121 Claim Settlement Jobs - Page 5

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 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 offers a flexible operating model that can meet the unique needs of each market segment.Claims processing team collects end-end data dataReporting to the Head of Analytics, Intel and Reporting, the F&R Reporting Analyst in Accenture will be responsible for repeatable reporting tasks for Property & Casualty (P&C) Claims Fraud and Recovery (F&R). This role will involve working with global data, performing data quality and management, and delivering data and reporting across all regions and lines of business. What are we looking for? Responsible for delivering reporting and metrics for GI Claims Fraud and Recovery on a cyclical basis. Work with large datasets to manage quality control process of data for Fraud and Recovery, i.e. gathering, cleansing, reconciling, and correcting data. Manage month-end process to submit and publish monthly data results for Fraud and Recovery, e.g. Fraud Preliminary Results, Monthly Claims Mapping Exercise, Activity Report, Fraud Regional Exhibits, Recovery MPR's, Expense Reports, GREAT Monthly Extract, Country Production Reports, etc. Produce monthly, quarterly, and annual results at a Global/ Regional/ LOB level, including but not limited to Monthly Business Reviews, Quarterly Business Reviews, Deep Dive reporting, etc Ability to learn quickly, produce high-quality results, team-player but can also work independently. Experience working with and interpreting large sets of data. Possess strong analytical, critical thinking, and problem-solving skills. Roles and Responsibilities: Responsible for delivering reporting and metrics for GI Claims Fraud and Recovery on a cyclical basis. Work with large datasets to manage quality control process of data for Fraud and Recovery, i.e. gathering, cleansing, reconciling, and correcting data. Manage month-end process to submit and publish monthly data results for Fraud and Recovery, e.g. Fraud Preliminary Results, Monthly Claims Mapping Exercise, Activity Report, Fraud Regional Exhibits, Recovery MPR's, Expense Reports, GREAT Monthly Extract, Country Production Reports, etc. Produce monthly, quarterly, and annual results at a Global/ Regional/ LOB level, including but not limited to Monthly Business Reviews, Quarterly Business Reviews, Deep Dive reporting, etc Qualifications Any Graduation

Job description- Bangalore , Brookfield We are looking for Experience in Claims Specialist in Healthcare is required Min 1 year of relevant experience required sal upto 4.5 lpa 5 days working, 2 days off cabs provided Good communication required Please apply for the job in Naukri.com. We will check & will update you. Do not search the number in Google and do not call us. The requirements are not yet active from Client's side.

To hand over Pre-Auth form to patient and explain the procedure in detail.To process Initial approval,final enhancement and co-ordinate with billing.To prepare and maintain data of patients availing cashless facility and status, check payable report.

Role: Claims Associate - P&C, Insurance, Healthcare, claims processing, claims adjudication Qualification: Graduates only Shifts: 24/7 rotational shifts Week Offs: 2 rotational week offs Transport: Two-way cab with 25 km radius (no transport allowance will be provided) SHL Parameters: Svar (B2 - 61) and Writex (B2 60) Interview Rounds: 1. HR 2. SHL Test 3. SD A Claims Processor is responsible for managing and processing insurance claims to ensure accurate and timely reimbursement. Their duties encompass reviewing claim submissions, verifying information, and coordinating with insurance agents and beneficiaries. Key responsibilities include: • You should have voice or semi-voice claims experience, knowledge of property and casualty claims with a minimum of 12 months experience. • Agent will be supporting Global customers except China and Japan • No relocations • Night allowance Onsite Permanent

