595 Claims Adjudication Jobs - Page 12

As a Claim Adjudication Manager you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator. Role Supervise claim adjudication staff to ensure claims are processed efficiently and accurately. Review complex or escalated claims and make final decisions on approvals or denials. Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers). Monitor team performance using KPIs (turnaround time, accuracy rate, etc.). Collaborate with medical coding, billing, provider relations, and legal teams as needed. Handle audits, quality assurance, and process improvement initiatives . Open for WFO/ Noida Extension Location/ Night shifts. Please share CV at annu.misra@rsystems.com

As a Claim Adjudication AGM you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator.Role Supervise claim adjudication staff to ensure claims are processed efficiently and accurately. Review complex or escalated claims and make final decisions on approvals or denials. Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers). Monitor team performance using KPIs (turnaround time, accuracy rate, etc.). Collaborate with medical coding, billing, provider relations, and legal teams as needed. Handle audits, quality assurance, and process improvement initiatives . Open for WFO/ Noida Extension Location/ Night shifts. Please share CV at annu.misra@rsystems.com

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 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 Preferences for this role include: 1.5+ 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. 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. Both Under Graduates and Postgraduates 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. **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.

RESPONSIBILITIES *Responding to Customers' Needs. ~Keeping an Eye on Trends and Monitoring Competition. *Communicating work and brand values with Marketing Team. *Developing a Growth Strategy.

Greetings from Access Healthcare Minimum 1year of experience required Should have Knowledge in payer or provider experience Candidate should have good communication skills Basic knowledge on Revenue cycle management Salary as per company norms Ready to work in night shift Location : Chennai Interested candidates can drop your resume through WhatsApp - 9944497268/9043315031

Key Responsibilities: Assist in developing and implementing sales and marketing strategies to drive business growth. Conduct market research to identify potential clients and market trends. Support the creation of promotional materials, including presentations and social media content. Engage with clients through various channels, understanding their needs and providing product information. Participate in sales meetings and contribute ideas for improving team performance. Maintain accurate records of sales activities and customer interactions. Collaborate with team members to achieve monthly and quarterly sales targets. Criteria :- Female Candidate only Age - 18-25 Immediate joinner Fresher will be preffered Location: Dombivli,Panvel,Karjat Contact no. - 9324483283

Caliber Organisation is a leading client servicing company, catering to esteemed organizations such as UNICEF, IndusInd Bank, Axis Bank, AU Small Finance Bank, and HDFC Bank. We are committed to nurturing talent and providing a platform for career growth. As a Business Leader , you will undergo comprehensive on-the-job training to gain in-depth knowledge of our organization and industry, with the opportunity to advance to higher positions based on performance. We are seeking highly motivated and ambitious FRESHERS to join our team as Marketing Team Leader. The role involves intensive training, exposure to various aspects of the organization, and the potential to lead a team based on individual performance. Designation: We are hiring for theTeam leader position. The trajectory of growth within the organization includes advancement into roles focused on Business Development and Business Management, offering ample opportunities for professional development and career progression. Location:Dombivli,Panvel

Here, the only person to stop you from succeeding is you As one of the most progressive sales and marketing companies we specialise in providing the clients we represent with an outsourced sales solution. With expanding demand comes expansion and we are currently opening 5 new offices around Mumbai in the coming 12 months and are recruiting for Business Management Officer Unlimited career growth Valuable skills that are highly transferable Weekly earnings and attractive incentives Be part of a high charged, motivated & fun environment Be part of a team-oriented and fun environment 1) Training and Developing team members to develop a high performance culture. 2) Training & imparting knowledge on sales and marketing techniques 3) Expanding Business across country 4) Customer Acquisition & Promotion: Acting as a point of contact on behalf of the client for promotion & brand development. 5) Expanding Business & mapping of new market segments in new territories across India. 6) Looking forward to people who have good command over English & local language. 7) To meet sales and performance expectations 8) Train and develop associates on regular basis Location: Thane,Mumbai,Navi Mumbai,Kalyan/Dombivli,MUMBAI ALL AREAS CONTACT ON: 9324483283

Dear, Greetings from RND Softech Pvt Ltd!! Job Description: Career Opportunities with RND Softech One day interview process...Immediate offer.... Designation: AR Caller/International voice process/Physician biller/Customer support associate Process: Medical billing , claim and denial managment ,Insurance Verification Process, US healthcare Responsibilities: Inbound and outbound calls and resolving queries. Provide Backend services to Clients Engaged in handling outbound calls of different business Units. End to End Transaction of Reports. Would be engaged in Shared Services of BPO Unit. Eligibility: Should be flexible to work in shifts. Strong Verbal command over English . Graduate fresher's in any stream can appear , should have a flair for excellent communication Hands on experience Shifts : US Timings Free Transportation provided. Work Location : Coimbatore We are looking at candidates who can join asap

