594 Claims Adjudication Jobs

Join our team as a Subject Matter Expert in Claims HC where you will leverage your expertise in Facets Claims and Claims Adjudication to optimize our claims processing systems. With a focus on Dental and Commercial Claims you will play a pivotal role in enhancing operational efficiency and ensuring compliance with industry standards. This office-based role offers the opportunity to work in a dynamic environment contributing to impactful projects that benefit both the company and society. Lead the analysis and optimization of claims processing workflows to enhance efficiency and accuracy. Oversee the implementation of Facets Claims and Claims Adjudication systems to ensure seamless integration and functionality. Provide expert guidance on Dental and Commercial Claims processes to ensure compliance with industry standards. Collaborate with cross-functional teams to identify and resolve system issues improving overall operational performance. Develop and maintain documentation for claims processing procedures to support training and knowledge sharing. Monitor and evaluate system performance recommending improvements to enhance service delivery. Conduct regular audits of claims processes to ensure adherence to regulatory requirements and company policies. Facilitate training sessions for team members to enhance their understanding of claims systems and processes. Analyze data trends to identify opportunities for process improvements and cost savings. Support the development of new claims processing initiatives to drive innovation and efficiency. Communicate effectively with stakeholders to provide updates on project progress and system enhancements. Ensure that all claims processing activities align with the company's strategic goals and objectives. Contribute to the development of best practices for claims management to support continuous improvement. Qualifications: - Demonstrate proficiency in Facets Claims and Claims Adjudication with a strong understanding of system functionalities. - Possess in-depth knowledge of Dental and Commercial Claims processes and industry standards. - Exhibit excellent analytical skills to identify and resolve complex system issues. - Show strong communication skills in English both written and verbal to effectively collaborate with team members. - Display a proactive approach to problem-solving and process improvement. - Have a minimum of 5 years of experience in claims processing with a focus on Dental and Commercial Claims. - Be able to work independently and manage multiple tasks in a fast-paced environment. Certifications Required: - Certified Professional Coder (CPC) or equivalent certification in claims processing.,

As a Dental Claims Processor at MetLife, you will be responsible for scrutinizing dental claim documents and settlements, ensuring accurate processing of claims according to healthcare guidelines and HIPAA regulations. Your role will involve handling escalations, meeting quality and productivity targets, and complying with internal policies, external regulations, and information security standards. You will need to have a good understanding of claims adjudication fundamentals, ICT & CPT Codes, and be able to learn, adapt, and implement process guidelines effectively. To qualify for this position, you should hold a Bachelor's degree in any stream or a diploma with a minimum of 15 years of education. Additionally, you should have at least 2 years of work experience in US Health Claims processing, preferably in claims adjudication. Proficiency in computer navigation, keyboarding, data entry, MS Excel, and MS Word is required. Knowledge of insurance principles related to the US Insurance industry, US culture, and dental claims terminologies will be advantageous. As a successful candidate, you must possess strong organizational and communication skills, demonstrate the ability to work independently and in a team environment, be self-disciplined, results-oriented, and have the ability to multitask. Attention to detail, a positive attitude, and being a team player are essential soft skills for this role. Joining MetLife, a globally recognized financial services company, will provide you with the opportunity to contribute to creating a more confident future for colleagues, customers, communities, and the world at large. If you are motivated by purpose and empathy, and aspire to transform the next century in financial services, MetLife welcomes you to be #AllTogetherPossible. Join us in making a difference!,

Arzion RCM is looking for Arzion Business Solutions - Trainee AR Caller in Chennai to join our dynamic team and embark on a rewarding career journeyAssisting experienced employees with their daily tasks and responsibilities.Observing and gaining hands-on experience in various aspects of the job.Receiving feedback and guidance from supervisors and mentors.Completing assigned projects and tasks under the supervision of experienced employees.Collaborating with team members and contributing to team projects.Demonstrating a strong work ethic, positive attitude, and a willingness to learn and grow.

- Offer comprehensive support through both phone and email communications. - Address complaints effectively, delivering suitable solutions and alternatives within established timeframes. - Conduct follow-ups to guarantee resolution. - Supply accurate and relevant information utilizing the appropriate tools. - Document and update notes for each call or email interaction. - Exceed expectations to prevent any inconvenience.

- Offer comprehensive support through both phone and email communications. - Address complaints effectively, delivering suitable solutions and alternatives within established timeframes. - Conduct follow-ups to guarantee resolution. - Supply accurate and relevant information utilizing the appropriate tools. - Document and update notes for each call or email interaction. - Exceed expectations to prevent any inconvenience.