Job Purpose "This position is open with Bajaj Finance ltd." Business process review according to IRDA compliances. Related to all insurance business partners Duties and Responsibilities PRINCIPAL ACCOUNTABILITIES (Accountabilities associated with the job) Ensure compliance in accordance with IRDA norms. KYC adherence of insurance customers. Claim settlement in accordance with IRDA guidelines. Compliance with Turn Around Time of claim settlements according to IRDA norms. Filing half yearly and annual returns. Coordination with business partners and helping them to maintain compliance. 4. MAJOR CHALLENGES (Challenges faced on an on-going basis in carrying out the job) Receiving data from business partners. Compliance related communication and data. Challenges related legal compliances. 5. DECISIONS (Key decisions taken by job holder at his/her end) Various Product related decisions 6. INTERACTIONS (Key working relationships a job holder needs to have INSIDE and OUTSIDE the company to accomplish the job) Internal Clients Roles you need to interact with inside the organization to enable success in your day to day work COE team Products team Relationships team Agents across the department Credit Operations insurance team Finance team Marketing team External Clients Roles you need to interact with outside the organization to enable success in your day to day work Partners Service Vendors 7. DIMENSIONS (Key numerical data which will reflect the scope and scale of activities concerning this job) Financial Dimensions (These should be quantifiable numerical amounts) N/A Other Dimensions (Significant volume dimensions associated with the job) ‚ Total Team Size: ‚ Number of Direct Reports:02 ‚ Number of Indirect Reports: ‚ Number of Outsourced employees: ‚ Number of locations:01 ‚ Number of products: 8. SKILLS AND KNOWLEDGE (Minimum acceptable proficiency for this job which best indicates the education and/or experience requirements of this job and not the incumbent) Required Qualifications and Experience a)Qualifications Certification of Insurance mgmt. Graduation (commerce preferred) b)Work Experience Insurance compliance experience of 5 to 6 years Strong understanding of legal compliances related to insurance Working knowledge of legal documentation Ability to work with MS office

Job Purpose "This position is open with Bajaj Finance ltd." Business process review according to IRDA compliances. Related to all insurance business partners Duties and Responsibilities PRINCIPAL ACCOUNTABILITIES (Accountabilities associated with the job) Ensure compliance in accordance with IRDA norms. KYC adherence of insurance customers. Claim settlement in accordance with IRDA guidelines. Compliance with Turn Around Time of claim settlements according to IRDA norms. Filing half yearly and annual returns. Coordination with business partners and helping them to maintain compliance. 4. MAJOR CHALLENGES (Challenges faced on an on-going basis in carrying out the job) Receiving data from business partners. Compliance related communication and data. Challenges related legal compliances. 5. DECISIONS (Key decisions taken by job holder at his/her end) Various Product related decisions 6. INTERACTIONS (Key working relationships a job holder needs to have INSIDE and OUTSIDE the company to accomplish the job) Internal Clients Roles you need to interact with inside the organization to enable success in your day to day work COE team Products team Relationships team Agents across the department Credit Operations insurance team Finance team Marketing team External Clients Roles you need to interact with outside the organization to enable success in your day to day work Partners Service Vendors 7. DIMENSIONS (Key numerical data which will reflect the scope and scale of activities concerning this job) Financial Dimensions (These should be quantifiable numerical amounts) N/A Other Dimensions (Significant volume dimensions associated with the job) ‚ Total Team Size: ‚ Number of Direct Reports:02 ‚ Number of Indirect Reports: ‚ Number of Outsourced employees: ‚ Number of locations:01 ‚ Number of products: 8. SKILLS AND KNOWLEDGE (Minimum acceptable proficiency for this job which best indicates the education and/or experience requirements of this job and not the incumbent) Required Qualifications and Experience a)Qualifications Certification of Insurance mgmt. Graduation (commerce preferred) b)Work Experience Insurance compliance experience of 5 to 6 years Strong understanding of legal compliances related to insurance Working knowledge of legal documentation Ability to work with MS office

It is a field job. You will have to travel within the assigned geography to meet Financial Consultant and customers. Your ability to build strong and sustainable distribution network will define your success. Your business targets will include the no. of active, successful Financial Consultants, distribution build up and overall premium. As a team manager, you will accompany the team of Financial Consultant on pre and post sales such as claim settlement. Life believes in technology driven sales and you will learn new technology/Mobility enhancements, to comply with the Sales Management Process. As a business professional you will be uphold organizational values in every action and ensure business ethics and integrity. You are expected to be compliant to regulatory and statutory regulations Locations:- Barddhaman, Kolkata, Lucknow, Gangtok, Ranchi, Bhavnagar, Godhra, Mahesana, Valsad, Patna, Guwahati, Dibrugarh

