16 Claim Processing Jobs

R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work Fo2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Responsibilities: Follow up with the payer to check on claim status. Responsible for calling insurance companies in USA on behalf of doctors/physicians and follow up on outstanding accounts receivables. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Candidates must be comfortable with calling on denied claims. Interview Details: Interview Mode: Face-to-Face Interview Walk-in Day : 07-Jun-2025 (Saturday) Walk in Timings :11 AM to 3 PM Walk in Address: Candor Tech Space Tower No. 3, 6th Floor, Plot 20 & 21, Sector 135, Noida, Uttar Pradesh 201304 Desired Candidate Profile: Candidate must possess good communication skills. Only Immediate Joiners can apply & Candidate must be confortable with Gurgaon Location. Provident Fund (PF) Deduction is mandatory from the organization worked. B.Tech/B.E/LLB/B.SC Biotech aren't eligible for the Interview. Candidates not having Healthcare experience shouldnt have more than 24 Months Exp. Undergraduate with Min. 12 Months Exp is mandatory. Benefits and Amenities: 5 days working. Both Side Transport Facility and Meal. Apart from development, and engagement programs, R1 offers transportation facility to all its employees. There is specific focus on female security who work round-the-clock, be it in office premises or transport/ cab services. There is 24x7 medical support available at all office locations and R1 provides Mediclaim insurance for you and your dependents. All R1 employees are covered under term-life insurance and personal accidental insurance.

Handle incoming calls &emails related to insurance claims with professionalism, empathy Provide accurate information and support to policyholders regarding claim status, documentation, procedures Proficient in CRM software and Microsoft Office tools Required Candidate profile Assist in claim intake, verification, and documentation in accordance with company and regulatory standards. Collaborate with internal claims Excellent verbal and written communication skills. Perks and benefits Perks and Benefits

I. Primary Responsibilities Prepare placement slips, generate UMR, calculate premiums, issue debit and credit notes for Cedants and Re-insurers Perform sanction checks on booked accounts, verify policies booked after inception, and organize debit notes, credit notes, and tax invoices for future reference Suggest and implement improvements to accounting processes for enhanced efficiency and accuracy Collaborate with internal teams, communicate with clients and liaise with regulatory bodies to ensure smooth operations and compliance II. Additional Responsibilities Understanding of best practices in business processes and quality assurance Ability to work independently and as part of a team to achieve quality and compliance objectives Commitment to maintaining confidentiality and handling sensitive information appropriately Willingness to continuously learn and develop new skills to enhance audit effectiveness Publish dashboards to suggest the improvement in matched and unmatched revenues III. Skills and Competencies Technical Proficiency and Understanding of Insurance service Excellent Written and Oral communication skills Interpersonal skills Ownership and Accountability Insurance domain knowledge IV. Minimum Qualifications Education Graduate in Finance/Accounting or Postgraduate with any Specialization Degree Bachelor / Master Licenses/Certificates Insurance Certification will be the additional advantage Work Experience Minimum 1+ year of experience of Quality Analysis in Insurance domain & reconciliation process Collaborate with Underwriters and Claims Adjusters. Experience with Post Policy Placements

* 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

Manages the processing of health insurance claims incld. coordinating with hospitals, patients, and insurance companies to ensure efficient and accurate claim processing, pre-authorization, document verification, and report generation & compliances.