Primary Responsibilities: Be able to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines Be able to review and analyze medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation Be able to extract and code various screening CPT codes and HCPCS codes from the documentation Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved in a timeframe that will assure compliance with regulatory and client guidelines Adherence with confidentiality and maintains security of systems Compliance with HIPAA policies and procedures for confidentiality of all patient records Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: Graduate Certified coder through AAPC or AHIMA Certifications accepted include CPC, CCS, CIC and COC – Anyone Fresher & Experience in Medical coding & years of Experience consider is 0.6 to 5 years Maximum Current coding certifications and must provide proof of certification with valid certification identification number during interview or Offer process Sound knowledge in Medical Terminology, Human Anatomy and Physiology Knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems Proficient in ICD-10-CM, CPT, and HCPCS guidelines At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone – of every race, gender, sexuality, age, location and income – deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission. Apply Internal Employee Application

Primary Responsibilities: Be able to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines Be able to review and analyse medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation Be able to extract and code various screening CPT codes and HCPCS codes from the documentation Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity Under general supervision, organizes and prioritizes all work to ensure that records are coded, and edits are resolved in a timeframe that will assure compliance with regulatory and client guidelines Adherence with confidentiality and maintains security of systems Compliance with HIPAA policies and procedures for confidentiality of all patient records Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so #NTRQ Required Qualifications: Graduate Certified coder through AAPC or AHIMA Certifications accepted include CPC, CCS, CIC and COC – Anyone Current coding certifications and must provide proof of certification with valid certification identification number during interview or Offer process Sound knowledge in Medical Terminology, Human Anatomy and Physiology Knowledge of security of systems and associated policies and procedures for maintaining the security of the data contained within the systems Basic understanding of the ED/EM levels based on MDM and appending modifiers to CPT codes as per NCCI edits and CPT guidelines Proficient in ICD-10-CM, CPT, and HCPCS guidelines At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission. External Candidate Application Internal Employee Application

Book your interview slot WhatsApp your profile @ 9623462146 / 7391077622 or Dipika@infiniteshr.com ******Hiring for P & C Insurance Team Manager / Sr TM , Salary upto 14.00L*** ****Hiring Team Manager Insurance process**** Salary upto 10 LPA Exp: 6 to 15 Yrs Salary : Upto 14 Lacs Regards Dipika Sharma 9623462146 7391077622 8888850831

Job Title: Motor Insurance Claims Handler (Bodily Injury Focus) Location: Bangalore Employment Type: Full-Time Department: Claims / Insurance Operations Reports To: Claims Team Lead / Claims Manager Job Summary: We are seeking a skilled and detail-oriented Motor Insurance Claims Handler with experience in bodily injury claims . The successful candidate will be responsible for managing and processing motor insurance claims efficiently and fairly, with a specific focus on bodily injury liability, third-party damages, and personal injury claims. This role requires strong analytical skills, empathy, and knowledge of motor insurance policies, local legislation, and medical terminology. Key Responsibilities: Handle and manage a portfolio of motor insurance claims, including bodily injury and third-party liability cases. Assess the validity of claims through careful investigation and policy review. Liaise with policyholders, third parties, medical providers, legal professionals, and law enforcement. Obtain and analyze medical reports, police reports, and other relevant documentation. Negotiate settlements in accordance with legal guidelines, policy terms, and internal procedures. Maintain accurate records of claim decisions and supporting documentation in the claims management system. Collaborate with legal and fraud teams where litigation or fraudulent activity is suspected. Keep up to date with changes in legislation and case law relevant to motor and injury claims. Ensure claims are processed within regulatory and internal timeframes. Deliver high-quality customer service during the claims lifecycle. Required Qualifications & Experience: Proven experience (1+ years) handling motor claims , specifically bodily injury or third-party personal injury . Familiarity with local insurance regulations and liability assessment. Experience working with medical terminology and understanding of injury classification. Knowledge of claims management systems and insurance software. Excellent verbal and written communication skills. Strong negotiation, analytical, and decision-making skills. Ability to manage multiple claims with attention to detail and urgency. Preferred Qualifications: Degree in Law, Insurance, Risk Management, or a related field. Insurance certifications. Experience with litigation claims or working with external legal counsel. Soft Skills: Empathy and tact when dealing with injured parties or sensitive situations. Integrity and professionalism. Resilience and ability to work under pressure. Collaborative mindset and team orientation. Contact Point : Deepanshu - 9900024811 / 9686682465 / 7259027282 / 7259027295 / 7760984460