Payment Mapping working of ESIC-LDH,ESIC-CHD/DHS,NRHM,CMS Keeping records of all panel payment mapping and gives to account department Coordination with ESIC LDH,ESIC CHD/DHS,NRHM,CMS for any query & sanction account maintaining Prepare daily MIS etc

• Maintain Client's Details • Look after the Backend processes ( New Policy Login / Renewals / Claim Settlements ) • Correspondence via email and make calls to Companies and Clients. • Prepare and compare quotations for Clients. Required Candidate profile Qualification: B.Com / BBA / MBA Experience: Minimum 2 Years in Insurance Excellent communication skills in English preferred ( Verbal and Written ) Perks and benefits 2nd and 4th Sats are off No Sales and No Targets

Responsibilities: Ensure timely claim settlements within policy limits Process medical bills accurately Collaborate with healthcare providers on claims resolution Manage mediclaim claims from start to finish

Dear Candidates, We are currently hiring Insurance Claim Associates for Ranchi Location. Interested candidate may send their CV to hrfirst@firstadvisorsinsurance.com

Skill required: Reinsurance - Collections Processing Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 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 meet the unique needs of each market segment.Canceling and rewriting insurance policies and endorsementsThe Collections Operations team focuses on managing collections and disputes such as debt collection, reporting on aged debt, bad debt provisioning, trade promotions, and outperform cash reconciliations. The team is responsible for follow up for missing remittances, prepare refund package with accuracy and supply to clients, record all collections activities in a consistent manner as per client process (tool), delivery of process requirements to achieve key performance targets, and ensure compliance to internal controls, standards, and regulations.Experience in reinsurance company handling roles within claims and technical accounts What are we looking for? Ability to perform under pressure Problem-solving skills Results orientation Prioritization of workload Strong analytical skillsKnowledge of German language would be added advantage Roles and Responsibilities: Analyze and process various treaty and facultative premiums statements in the system Ensure cash call refunds are booked on time Maintain adequate trackers for all aspects of SOAs are maintained Analyse and process various types of claims in the system Analyse, Process and track large losses Ensure payment transactions are revied and cash is allocated in timely manner Ensure adequate follow ups are done to ensure to keep unallocated cash to the minimal Ensure outstanding balances are tracked, followed up and reported periodically to the stakeholders. Liaise and work with various stake holders to ensure all queries are addressed on time Taking ownership and be accountable for activities performed Have good analytical skills Good and effective communication with good networking skills Please note that this role may require you to work in rotational shifts Qualification Any Graduation

It is a field job. You will have to travel within the assigned geography to meet Financial Consultant and customers. Your ability to build strong and sustainable distribution network will define your success. Your business targets will include the no. of active, successful Financial Consultants, distribution build up and overall premium. As a team manager, you will accompany the team of Financial Consultant on pre and post sales such as claim settlement. Life believes in technology driven sales and you will learn new technology/Mobility enhancements, to comply with the Sales Management Process. As a business professional you will be uphold organizational values in every action and ensure business ethics and integrity. You are expected to be compliant to regulatory and statutory regulations Locations:- Bangalore, Belgaum, Bellary, Bijapur, Davangere, Gulbarga, Hassan, Hubli, Mangalore, Mysore, Shimoga, Tumkur, Udupi

Job Description: Please be informed that the below requirement is for US claims experience. We are exclusively seeking for people who have worked on US claims, where they have practical expertise evaluating past claims and acting appropriately on current claims. Please refrain from sharing profiles of people who work on automated tools or other claims. Interview Rounds – teams interview followed by face to face interview Graduates only Flexible with Shifts (Night Shift) Work location – Airoli (MDC7) CTC-30k Notice Period – Immediate joiners Interested candidates can send their CV to sujath_a@trigent.com or Whatsapp/Call HR Sujath Ali - 7680048497

To be liaison between the patient, the hospital, and Swasthya Sathi & TPA, managing claim processing by coordinating with the TPA to facilitate timely claim settlements and patient billing, all while adhering to insurance guidelines and regulations.