R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work Fo2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Responsibilities: Follow up with the payer to check on claim status. Responsible for calling insurance companies in USA on behalf of doctors/physicians and follow up on outstanding accounts receivables. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Candidates must be comfortable with calling on denied claims. Interview Details: Interview Mode: Face-to-Face Interview Walk-in Day : 05th April 2025 (Saturday) Walk in Timings :11 AM to 3 PM Walk in Address: Candor Tech Space Tower No. 3, 6th Floor, Plot 20 & 21, Sector 135, Noida, Uttar Pradesh 201304 For any queries contact on 8317044614 Desired Candidate Profile: Candidate must possess good communication skills. Only Immediate Joiners can apply. Provident Fund (PF) Deduction is mandatory from the organization worked. B.Tech/B.E/LLB/B.SC Biotech aren't eligible for the Interview. Candidates not having Healthcare experience shouldnt have more than 24 Months Exp. Undergraduate with Min. 12 Months Exp is mandatory. Benefits and Amenities: 5 days working. Both Side Transport Facility and Meal. Apart from development, and engagement programs, R1 offers transportation facility to all its employees. There is specific focus on female security who work round-the-clock, be it in office premises or transport/ cab services. There is 24x7 medical support available at all office locations and R1 provides Mediclaim insurance for you and your dependents. All R1 employees are covered under term-life insurance and personal accidental insurance.

Role Objective : To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities : • Process Accounts accurately basis US medical billing within defined TAT • Able to process payer rejection with accuracy within defined TAT. • 24*7 Environment, Open for night shifts • Good analytical skills and proficiency with MS Word, Excel, and PowerPoint Qualifications : Graduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill Set: Candidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. Non RCM (US Healthcare experience) candidates: BE/BTech pass-outs are not eligible and any experience above 2 years are not eligible Perks and Benefits: 5 days working Both side cabs (subject to hiring zone) Meal Health Insurance Chance to work in a Great Place to Work Certified Company (Winner for Three Consecutive Years) Interested and eligible candidates can call Namrata on 7059644807 to schedule an interview. Candidates can also come for Walk-Interview between 1-4 PM (entry time) at below mentioned address. Reference Name on CV - Namrata Lama (HR). Address : Tower 1, 2nd floor, Candor Techspa ce,Sector 48,Tikri , GURGAON, Haryana, India

RCM (Revenue Cycle Management) and Claim Processing for US Healthcare. Charge posting, eligibility verification, claim filing, denial management, appeal process, quality control. Address and resolve billing and claim related issues. Required Skills Minimum 2 years of experience as Team Leader in a similar industry for the Team Leader role. Minimum 3 years of experience in US Medical Billing/RCM for the Subject Matter Expert role. Minimum 1.5 years of experience in US Medical Billing/RCM for the Senior Process Associates role. Good knowledge of Microsoft Excel. Very good analytical and problem-solving skills. Must have good communication skills. About company: GreenWave Technologies India Pvt. Ltd. is a subsidiary company of OPN Healthcare (Oncology Provider Network) in California, USA. OPN is a technology enabled specialty healthcare services company focused on cancer care. It partners with physicians and aligns their practices with health insurance organizations and other healthcare payors to deliver oncology care while managing costs efficiently. OPNs capabilities with oncology network management, care and utilization management, revenue cycle management (RCM), data analytics and IT services lead the value-based oncology market.

AXA XL is looking for talented individuals to support our business across all product lines and geographies. This is an exciting opportunity to be part of a dynamic, global business. DISCOVER your opportunity What will your essential responsibilities include? Process the treaty contract set up in multiple system i.e., Genius, the Frame and Procede. Process the reinsurance recoveries in the multiple system i.e., Genius, the Frame. Process the facultative reinsurance contract set ups as per the process guidelines in both ProCede and the frame. Get them reviewed. Ensure collections / advices are issued promptly to relevant parties. Respond to broker queries and collaborate with Ceded Technical accounting. Assist in data collection and adhoc processing exercises arising from time to time. reporting. Request for test bordereaux. Review them and obtain signoffs before requesting live bordereaux. Prepare QS RI statement of accounts. Update QS trackers. Good understanding of the recoveries of facultative and treaty proportional contract recoveries processing. Respond on CRA DQ report for facultative recoveries accuracy of bordereaux to be sent to reinsurers. Identify own and individual team members training requirements to enable effective job completion. Assist in any other projects for data collection and assist in various Ceded Re UATs. You will report to Assistant Manager. SHARE your talent Were looking for someone who has these abilities and skills: Required Skills and Abilities: Bachelors degree or equivalent experience and preferably professional Reinsurance certifications. Relevant years of experience within a reinsurance\claim processing\underwriting support role. Proficiency in excel and good to have source systems knowledge i.e., Genius, the Frame and ProCede. Good communication skills. Desired Skills and Abilities: Individuals in these roles will demonstrate the following at an intermediate level, in addition to the AXA Values and Commitments. Integrity. Communication. Flexibility. Problem Solving. Outcome Orientation.

