92 Claim Processing Jobs

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...

- Desired qualification: BHMS/ BAMS/ BDS/ BPT/ MPT/ BUMS - To check documents and process medical insurance claims - Prior experience in cashless/reimbursement/pre-auth claims preferred Required Candidate profile - Should have relevant experience in medical/health claims processing.

You are being hired as a Provider Support (Associate/Specialist/Executive) for the Inbound Voice Process at Integrum Outsource Solutions Private Limited. Your main responsibilities include analyzing, reviewing, and adjudicating provider claims, ensuring compliance with company policies and regulations, verifying member eligibility and benefit coverage, and maintaining HIPAA compliance. Key Responsibilities: - Analyze, review, and adjudicate provider claims. - Ensure compliance with company policies, state and federal regulations, and client guidelines. - Verify member eligibility, benefit coverage, and authorization requirements. - Utilize domain knowledge to solve problems and improve workf...

JOB 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.

As a Health Admin Services New Associate at Accenture, you will be a part of the Healthcare Claims team responsible for the administration of health claims, including health, life, and property & casualty claims. Your main responsibilities will include registering claims, editing & verification, claims evaluation, and examination & litigation. Your role involves embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrow. **Key Responsibilities:** - Registering health claims - Editing and verifying claims - Evaluating claims - Examining and...

Job Summary: We are looking for a skilled and detail-oriented AR Caller to join our healthcare RCM team. The AR Caller will be responsible for following up with insurance companies and patients on outstanding medical claims, ensuring accurate and timely reimbursement for healthcare services rendered. Key Responsibilities: Review unpaid or denied medical claims from insurance companies. Follow up with insurance companies via phone calls to understand claim status and resolve denials or delays. Initiate appeals or re-submissions as required to ensure maximum claim reimbursement. Document all call details and actions taken accurately in the billing system. Analyze and understand Explanation of ...

As an Insurance Coordinator at our company, you will be responsible for handling insurance approvals, documentation, claim processing, patient guidance, and coordination with TPA to ensure smooth hospital billing processes. Your role will play a crucial part in ensuring the financial aspects of patient care are efficiently managed. **Key Responsibilities:** - Handle insurance approvals and documentation - Process insurance claims accurately and in a timely manner - Provide guidance to patients regarding insurance coverage and billing procedures - Coordinate effectively with Third-Party Administrators (TPA) to streamline hospital billing processes **Qualifications Required:** - Minimum 1 year...

Globe Toyota is looking for an experienced Assistant Manager – Insurance (Automobile Industry Only) who can independently handle motor insurance operations, renewals, customer coordination, insurer communication, and dealership insurance performance. Required Candidate profile Experience ONLY from Automobile (4-wheeler) Insurance Strong knowledge of motor insurance, renewals & claims Ability to coordinate with insurer partner Target oriented & disciplined with SOP adherence

Role Overview: As a Health Admin Services New Associate at Accenture, you will be embedded in digital transformation in healthcare operations, driving superior outcomes and value realization today while enabling streamlined operations to serve the emerging health care market of tomorrow. You will be a part of the Healthcare Claims team responsible for the administration of health claims, including core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation. Key Responsibilities: - Registering health, life, and property & causality claims - Editing and verifying claim details - Evaluating claims - Handling examination & litigation ...

Role Overview: You will be responsible for conducting primary and secondary reviews of medical claims to ensure accurate reimbursement calculations aligning with self-funded benefit plan language. Utilize Microsoft Office tools to create letters, explanations, and reports to clarify medical reimbursement methods. Your input will be valuable for enhancing processes and driving continuous improvement. You will need to share daily production reports with the stateside manager for evaluation and feedback. Maestro Health will equip you with the necessary applications and access for claim repricing. It is essential to complete access requests within the first week of the project start date to comm...

As a Claim Coordinator, your primary responsibility will be to coordinate with various TPAs and insurance companies for claim processing and approvals. This includes verifying insurance documents, policy details, and patient eligibility. You will also assist in pre-authorization and cashless treatment approvals for insured patients. Your role will involve following up on pending claims, rejections, and reimbursements, ensuring that accurate and updated records of all insurance-related transactions and documentation are maintained. Key Responsibilities: - Coordinate with TPAs and insurance companies for claim processing and approvals - Verify insurance documents, policy details, and patient e...

As a Sr. AR Executive in the RCM process for medical billing, your role involves contacting insurance companies, patients, and healthcare providers to follow up on outstanding medical claims. You will be responsible for identifying and resolving issues with unpaid or denied claims, reviewing insurance remittance advice, and maintaining accurate records of all communication. Collaboration with internal departments to resolve billing discrepancies, providing excellent customer service, and staying updated on industry trends are key aspects of your role. Your key responsibilities include: - Contacting insurance companies, patients, and healthcare providers to follow up on outstanding medical cl...

As a Client Service Representative, your role involves providing clear answers to clients on any coverage or billing questions, including information on rate fluctuations or policy changes. You will ensure that clients fully understand the updates and changes to their policies by updating policy changes on customer accounts in our book of business and informing clients about policy changes according to NAIC regulations. Key Responsibilities: - Consult with clients to help process quotes and issue renewals or any updates needed to current policies - Gather all documentation needed for reporting a claim and contact an adjuster to process it against a current policy - Meet regularly with agents...

Company Description Medusind is a leading provider of innovative billing and revenue cycle management solutions for the medical and dental sectors. With expertise across various specialties, Medusind supports over 6,000 healthcare providers with cutting-edge technology and client-focused services. Our team of over 3,000 dedicated professionals, including AAPC-certified coders, ensures maximum revenue and operational efficiency for clients. Headquartered across 12 locations in the US and India, Medusind is ISO 27001 certified and fully HIPAA compliant. We are committed to client satisfaction through transparency, advanced technology, and a forward-thinking approach to healthcare solutions. Ro...

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 ac...

As an Insurance Executive, your role involves handling all vehicle insurance-related activities with a focus on providing excellent customer service and ensuring smooth operations at the showroom. Key Responsibilities: - Handle new vehicle insurance and renewal insurance for all customers. - Coordinate with insurance companies for quotation, policy issuance, and claim processing. - Explain insurance plans, coverage, and benefits to customers clearly. - Ensure all insurance documents are accurate and submitted on time. - Maintain daily records of insurance sales, renewals, and pending cases. - Support the sales team during vehicle delivery by arranging insurance papers. - Handle claim assista...

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...