You will be handling the specific part of market which will be assigned by the company. You would have to meet the client at their work space and give corporate Presentation about the product, doing negotiation by communicating with patience and by solving their query. Having Strong interpersonal skill is must for dealing with the clients and need to be self motivated. Skills Required: Contributes to team effort by accomplishing related results as needed. Maintains quality service by establishing and enforcing organization standards. Identifies product improvements or new products by remaining current on industry trends, market activities, and competitors. Maintains relationships with clients by providing support, information, and guidance; researching and recommending new opportunities; recommending profit and service improvements. Sells products by establishing contact and developing relationships with clients. Criteria: Immediate joiner Age - 18 to 25 Location - Mumbai all areas, Mumbai Suburbs, kalyan,Dombivli,Panvel

We train and develop freshers at different level of BUSINESS giving them an exposure in marketing,management, team handling, client servicing, training & Development, Accounts and Finance. Job Role- * Working for business management and development profile for clients. * Training and developing people in business management and development * Managing clients and providing the best services * Doing B2B campaigns for business management and development * Organizing events, seminars and workshop at corporate level * Maintaining relationship with HNI Clients and customers * Handling a team of 20-25 associate Required Candidate profile *Graduates & post Graduates who aspires to build themselves as leaders in the industry *Dynamic & Hardworking *Ambitious & Positive Thinker * Freshers can Apply * Post Graduate/Graduate Freshers Location-Thane,Mumbai,Navi Mumbai,Mumbai All Areas, Kalyan/Dombivli

Required Candidate profile Caliber Organisation is a leading client servicing company, catering to esteemed organizations such as UNICEF, IndusInd Bank, Axis Bank, AU Small Finance Bank, and HDFC Bank. We are committed to nurturing talent and providing a platform for career growth. As a Management Trainee, you will undergo comprehensive on-the-job training to gain in-depth knowledge of our organization and industry, with the opportunity to advance to higher positions based on performance. Location- Thane,Navi Mumbai,Mumbai,Dombivli,Panvel,Karjat,mumbai all areas, MUMBAI SUBURBS, kalyan Desired Candidate Profile *Dynamic & Hardworking *Freshers *Excellent Interpersonal and Communication skills *Graduate & Post Graduate Freshers *Freshers willing to get trained in all the areas of management.

Management freshers into sales marketing PR -Brand awareness/ customer acquisition -Developing team and providiing and providing effective trainiing -mentoring & managing team to achieve desired performance -understanding financial aspects REQUIRED CANDIDATE PROFILE -Creative & positive -well groomed -GOOD ETIQUETTE -willingness to learn -training provided -has a smile & great leadership qualities *Age 18-27 *Freshers can apply *Immediate joiner Locations : thane, navi mumbai, mumbai all areas, MUMBAI SUBURBS, MUMBAI, kalyan, dombivli, panvel,

Job description Quality Auditor - Claims Adjudication Location : Navalur,Chennai Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 3-8 years of excellent knowledge on client specifics and experience in all types of Claims Adjudication. Good experience in Quality team handling. Perform quality review of claims based on the documentation provided by client to ensure claim output meets all customer specifications Collects all findings during the audits and perform effective root cause analysis along with examiners & ops supervisors Generate multiple level of analysis from the audit findings and identify opportunities to improve overall process Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Conduct 1-0-1 coaching / feedback on specific error scenarios Provide suggestions to Trainer and Ops on the slow performers who needs additional coaching / re-training on specific areas Tracks all feedback from client and provide constructive information to agents during daily quality team huddle Participates in client knowledge calibration exercise Understanding Client P&Ps and auditing documents / claims based on instruction guidelines. Record audit findings and prepare audit reports and circulate quality dashboard Organize ILP review meeting and quality briefings to update associates on any quality issues Analyze internal/client feedback and respond with details Handling Feedback sessions efficiently. Interested Candidates share your CV - deepalakshmi.rrr@firstsource.com / 8637451071 Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or deepalakshmi@firstsource.com email addresses.