Urgent requirement for BHMS/BAMS/BDS -Chennai(Annasalai) Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436/7058036074 or share their updated resumes to hr9@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: BAMS / BHMS / BDS graduate. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Venue details: MDIndia Health Insurance TPA Pvt. Ltd., Raheja towers, Unit 005, Delta wing no-177, Beside LIC building, Annasalai, Chennai-600002.

Contact insurance companies to verify claim status and follow up on pending claims Review and analyze outstanding accounts receivable Resolve claim denials and discrepancies effectively Ensure timely collection of payments and minimize revenue loss Required Candidate profile Work closely with the billing team to resolve claim-related issues Maintain accurate documentation and update the system regularly Adhere to HIPAA compliance and industry standards Free Recruitment Perks and benefits Perks and Benefits

About US At CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities, and shareholders every day. One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We are devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being. CIGNA Healthcare believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization. Working at CIGNA Healthcare will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us! JOB PURPOSE The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization. RESPONSIBILITIES AND DUTIES Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication. Adjust error claims according to actual situation. Monitor and highlight high-cost claims and ensure relevant parties are aware. Well handle recoupment and reconciliation work, communicate with providers and members via call and email for collection and explanation. Processes claims from members and providers. Assists queries from providers and payers via phone calls or e-mails. Maintains files for authorizations and other reports. Assesses and processes claims in line with the policy coverage and medical necessity. Be fully versed with medical insurance policies for various groups / beneficiaries. May assist in training colleagues and asked to share knowledge. Accurately assesses eligibility within the policy boundaries. Monitors and maintains the claims processing as per the defined terms and policy of the organization. Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis. Monitors the qualitative and quantitative measures for claims & pre-approvals. Ensures compliance to any changes in terms of system parameters or process. Maintains quality as per framework for accuracy. Maintains productivity and responsiveness to the work allocated. Collaborate with other stakeholders / teams to resolve queries including complex queries. Actively support all team members to enable operational goals to be achieved. Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score). Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. Accurate data input to the system applications. Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods. Following up own workload (volume and timing): keeping an eye on chronology and processing time of the work volume and taking suitable actions. Participate efficiently in processing the flow of claims: inform the supervisor about claims lacking clarity and about possible ways of optimizing the processes. A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactions are important motivators. Monitor and highlight high-cost claims and ensure relevant parties are aware. Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication. Adjust error claims according to actual situation. Well handle recoupment and reconciliation work, communicate with providers and members via call and email for collection and explanation. Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly. Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved KNOWLEDGE, SKILLS AND EXPERIENCE At least 3-4 years of experience performing a similar role. Experience of working for an international company, preferred but not essential. Claims processing or insurance experience, preferred but not essential. Broad awareness of medical terminology, advantageous. Excellent organizational skills, capable of following and contributing to agreed procedure. Strong administration awareness and experience, essential. Strong skills in Microsoft Office applications, essential. First class written and verbal communication skills, essential. Ability to communicate across a diverse population, essential. Capable of working independently, or as part of a team. Good time management, ability to work to tight deadlines. Flexible and adaptable approach, sometimes working in a fast-paced environment. Passion for achieving agreed objectives. Confident in calling out when facing issues. Should be flexible to work in shifts and on staggered weekends COMMUNICATIONS AND WORKING RELATIONSHIPS The job holder must ensure building strong effective relationships with all his matrix partners and demonstrating approachability and openness. He/ She must be able to foster strong internal and external communication standards. Education * : Graduate (Any) - medical, Paramedical, Commerce, Statistics, Mathematics, Economics or Science. Experience Range * : Minimum 3-4 years and up to 4 years of experience in processing of healthcare insurance claims. Foundational Skills * Expertise in EU insurance claims processing Work Timings * : 7:30AM to 4:30PM IST(Flexible shift) Job Location * : Bengaluru (Bangalore)