Senior Finance Analyst Accounts Receivable Client Finance - JLL Business Service (Gurugram) What this job involves: Conduct a comprehensive analysis of bank deposits and execute precise application of deposits to designated tenant accounts Perform in-depth analysis of tenant ledger histories to identify and resolve discrepancies in payment transactions Performing quality checks to ensure all the deposits are correctly applied against each tenant's accounts Query handling working upon all queries received and keeping a close tab on any pending queries that could be resolved, and following up on the rest Collaborate with Accounting and Property Management professionals to facilitate appropriate payment application Investigate duplicate payments and transaction errors to maintain financial accuracy Participate in special department projects/initiatives as directed Maintain exemplary documentation systems for archiving, records retention, and audit compliance Identify and escalate unresolved matters through appropriate channels with recommended solutions Provide expert support to cross-functional teams and processes when required Maintain comprehensive and current process documentation, including SOP, Process Maps, and tracking mechanisms Provide technical guidance to team members and support performance improvement initiatives Sounds like you To apply, you need to have the following: Employee Specifications Strong Finance background, Commerce graduate or Post Graduate is preferred. Minimum 3-5 years of experience in Order to Cash, specifically the Cash Application role is preferable Strong analytical skills with attention to detail and logical thinking and carries a positive attitude to develop solutions quickly Impactful communication (written and verbal) to interact with clients and strong interpersonal skills Demonstrated consistency in values, principles, and work ethic Working knowledge of MS Office (MS Word, Excel, PowerPoint, Outlook) required Performance Objectives Works within established procedures with a moderate degree of supervision Identifies the problem and all relevant issues in straightforward situations, assesses each using standard procedures, and makes sound decisions

Review Google for missing data elements. Initiate request for medical via system. Ability to prioritize and maintain quality. Clear and accurate written and verbal communication (Scripted and Templatized) with stateside Required Candidate profile Knowledge about the Insurance industry in US Knowledge about US Culture Knowledge of Insurance principles Knowledge of Disability domain interpret business documents. Good verbal comms

FHRM is looking for Credentialing Specialist to join our dynamic team and embark on a rewarding career journey Credential Verification: Credentialing Specialists collect and verify all relevant documents and information from healthcare providers, including medical licenses, certifications, education, training, work history, and references. Provider Enrollment: They facilitate the enrollment of healthcare providers in insurance networks and government healthcare programs by ensuring that all necessary paperwork and credentials are in order. Compliance: Credentialing Specialists ensure that healthcare providers comply with legal and regulatory requirements, as well as with the organization's policies and standards. Application Processing: They process applications for medical staff privileges or employment, which typically involves gathering and assessing information about the provider's background and qualifications. Verification of References: Credentialing Specialists contact references and previous employers to verify the provider's work history and obtain feedback on their performance and professionalism. License and Certification Monitoring: They continuously monitor the status of licenses and certifications to ensure that they are up to date. This includes tracking expiration dates and initiating renewals when necessary. Peer Review: In some cases, they assist in coordinating the peer review process, where healthcare providers are evaluated by their peers to ensure that they meet the organization's clinical and ethical standards. Database Management: They maintain accurate records and databases of healthcare providers' credentials and documentation, making this information accessible to the organization's leadership and relevant departments. Communication: Credentialing Specialists liaise with healthcare providers, administrative staff, and regulatory authorities to ensure all requirements are met. Reappointment: They manage the recredentialing or reappointment process, ensuring that healthcare providers remain in compliance with all requirements for continued practice. Quality Improvement: They participate in quality improvement initiatives related to the credentialing process, making recommendations for process enhancements. Compliance with Accreditation Standards: They ensure that the credentialing process aligns with the accreditation standards of relevant accrediting bodies. Freshers may apply (with US dialing experience)

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 1st Floor, H8M9+677, Block D, Noida Sector 3, Noida, Uttar Pradesh 201301 Interested candidates can share their resumes to WhatsApp to 9795919025

What this job involves: Analysing cash/amount received in the bank deposits and making the application against the tenant accounts Analyse and research tenant ledgers history against the over/short payments. Query handling working on all queries received and keeping a close tab on any pending queries that could be resolved and following up on the rest. Contact accountants and Property teams whenever necessary to determine the proper payment application. Research and analyse duplicate and erroneous payments. Escalate unresolved issues/concerns. Assist in training new employees as needed. Working on different process-related and ad-hoc reports Keeping all the process-related documents intact on a real-time basis Sounds like you To apply, you need to have the following: Employee Specifications Strong Finance background, Commerce graduate or Post Graduate is preferred. Minimum 0-2 years of experience in Order to Cash, specifically Cash Application role is preferable. Strong analytical skills with attention to detail and logical thinking and carry a positive attitude to develop solutions quickly Strong interpersonal skills Demonstrated consistency in values, principles, and work ethics Working knowledge of MS Office (MS Word, Excel, PowerPoint, Outlook) required Performance Objectives Works within established procedures with a moderate degree of supervision Identifies the problem and all relevant issues in straightforward situations, assesses each using standard procedures, and makes sound decisions