Responsibilities: • Analyze and evaluate workers's compensation claim payments using client proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state workers compensation fee schedule and/or PPO contract. Research, request and acquire all pertinent medical records, implant manufacturers invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement. Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement. Prepare correct Workers Comp initial bill packet or appeal letter using Client systems tools and submit with all necessary supporting documentation to insurance companies. Other duties as required. Education: Diploma / Bachelors Degree in any discipline. Experience: • Experience working for a US based BPO OR US healthcare insurance industry experience OR a similar experience recommended. • Competent in MS Office Suite and Windows applications. Skills and Prerequisites: • Strong verbal communication skills. • Fast and accurate typing skills while maintaining a conversation. • Multitasking of data entry while conversing with Client contacts and insurance companies. • Ability to professionally and confidently communicate to outside parties via phone, email and fax. • Ability to handle large volumes of work while maintaining attention to detail. • Ability to work in a fast-paced environment. • Work under limited supervision, manage multiple tasks and prioritize assignments within limited time constraints. • Effectively communicate issues/problems and results that impact timelines for project completion. • Ability to interact professionally at multiple levels within the organization. • Timely and regular attendance.

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims needs to be completed adhering to required TAT and quality SLA. Key Results Production, Quality Shift and Schedule adherence Process Knowledge Minimum Eligibility: Candidates should have minimum 1 year Experience in Claims Adjudication & Claims Adjustment or Claims Adjudication with Appeals & Grievances. Shift Details: Night shift / Flexible to work in any shift and timingCab Boundary Limit: Up to 30 km (One way drop cab) Job Location: Firstsource Solution Limited,5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103.Landmark near Vivira Mall. Contact: Arun HR Phone: 8015721106 Email: arun.kumar9@firstsource.com If you are interested please share your updated CV to the arun.kumar9@firstsource.com or 8015721106 Join us to be part of a dynamic team with career growth opportunities. We look forward to seeing you at the interview! You can refer your friends as well! Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or arun.kumar9@firstsource.com

Interested Candidates may connect with Ms.Zoya Shamsi +91 7251000195 (11am-5pm) About the Role: We are seeking a highly motivated and experienced individual with a medical background to join our dynamic team as a Medical Claims Call Center Representative. In this role, you will be the frontline of our customer service, handling inbound calls related to medical claims and rejections. Your primary focus will be to provide exceptional customer service while resolving inquiries and concerns effectively, ensuring a positive experience for every Niva Bupa member. Key Responsibilities: Answer incoming customer calls promptly and professionally. Assist customers with navigating medical claims, including inquiries about submissions, rejections, and procedures. Provide accurate and detailed information about claim processes, documentation requirements, and insurance coverage. Investigate and resolve customer concerns with a focus on high satisfaction and clear communication. Collaborate with internal departments like claims processing to address complex issues and expedite resolutions. Maintain extensive knowledge of Niva Bupa products, medical billing codes, and claim procedures. Document customer interactions and update records accurately in our system. Identify and escalate critical or unresolved issues to the appropriate supervisor. Adhere to company policies, procedures, and compliance guidelines. Key Requirements: Education & Certificates: B.Pharm & M.Pharm. Minimum 1-3 years of call center experience, preferably in healthcare or medical insurance. Strong knowledge of medical terminology, insurance claim procedures, and billing codes. Excellent verbal and written communication skills. Ability to handle high call volumes and prioritize customer needs effectively. Strong problem-solving and decision-making abilities. Attention to detail and accuracy in data entry and documentation. Exceptional customer service skills with a friendly and professional demeanor. Proficiency in computer systems, including CRM software and Microsoft Office Suite. Ability to work effectively in a team-oriented environment. Flexibility to work various shifts as per business requirements. What you'll gain? A competitive salary package of up to Rs. 3.5 LPA, based on your experience and Interview performance. Be part of a growing and respected healthcare company. Make a real difference in the lives of our members by providing exceptional customer service. Work in a dynamic and supportive environment with opportunities for growth and development. Competitive salary and benefits package. Ready to join Niva Bupa and contribute to a team dedicated to improving lives? Apply today!

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Looking for voice process only. Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : Lithan Kumar HR (7339696444) Those who have experience in Non voice please don"t apply

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : Varsha HR (8056370297) Those who have experience in Non voice please don"t apply

Role & responsibilities Handle end-to-end RCM (Revenue Cycle Management) processes efficiently. Manage AR (Accounts Receivable) follow-up through voice-based communication. Work on claims related to Workers Compensation, Claims Adjudication, and Liability. Experience: Minimum 1 year in AR Voice Process Shift: Night shift (Free pickup & home drop provided) Communication : Excellent spoken English is mandatory Location: Chennai Interested candidates can share their CV to Shobana K 8248223875 Note: non voice experienced candidate kindly don't apply for voice process