Role & responsibilities A key member of Customer Service Operations team, responsible for providing an efficient, effective and compliant service to policyholders. Key accountabilities include handling of simple and complex cases, quality in service delivery, accuracy in providing and capturing information while adhering to compliance guidelines and support to team managers. Preferred candidate profile Good verbal and written communication skills Freshers eligible ; Preference would be given to individuals from an insurance background with approximately 1 years experience (Insurance Associate) with experience in handling written communication Perks and benefits Hybrid working mode

Role Summary: As a Fraud Analyst (Pre-Pay), within the Payment Integrity Department you will be directly supporting Cignas affordability commitment within Cigna International's business. This role is responsible for identifying and preventing fraudulent, wasteful and abusive expenses from around the globe and supporting the Payment Integrity FWA Team with client reporting. Responsibilities: Manages Team mailbox and responds or directs enquiries appropriately. Acts as initial review point for (possible) fraudulent claims. Identifying claims with potential waste and abuse Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity. Contact providers requesting documents and confirming information. Uphold documentation and process standards Partner with cost containment teams in other geographies to share best practices. Participate in projects to improve business processes. Ensure team savings are tracked and reported accurately. Partner with Payment Integrity teams in other locations to share FWA claiming schemes. Partner with Data Analytics team in building future FWA triggers automation. Support the production of investigation reports to internal and external stakeholders by compiling and storing evidence appropriately. Skills and Requirements: You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best. Experience of fraud investigation strongly desired. Minimum of 2 years of health insurance or health care provider experience. Knowledge of claims coding, regulatory rules and medical policy. Medical/ paramedical qualification is a definite plus. Demonstrated strong organization skills. Strong attention to detail. Ability to quickly learn new and complex tasks and concepts. Critical mind-set with ability to identify cost containment opportunities. Excellent verbal and written communication skills. Ability to balance multiple priorities at once and deliver on tight timelines. Flexibility to work with global teams and varying time zones effectively. Confidence to deal with internal stakeholders and ability to work with a cross functional team. Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines. Fluency in foreign languages in addition to fluent English is a strong plus.

Role: Manager / Senior Manager / Chief Manger /AVP-Health Investigations Vertical : ICLM Health Investigations Experience : 0 To 10+ years Lead and manage large teams for Health Claim investigations(CAT) Allocating claims investigation to internal and external resources Fraud Detection Identifies issues and potential solutions on all aspects of the claim processing & Investigation Taking regular and timely follow-up of allocated claims with internal and external resources. Carry out audit on the closure provided by internal and external resources. Adherence to TAT and Quality Guidelines Analysis of MIS reports / dashboards on time to time, inputs share to concern stakeholders. For constructive change which help in betterment of growing business. Education qualification: Needed is MBBS/ BHMS / BAMS/ BDS / D Pharm / B Pharm / Physiotherapis t Key Skills Health Claim Investigations Fraud Detection & Analysis Claim Processing Risk Assessment Team Leadership Digital & Hybrid Investigation Techniques Evidence Collection & Documentation Compliance & Regulatory Adherence MS Office & Excel Proficiency Professional Interested candidates can share their updated profile at shobha.samal@ext.icicilombard.com or 7045338823

Communicate names of Insurance company which you have empanelment & make them aware regarding Authorization /Preauthorization process Resolve all issue relate to IPD, OPD and Cashless insurance claim settlement from entry to Exit of patient JD cont.. Required Candidate profile 1-3 years of Experience in T.P.A activities Good knowledge of Insurance companies and related processes. Experience in TPA is must Looking for immediate joiner