To be liaison between the patient, the hospital, and TPA, managing claim processing by coordinating with the TPA to facilitate timely claim settlements and patient billing, all while adhering to insurance guidelines and regulations.

Review/Investigation of open claims and decide the admissibility of Claim Appoint Investigator for suspected fraud claims and follow up /co-ordination with external Investigator Review of Investigation report and recommend for admissibility of claims Required Candidate profile Body shop experience, handling 4W or commercial vehicle or field survey experience (motor) Investigation of Own damage claims experience can be added advantage

To survey and assess the Claim Application and Making Reports/ Assessments for the losses To determine whether the Claim is genuine or not and ensure damaged vehicle is surveyed To handle customer/channel escalations To process and settle the claims Required Candidate profile Diploma/ BE/ BTech- Automobile, Mechanical Workshop Background/ General Insurance preferred Excellent communication and technical knowledge Should have Good Negotiation skills and geographic knowledge

Job Title SAP CRM TPM Consultant Responsibilities A day in the life of an Infoscion As part of the Infosys consulting team, your primary role would be to actively aid the consulting team in different phases of the project including problem definition, effort estimation, diagnosis, solution generation and design and deployment You will explore the alternatives to the recommended solutions based on research that includes literature surveys, information available in public domains, vendor evaluation information, etc. and build POCs You will create requirement specifications from the business needs, define the to-be-processes and detailed functional designs based on requirements. You will support configuring solution requirements on the products; understand if any issues, diagnose the root-cause of such issues, seek clarifications, and then identify and shortlist solution alternatives You will also contribute to unit-level and organizational initiatives with an objective of providing high quality value adding solutions to customers. If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Technical and Professional Requirements: Minimum 2+ years of overall SAP experience. Must have Hands-on project experience latest SAP TPM (Trade Promotion Management) covering technical/functional skills for end-to- end configuration and customization SAP CRM, CBP, TPM, Funds management, Pricing, Claims and Settlement. Must have configuration experience of planning product hierarchy, operational planning, scenario planning, baseline planning other planning supported in CBP screen. Also, must have master data configuration knowledge in SAP CRM for SAP Trade management solution. Must have knowledge about ECC integration for master data replication, SAP SD OTC cycle, pricing, rebates, deduction claim settlement functionality. Lead and drive the CRM/ TPM process workshops and lead the Functional Design Requirement gathering, functional, technical design Budgeting, planning help to program manager. Experience in AMS project /support projects, Different ticket tracking & monitoring tools in CRM /TPM Functionality. Preferred Skills: Technology->SAP Technical->SAP Trade Management->SAP Trade Promotion Management Additional Responsibilities: Ability to work with clients to identify business challenges and contribute to client deliverables by refining, analyzing, and structuring relevant data Awareness of latest technologies and trends Logical thinking and problem solving skills along with an ability to collaborate Ability to assess the current processes, identify improvement areas and suggest the technology solutions One or two industry domain knowledge Educational Requirements Bachelor of Engineering Service Line Enterprise Package Application Services * Location of posting is subject to business requirements