Selected Intern's Day-to-day Responsibilities Include. Assist with Lead GenerationEngage with CXOs via cold calls, emails, and LinkedIn. Do Consultative PitchingUnderstand business needs and present tailored solutions. Deliver Concept PresentationDeliver impactful presentations to secure business opportunities. Write ProposalsDevelop compelling techno-commercial proposals. Help with Deal ClosureNegotiate and finalize contracts for seamless onboarding. Support Account ManagementBuild and maintain strong client relationships. Ensure Business Lifecycle ManagementWork with business leads to optimize processes. Keep Market AwarenessStay updated on industry trends and technology advancements. About CompanyWe are an engineering company with leading capabilities in digital transformation, internet-related services and products, data science, development operations, product as a service, technology consulting, and software engineering. Trusted by industry giants, we have a proven track record in providing customized digital solutions across various industry segments.

Arzion RCM is looking for Senior AR Caller to join our dynamic team and embark on a rewarding career journey Tellecaller is responsible for various tasks including planning, execution, and management of related duties They should possess relevant skills and experience to excel in this role Duties include teamwork, problem-solving, and achieving organizational goals Candidates must have strong communication and technical abilities Responsibilities include project management, strategy execution, and performance optimization (More details as per role requirements )

About Client Hiring for One of the Most Prestigious Multinational Corporations! Job Title : P&C Claims Management Qualification : Any Graduate and Above Relevant Experience : 1 to 5 years Must Have Skills : 1.Experience in P&C Claims Management, preferably with BPO/Insurance process exposure. 2.Strong experience handling FNOL (First Notice of Loss) or FROI (First Report of Injury) cases. 3.Knowledge of claims systems like Guidewire, Duck Creek, Majesco, or similar platforms. 4.Familiarity with ISO, NCCI, and WCIRB reporting requirements. 5.Proficient in MS Office (Excel, Word) and data entry with attention to detail. 6.Strong communication and interpersonal skills with a customer-centric approach. 7.Ability to multi-task in a fast-paced and compliance-driven environment. Good Have Skills : Knowledge and expertise in FNOL (First Notice of Loss) or FROI (First Report of Injury) Roles and Responsibilities : 1.Manage end-to-end claims processing for Property & Casualty lines including auto, home, general liability, and workers compensation. 2.Perform FNOL/FROI intake, assess coverage, and initiate claim setup using internal systems. 3.Verify policy information, document incidents accurately, and identify subrogation opportunities. 4.Maintain consistent communication with policyholders, claimants, vendors, and internal teams. 5.Support claims adjudication by gathering and reviewing supporting documentation, police reports, medical records, etc. 6.Ensure compliance with applicable state regulations and client-specific SLAs. 7.Coordinate with adjusters, underwriters, and legal teams where necessary. 8.Generate and maintain accurate records for audit and reporting purposes. 9.Continuously identify and escalate potential fraud or misrepresentation concerns. 10.Participate in process improvement initiatives and training sessions. Location : Mumbai CTC Range : 3.5 to 6 LPA (Lakhs Per Annum) Notice Period : Immediate Mode of Interview : Virtual Shift Timing : Night Shift Mode of Work : Work From Office -- Thanks & Regards, Chaitanya HR Analyst Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432445 | WhatsApp @ 8431371654 chaitanya.d@blackwhite.in | www.blackwhite.in

Responsibilities: * Manage claims from intake to settlement. * Adjudicate medical necessity & settle claims fairly. * Ensure timely claim payment & employer satisfaction. * Process mediclaim & health insurance claims accurately.

Project Role : Business Analyst Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Must have skills : GuideWire Integration Good to have skills : NAMinimum 2 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As a Business Analyst, you will engage in a variety of tasks that involve analyzing organizational processes and systems. Your typical day will include assessing the current state of business models, identifying customer requirements, and defining future states or business solutions. You will conduct research, gather data, and synthesize information to support decision-making and improve integration with technology, ensuring that the organization meets its strategic goals effectively. Roles & Responsibilities:- Expected to perform independently and become an SME.- Required active participation/contribution in team discussions.- Contribute in providing solutions to work related problems.- Facilitate workshops and meetings to gather requirements and feedback from stakeholders.- Develop detailed documentation of business processes and system requirements. Professional & Technical Skills: - Must To Have Skills: Proficiency in GuideWire Integration.- Strong analytical skills to assess business processes and identify areas for improvement.- Experience with process mapping and modeling techniques.- Ability to communicate effectively with both technical and non-technical stakeholders.- Familiarity with project management methodologies. Additional Information:- The candidate should have minimum 2 years of experience in GuideWire Integration.- This position is based at our Bengaluru office.- A 15 years full time education is required. Qualification 15 years full time education