Graduate from recognized universities. (B Tech CSE/IT not eligible). Freshers and experienced candidates from 2.5 to 4 years are eligible Preferred candidates with Claims/Claims Adjudication Experience with BPO sector/ domain are preferrable Possess strong Problem solving skills, analytical knowledge and communication skills- both written and verbal. Collaborative, high-energy and diligent work ethics to be displayed at all times. Strong ability to multi-task and support different functions based on business requirements. Complete tasks according to the established standards with limited instruction and supervision. Should possess team-based working style coupled with the zeal to expand the learning horizon and be open to new learning. Willingness to work in shifts in different time zones. Professional attitude and projection of professional company image. Ability to work under pressure esp. during Peak seasons. Stay aligned to the Company's Mission, Vision & Values.

About the Team The Claims team at Navi is responsible for delivering a fast, transparent, and customer-first claims experience. From initial intimation to final settlement, whether cashless or reimbursement, they manage the end-to-end process with a strong focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and use data-driven insights and process automation to improve claim resolution speed and customer satisfaction. About the Role The role involves end-to-end medical claims adjudication, including reviewing treatment records, verifying eligibility, identifying potential fraud, and making informed claim decisions. It requires coordination with providers, customers, and internal stakeholders to ensure TAT and SLA adherence. The Medical Officer is also expected to support cost negotiations and assist in claim analytics. Strong communication, regulatory knowledge, and problem-solving skills are essential, along with a background in medicine. What We Expect From You Reviewing and evaluating medical claims to determine their eligibility for payment Investigating medical claims to identify fraud Communicating with claimants, providers, and other parties involved in the claim Making decisions about medical claims, such as whether to approve or deny a claim Negotiate with the treating doctor/ hospital to reduce the unjustified hospitalization cost Automate the system and bring in improvements to claims processes Monitoring systems and processes to ensure sustained levels of performance Liaison with internal stakeholders to ensure the deadlines of TATs and SLAs & Work towards the designated Tasks Tracking of customer communication for effective grievance resolution within TAT & SLAs Knowledge of products, regulations, and guidelines is a must to ensure process compliance. Claim Analytics- Periodical claim analysis to identify fraud and monitor claim performance metrics. Informing the customer about the rejection of their claim through a call Team Management- Build and manage a team of processing doctors supporting the function Must Haves Ability to handle independent assignments & having the acumen to draw logical conclusions He/she should have a broad understanding of Claims Practice Sharp business acumen to understand health insurance claim servicing needs Excellent communication skills, including writing reports and presentations Ability to anticipate potential problems and take appropriate corrective action Knowledge of health regulations, IRDA circulars is a must. Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Candidates having data analytics experience would be an added advantage. Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Inside Navi We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal & Home Loans to UPI, Insurance, Mutual Funds, and Gold, we are building tech-first solutions that work at scale, with a strong customer-first approach. Founded by Sachin Bansal & Ankit Agarwal in 2018, we are one of India's fastest-growing financial services organisations. But we are just getting started! ` Our Culture The Navi DNA Ambition. Perseverance. Self-awareness. Ownership. Integrity. We are looking for people who dream big when it comes to innovation. At Navi, you'll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you're driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each otherand that starts with every one of us. Why You'll Thrive at Navi At Navi, it's about how you think, build, and grow. You'll thrive here if: Youre impact-driven : You take ownership, build boldly, and care about making a real difference. You strive for excellence : Good isn’t good enough. You bring focus, precision, and a passion for quality. You embrace change : You adapt quickly, move fast, and always put the customer first.

