1065 Claims Adjudication Jobs

Handle Provider Chat queries and meet client SLA 5*10 Operation during weekdays Should have a valid degree & good in communication Adhere to client shift time and break hours Customer holidays are followed and hence need to work on India Holidays Should have experiance in handling Microsoft excel, words

Handle Provider Chat queries and meet client SLA 5*10 Operation during weekdays Should have a valid degree & good in communication Adhere to client shift time and break hours Customer holidays are followed and hence need to work on India Holidays Should have experiance in handling Microsoft excel, words

Candidate will be responsible for handling dental insurance claims, verifying patient eligibility, processing claims from various insurance providers, and ensuring smooth communication between patients, providers Required Candidate profile Experience in dental insurance claims processing or similar roles. Working on claims from various insurance providers Proficient in dental software Send profiles recruitment1.hipl@gmail.com

Join our team as an AR Caller & Denials Management Specialist! Handle accounts receivable, resolve denials, and ensure timely payments. Immediate openings available. Apply now! Initial 6 Months Work from Office. Required Candidate profile Experienced AR Callers & Denials Management Specialists sought! Proficiency in AR calling, denials resolution, healthcare billing processes, and strong communication skills required.

Join our team as an AR Caller & Denials Management Specialist! Handle accounts receivable, resolve denials, and ensure timely payments. Immediate openings available. Apply now! Initial 6 Months Work from Office. Required Candidate profile Experienced AR Callers & Denials Management Specialists sought! Proficiency in AR calling, denials resolution, healthcare billing processes, and strong communication skills required.

Join our team as an AR Caller & Denials Management Specialist! Handle accounts receivable, resolve denials, and ensure timely payments. Immediate openings available. Apply now! Initial 6 Months Work from Office. Required Candidate profile Experienced AR Callers & Denials Management Specialists sought! Proficiency in AR calling, denials resolution. Immediate joiners preferred. Send CV recruitment1.hipl@gmail.com

Join our team as an AR Caller & Denials Management Specialist! Resolve denials and ensure timely payments. Immediate openings. Apply now! Initial 6 Months Work from Office. Required Candidate profile Experienced AR Callers & Denials Management Specialists sought! Proficiency in AR calling, denials resolution. Immediate joiners preferred. Experience in ECW software must

Join our team as an AR Caller & Denials Management Specialist! Resolve denials and ensure timely payments. Immediate openings. Apply now! Initial 3 Months Work from Office. Required Candidate profile Experienced AR Callers & Denials Management Specialists sought! Proficiency in AR calling, denials resolution. Immediate joiners preferred. Experience in ECW software must

•Provider Enrollment experience with multiple payers is must •Create and maintain files for Credentialing applications and renewals • Compile and maintain current and accurate data for all providers • Completion, submission, Follow up of applications Required Candidate profile • Minimum of 2 year of Provider Enrollment experience • Experience using PECOS, processing enrollment with Medicaid, and using CAQH Immediate joiners preferred. Send CV to recruitment1.hipl@gmail.com

•Provider Enrollment experience with multiple payers is must •Create and maintain files for Credentialing applications and renewals • Compile and maintain current and accurate data for all providers • Completion, submission, Follow up of applications Required Candidate profile • Minimum of 2 year of Provider Enrollment experience • Experience using PECOS, processing enrollment with Medicaid, and using CAQH Immediate joiners preferred. Send CV to recruitment1.hipl@gmail.com

Assisting with the preparation of operating budgets, financial statements, and reports. Processing requisition and other business forms, checking account balances, and approving purchases. Advising other departments on best practices related to fiscal procedures. Managing account records, issuing invoices, and handling payments. Collaborating with internal departments to reconcile any accounting discrepancies. Analyzing financial data and assisting with audits, reviews, and tax preparations. Updating financial spreadsheets and reports with the latest available data. Reviewing existing financial policies and procedures to ensure regulatory compliance. Providing assistance with payroll administration. Keeping records and documenting financial processes.

Positions General Duties and Tasks: Process Insurance Claims timely and qualitativelyMeet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. Tobe in a position to handle training for new hires Work together withthe team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case ofany defaulters. Encourage the team to exceed their assigned targets.**Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Requirements for this role include: Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 3+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.

