnostic reports to assign appropriate codes for radiology services. Ensure coding accuracy and compliance with relevant regulations and guidelines. Collaborate with radiologists and other healthcare professionals to clarify documentation and coding quer...

As an AR Caller / Senior AR Executive at Wave Online (Cochin), a rapidly growing healthcare BPO specializing in end-to-end revenue cycle management, your responsibilities will include: - Reviewing and analysing accounts receivable reports for timely follow-up on outstanding claims. - Initiating calls to insurance companies to resolve pending claims or denials. - Handling claim rejections, denials, and follow-up processes efficiently. - Working on bundled claims and understanding authorization processes. - Meeting client-specific KPIs and productivity targets. - Documenting all activities accurately in the client system. - Maintaining a high level of professionalism and customer service durin...

As an insurance customer service representative, your role will involve providing clear answers to clients regarding any coverage or billing inquiries, including explaining rate fluctuations or policy changes to ensure full comprehension. You will be responsible for updating policy changes on customer accounts within our book of business and notifying clients about these changes in accordance with NAIC regulations. Your key responsibilities will include consulting with clients to facilitate the processing of quotes, issuing renewals, or making any necessary updates to current policies. Additionally, you will be required to gather all necessary documentation for reporting a claim and liaise w...

Role Overview: You will be working as a CRM Helpdesk - Claim Processing Executive with a background in health insurance at Watch Your Health. Your main responsibilities will include resolving customer queries related to policy coverage and health claim processes, driving claims application for submission and tracking by employees, acting as the direct point of contact for specific corporate clients, collecting and dispatching claim documents, coordinating with internal claims units to ensure seamless processing, staying updated on health insurance regulations, maintaining data confidentiality, and traveling twice a week between branches to solve customer queries. Key Responsibilities: - Impl...

As an individual responsible for administering health insurance policies, your role will involve ensuring accurate implementation and adherence to insurance guidelines. You will oversee the claims submission and processing workflow to guarantee timely and precise handling of claims. Your assistance will be crucial in addressing beneficiaries" health insurance queries, claims, and services. Additionally, you will maintain and analyze data related to claims, policy renewals, and beneficiary services to identify trends and enhance processes. It is essential to ensure compliance with regulatory standards and internal policies concerning health insurance. Collaboration with healthcare providers a...

As a Provider Support (Associate/Specialist/Executive) at Integrum Outsource Solutions Private Limited, you will be responsible for handling the Inbound Voice Process, specifically providing eligibility, benefits, and claim status support through calls. Your role involves ensuring high-quality service delivery and adherence to compliance standards. Key Responsibilities: - Analyze, review, and adjudicate provider claims. - Ensure compliance with company policies, state and federal regulations, and client guidelines. - Review claims for cost reasonability and medical necessity. - Communicate with reinsurance brokers for claim processing information. - Verify member eligibility, benefit coverag...

Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations 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 world's 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 ...

A Release of Information (ROI) Executive in US Healthcare is responsible for managing the disclosure of medical records and ensuring compliance with HIPAA (Health Insurance Portability and Accountability Act) and other regulations. This role is crucial in handling patient information requests while maintaining confidentiality and accuracy. Mandatory Skills: Indexing , US Healthcare Medical Records Roles & Responsibilities Process Medical Record Requests Handle patient record requests from patients, providers, insurers, and legal entities while ensuring accuracy. Ensure HIPAA Compliance Follow privacy laws to protect patient information and prevent unauthorized disclosures. Coordinate with St...

Responsible for handling backend operations, data entry, documentation, record management, claim processing, and daily reporting through PC. Ensure accuracy, timely updates, and smooth support to front-end teams

Role & responsibilities Short Paid Claim Contesting Executive-Drive timely and accurate contesting of short-paid claims across hospital-insurer interfaces, ensuring recovery yield and SOP compliance. Analyze short-paid claims and categorize by deduction type, insurer, and RCA triggers. Draft and submit contest letters with supporting documentation via IHX and insurer portals. Track contesting outcomes and escalate unresolved cases per SLA timelines. Collaborate with unit credit cells and central recovery team for RCA discipline and documentation hygiene. Maintain dashboards for contesting status, win-loss ratios, and financial impact. Ensure adherence to SOPs and flag deviation trends for go...

Role & responsibilities Maximize recovery of outstanding claims from TPAs and insurers through disciplined follow-up, documentation, and stakeholder coordination. Monitor aging reports and follow up on pending claims across TPAs and insurers. Coordinate with internal billing, credit cell, and finance teams for claim documentation and query resolution. Engage with insurer/TPA representatives to expedite settlements and resolve disputes. Maintain tracker for recovery status, escalations, and financial realization. Support RCA documentation and contesting for short-paid or denied claims. Prepare weekly MIS and recovery dashboards for leadership review. Preferred candidate profile Familiarity wi...