About The Role Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(International) - 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 you do 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 tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.The business processes, operations and interactions of third party administrators of prescription drug programs, understanding of the processes used to manage programs for payers, process and pay prescription drug claims, develop and maintain the formulary, contract with pharmacies and negotiate discounts and rebates with drug manufacturers. What are we looking for Ability to perform under pressureAdaptable and flexibleAbility to establish strong client relationshipWritten and verbal communicationPrioritization of workload Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development process to deliver high-quality solutions. You will also engage in problem-solving and decision-making to guide your team effectively, fostering an environment of collaboration and innovation. Roles & Responsibilities:- Expected to be an SME.- Collaborate and manage the team to perform.- Responsible for team decisions.- Engage with multiple teams and contribute on key decisions.- Provide solutions to problems for their immediate team and across multiple teams.- Facilitate knowledge sharing and mentoring within the team to enhance overall performance.- Monitor project progress and ensure alignment with business objectives. Professional & Technical Skills: - Must To Have Skills: Proficiency in Business Requirements Analysis.- Good To Have Skills: Experience with Guidewire BillingCenter BA, Insurance Claims.- Strong analytical skills to assess business needs and translate them into technical requirements.- Ability to communicate effectively with both technical and non-technical stakeholders.- Experience in project management methodologies to ensure timely delivery of projects. Additional Information:- The candidate should have minimum 5 years of experience in Business Requirements Analysis.- This position is based at our Hyderabad office.- A 15 years full time education is required.- Resource need to work in Shift B(12:30pm till 10:00pm) Qualification 15 years full time education

Roles and Responsibilities : Review and process claims from receipt to payment, ensuring accuracy and timeliness. Conduct thorough provider data management, including verification of provider information and eligibility checks. Collaborate with internal stakeholders to resolve claim discrepancies and ensure compliance with regulatory requirements. Maintain accurate records of all interactions with providers, patients, and insurance companies. Job Requirements : 1-4 years of experience in US Healthcare Claims Adjudication or related field. Strong understanding of PDM (Provider Data Management) systems and processes. Proficiency in reviewing medical records, diagnosis codes, and treatment plans for accuracy.

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-5 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

TATA AIG General Insurance Company Limited is looking for Manager - Commercial Claims to join our dynamic team and embark on a rewarding career journey Delegating responsibilities and supervising business operations Hiring, training, motivating and coaching employees as they provide attentive, efficient service to customers, assessing employee performance and providing helpful feedback and training opportunities. Resolving conflicts or complaints from customers and employees. Monitoring store activity and ensuring it is properly provisioned and staffed. Analyzing information and processes and developing more effective or efficient processes and strategies. Establishing and achieving business and profit objectives. Maintaining a clean, tidy business, ensuring that signage and displays are attractive. Generating reports and presenting information to upper-level managers or other parties. Ensuring staff members follow company policies and procedures. Other duties to ensure the overall health and success of the business.

""" Checks for completeness and appropriateness of source data. Involved in fact finding, information search and data gathering. Verifies and compiles data. Identifies and resolves routine and recurring problems. Skills Required Ability to analyze and process transactions based on rules. Able to integrate knowledge as a skilled specialist. Possess strong domain knowledge in Healthcare and Insurance domain. """

Job Summary Join our dynamic team as a Claims Processing Specialist where you will play a crucial role in ensuring the accuracy and efficiency of claims adjudication. With a focus on Medicare and Medicaid claims you will contribute to the seamless processing of claims enhancing our service delivery. This hybrid role offers the flexibility of working both remotely and on-site during night shifts. Responsibilities Process claims with precision ensuring adherence to Medicare and Medicaid guidelines. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Utilize claims adjudication software to enhance processing efficiency. Provide feedback on process improvements to enhance service delivery. Maintain up-to-date knowledge of industry regulations and compliance standards. Communicate effectively with stakeholders to ensure clarity and resolution of claims issues. Document claims processing activities accurately for audit and reporting purposes. Support the team in achieving departmental goals and objectives. Participate in training sessions to stay informed about the latest claims processing techniques. Ensure confidentiality and security of sensitive claims information. Contribute to a positive work environment by supporting colleagues and fostering teamwork. Adapt to changing priorities and work effectively under pressure. Qualifications Demonstrate proficiency in claims adjudication processes and software. Possess strong analytical skills to identify and resolve claims discrepancies. Exhibit excellent communication skills for effective stakeholder interaction. Show a keen understanding of Medicare and Medicaid claims requirements. Display attention to detail in processing and documenting claims activities. Have the ability to work independently and collaboratively in a hybrid work model. Certifications Required Not required

Davies is looking for an experienced Processing Specialist to join our growing team! As a Processing Specialist, you will assist the claims departments with general clerical functions. Reporting to the Processing Supervisor, you will open and scan mail documents, including attaching scanned documents in the claims system.

Insurance Verification Associate Desired Candidate Profile: Should be having excellent communication skills with Dental billing experience and willing to work in night shift. Minimum 1 Year of experience in AR is Mandatory. Only Experience from US Healthcare Medical or Dental Billing Will be Considered. Location : Mohali ( TDI Business Center near VR Punjab Mall) Exp : 1 ?? 3 Years Week Off : Saturday & Sunday Salary : Best In The Industry/Night Meals and refreshments Notice Period : One Month Preferable Shift : Night Shift Apply Now