Dear All, We are hiring for AS400 Developer AS/400 Technical Lead. Position Summary : Seasoned AS/400 Technical Lead to drive end-to-end developmentfrom design through deployment and post-implementation. Lead the delivery of scalable, mission-critical solutions in a dynamic environment with Strong AS/400 and RxClaim development experience, Proven leadership in technical delivery and ability to thrive in fast-paced, collaborative teams. Required Skills : SYNON, AS/400, RPGILE, CLLE, SQLRPGLE, RxClaim. Preferred Skills : RxClaim Adjudication Development Experience.

Position's General Duties and Tasks In these roles you will be responsible for: Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables. Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met Analyzing medical insurance claims for quality assurance Resolving moderately routine questions following pre-established guidelines Performing routine research on customer inquiries. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Requirements for this role include: Ability to work regularly scheduled shifts from Monday-Friday 8:30PM to 5:30AM or 10:30PM to 7:30AM. High school diploma 1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 0-6 months of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English. 0-6 months of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions *** The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. *** All new hires will be required to successfully complete our Orientation/Process training classes and demonstrate proficiency of the material.

Positions General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts. ***Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement."

Quality executive is responsible to perform activities outlined in the Service Quality Plan and identify agent / program level improvement opportunities. Executive is required to work closely with the production resource to ensure adherence to the client and process specific requirements. Ensure that regular feedback and error sharing sessions are conducted to avoid repetition of errors and help improve overall performance. Other activities of the quality executive include reporting, calibrations, process analysis and attending client and internal meetings. Responsibilities: Responsible for call/data quality monitoring. Provide feedback to agents using prescribed feedback model. Mentoring and coaching agents on process level issues. Monitor adherence to compliance procedures and processes. Responsible for reporting program level quality score to the process owners. Responsible for conducting calibration and performance review call in terms of quality with the internal team. (Initially will be assisting the senior quality analyst, training and guidance will be provided to be able to lead such meetings in future). Conduct refresher training on the basis of the errors identified. Communicate process updates by conducting a session as and when required. Maintaining update log and sharing it with the team on a regular basis. Perform brainstorming and root cause analysis to analyze data and provide tips or suggestions to operations/management team. Identify and highlight potential risk areas and recommend preventive action. Interested candidates can share their resumes on atish.chintalwar@cotiviti.com

BA profile with experience in Payment including hands on GPF application Experienced in Capital Markets, specifically Risk (Market, Credit) and Regulatory implementation Experienced in Capital Markets product types and asset classes Well-versed in creating BRD & FRD Experienced in SQL; you are able to deal with large volumes of data Familiar with financial security elements such as stocks, bonds, mutual funds, etc. Experience on Payments domain preferred, great communication should be able to engage with business users Mandatory Competencies BA - Business Knowledge BA - Client Interaction BA - Communication - Verbal, Written BA - Create Specifications / BRD/ FRD BA - Create Specifications / BRD/ FRD FS Domain - Retail Banking & Payments - ISO 20022 Based Real Time Payments Systems Payment Domain - Payment - Payment.

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: 1-3 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.

Bpo Hiring For Health Care Domain Voice Process 6.5 LPA Location Gurugram Only Graduates. No B.E./Btech/UG''s Minimum 1 Year of Voice Experience With International BpO MUST Pls Cal Dipankar @ 9650094552 Email CV @ jobsatsmartsource@gmail.com