Skill required: Reinsurance - Collections Processing Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 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 meet the unique needs of each market segment.Canceling and rewriting insurance policies and endorsementsThe Collections Operations team focuses on managing collections and disputes such as debt collection, reporting on aged debt, bad debt provisioning, trade promotions, and outperform cash reconciliations. The team is responsible for follow up for missing remittances, prepare refund package with accuracy and supply to clients, record all collections activities in a consistent manner as per client process (tool), delivery of process requirements to achieve key performance targets, and ensure compliance to internal controls, standards, and regulations. What are we looking for? Ability to perform under pressure Problem-solving skills Written and verbal communication Commitment to quality Agility for quick learning Knowledge of German Language would be an added advantage. Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems Your day to day interaction is with peers within Accenture before updating supervisors In this role you may have limited exposure with clients and/or Accenture management You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments The decisions you make impact your own work and may impact the work of others You will be an individual contributor as a part of a team, with a focused scope of work Please note that this role may require you to work in rotational shifts Roles & Responsibilities Analyze and process various treaty and facultative premiums statements in the system Ensure cash call refunds are booked on time Maintain adequate trackers for all aspects of SOAs are maintained Analyse and process various types of claims in the system Analyse, Process and track large losses Ensure payment transactions are revied and cash is allocated in timely manner Ensure adequate follow ups are done to ensure to keep unallocated cash to the minimal Ensure outstanding balances are tracked, followed up and reported periodically to the stakeholders. Liaise and work with various stake holders to ensure all queries are addressed on time Taking ownership and be accountable for activities performed Qualifications Any Graduation

Key Responsibility Areas (KRA) Hospital TPA Desk Executive Designation: MDIndia TPA Desk Executive Location: Assigned Hospital Reporting To: MDIndia Provider Management Head Office 1. Claims Processing & Coordination Facilitate the Green Channel process to ensure zero waiting time for patient admissions and discharges. Prioritize and assist with the admission of VIP clients and corporate patients for a seamless experience. Support the end-to-end processing of cashless and reimbursement claims efficiently. Coordinate with the hospital billing and finance team for smooth claim approvals and disbursements. Liaise with the Head Office to resolve claim-related issues promptly. 2. Patient Assistance & Query Resolution Serve as the single point of contact for patients regarding their insurance claims for the specific hospital. Educate patients and their families about the claim process, required documentation, and eligibility criteria . Address and resolve patient grievances related to claims processing, escalating unresolved issues when necessary. 3. Hospital Liaison & Relationship Management Maintain strong professional relationships with hospital administrators, doctors, and billing teams. Collaborate with hospital staff to ensure seamless admission and discharge procedures for insured patients. Conduct regular meetings with hospital management to streamline TPA processes and improve service efficiency. 4. Reporting & Communication Prepare and submit daily/weekly reports on claim status, patient queries, and pending cases to the central office. Communicate any hospital-specific challenges, delays, or process gaps to management for quick resolution. Stay updated with latest TPA policies, regulatory guidelines, and hospital agreements . 5. Fraud Prevention & Risk Mitigation Adhere to strict protocols to prevent fraudulent activities in claims processing. Ensure seamless coordination with the MDIndia Head Office team to mitigate risks. 6. Customer Service & Satisfaction Provide prompt support and clear guidance to insured patients for a positive customer experience. Conduct feedback sessions to identify patient concerns and suggest process improvements. Enhance customer satisfaction by reducing waiting time for admissions, claims, and grievance resolution. 7. Wellness & Value-Added Services Coordination Coordinate with hospital teams for VIP health checkups, doctor consultations, and second opinion arrangements . Organize OPD service arrangements in the hospital for insured patients. Inform the Head Office team about new hospital initiatives and developments. Keep the Head Office updated on competitor processes and industry trends for strategic planning. Key Performance Indicators (KPIs) 1. Turnaround Time (TAT) – Speed of priority admissions and discharges. 2. Claim Accuracy Rate – Number of claims processed without discrepancies. 3. Patient Satisfaction Score – Feedback from patients and hospital staff. 4. Compliance Adherence – Ensuring 100% compliance with regulatory requirements. 5. Hospital Coordination Efficiency – Effectiveness of hospital staff and management liaison. 6. Query Resolution Time – Average time taken to resolve patient/hospital queries. 7. Wellness Service Delivery – Efficiency in coordinating VIP checkups, OPD services, and second opinions.