Job Title: TPA Manager Location: Miri Piri Institute of Medical Science & Research, Shahabad Markanda, Kurukshetra (Haryana) Hospital Strength: 420+ bedded upcoming super-specialty hospital & upcoming medical college (100 MBBS seats) Position Overview We are seeking an experienced and detail-oriented TPA Manager to lead and manage all Third-Party Administrator (TPA), insurance, CGHS, ECHS, and Ayushman cases. The role involves overseeing pre-authorization, billing, claims settlement, and ensuring smooth coordination between patients, TPAs, and hospital departments while maintaining compliance and accuracy. Key Responsibilities Handle end-to-end TPA, Insurance, Ayushman, CGHS, and ECHS cases. Coordinate with patients, TPA representatives, and consultants for pre-authorization approvals. Monitor real-time admission intimation, approval status, and treatment cost estimates. Ensure accurate preparation and timely submission of claims to TPAs/Insurance companies. Follow up on pending claims, resolve queries, and minimize claim rejections. Maintain updated records of approvals, discharges, and settlement status. Collaborate with billing, finance, and medical teams for seamless case management. Train and guide TPA executives in documentation and claim processing. Ensure compliance with NABH requirements, audit standards, and hospital policies. Generate MIS reports on approvals, rejections, pending claims, and revenue flow. Eligibility Qualification: Graduate/Postgraduate in Healthcare Administration, Finance, or related field. Experience: Minimum 5 years of experience in TPA/Insurance management in a multi-specialty hospital. Skills: Strong knowledge of insurance/TPA processes, claim settlement, negotiation, MIS reporting, patient handling, and excellent communication. Why Join Us? Be part of an upcoming medical college with 100 MBBS seats backed by the credibility of SGPC . Opportunity to work in a 420+ bedded super-specialty hospital with advanced facilities. Supportive work culture, timely salary , and ethical governance. Significant scope to grow in hospital operations and insurance management. Contact for Queries: +91 9650779097 Email: miripirihr@gmail.com

Mega Walk-in Drive US Healthcare (Claims Adjudication) Date: 19th & 20th September 2025 Time: 11:30 AM 4:00 PM Venue: Sagility, KCT Tech Park, Thudiyalur Rd, Saravanampatti, Coimbatore, Tamil Nadu 641049 We Are Hiring Experienced Professionals! Join our growing team in US Healthcare Claims Adjudication Minimum Requirement 3.6+ years of experience in US Healthcare (Claims Processing & Adjudication) Additional Opportunities in Sagility : We have openings for WFM & Training functions Also for Internal Contact Center Operations (Inbound calls) Open Positions Team Leader Operations Quality Specialist Subject Matter Expert (SME) Process Trainer Quality Team Leader Assistant Manager Operations Deputy Manager Operations Senior Manager Operation Documents to Carry: Updated Resume (2 copies) Govt. ID Proof (Aadhar/PAN/Passport) Recent Passport-size Photographs Why Join Us? Work with a leading US Healthcare brand Fast-track career growth across leadership roles Attractive benefits & rewards Interested folks please Walkin directly to Sagility office and connect with our recruitment team on : 9597910418 / 8309217838

Role & responsibilities We are looking for an accomplished Doctors with significant ICU experience and a strong ability to manage both clinical and non-clinical responsibilities. The ideal candidate will excel in patient care, clinical documentation, and possess in-depth knowledge of medical documentation essential for insurance claims processing. Key Responsibilities: Patient Documentation: Manage patient medical history and progress notes with precision. Claims Processing: Handle preauthorization and reimbursement claims, including validation and processing. Clinical Records: Maintain accurate clinical documentation in compliance with healthcare standards. Collaboration: Work closely with consultant surgeons and physicians on treatment management. Diagnostic Insights: Provide valuable insights on diagnostic tests, laboratory results, and imaging to support treatment decisions. Real-Time Support: Collaborate with bedside teams to offer real-time critical care expertise. Regulatory Updates: Stay informed on the latest medical guidelines, insurance policies, and healthcare regulations. TPA experience is a plus Preferred candidate profile

Bpo Hiring For Health Care Domain Voice Process 6.5 LPA Location Gurugram Only Graduates. No B.E./Btech/UG''s Minimum 1 Year of Voice Experience With International BpO MUST Pls Cal Dipankar @ 9650094552 Email CV @ jobsatsmartsource@gmail.com

We are seeking candidates with a minimum of 1 year of experience in Indian health Insurance/TPA who have strong communication and along with good medical knowledge in Claims Adjudication •Degree in BAMS, BHMS, BSMS, or MBBS (strictly required)

Positions General Duties and Tasks: Process Insurance Claims timely and qualitativelyMeet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. Tobe in a position to handle training for new hires Work together withthe team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case ofany defaulters. Encourage the team to exceed their assigned targets.**Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Requirements for this role include: Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 3+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.