595 Claims Adjudication Jobs - Page 14

: Paytm is India's leading mobile payments and financial services distribution company. Pioneer of the mobile QR payments revolution in India, Paytm builds technologies that help small businesses with payments and commerce. Paytm’s mission is to serve half a billion Indians and bring them to the mainstream economy with the help of technology. Expectations/ 1. Must have Smart Phone, Bike & Helmet 2. Candidate must have a zeal for Growth 3. Candidate should have good market knowledge 4. Must have done a Channel Sales Role before with 5 Member Sales Team handled before 5. Must understand concepts of distribution, expansion, metrics 6. Must have experience in getting team earn Lucrative Incentives Education Graduate or above / Post Graduation preferred. s- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective customers , Handle the Team Members and motivate them for better sales , Ensure the team members are in market where enrollments & usage are done regularly. Should have good networking capabilities and be willing to travel extensively throughout their specified areas Key Role: Manage an assigned geographic sales area to maximize sales target and meet corporate. Objectives Build Database of key contact persons in the assigned geography. Build and maintain relationships with key client personnel Manage Category leads from qualification to closure

s- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective customers , Handle the Team Members and motivate them for better sales , Ensure the team members are in market where enrollments & usage are done regularly. Should have good networking capabilities and be willing to travel extensively throughout their specified areas Key Role: Manage an assigned geographic sales area to maximize sales target and meet corporate. Objectives Build Database of key contact persons in the assigned geography. Build and maintain relationships with key client personnel Manage Category leads from qualification to closure

: Paytm is India's leading mobile payments and financial services distribution company. Pioneer of the mobile QR payments revolution in India, Paytm builds technologies that help small businesses with payments and commerce. Paytm’s mission is to serve half a billion Indians and bring them to the mainstream economy with the help of technology. Expectations/ 1. Must have Smart Phone, Bike & Helmet 2. Candidate must have a zeal for Growth 3. Candidate should have good market knowledge 4. Must have done a Channel Sales Role before with 5 Member Sales Team handled before 5. Must understand concepts of distribution, expansion, metrics 6. Must have experience in getting team earn Lucrative Incentives Education Graduate or above / Post Graduation preferred. s- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective customers , Handle the Team Members and motivate them for better sales , Ensure the team members are in market where enrollments & usage are done regularly. Should have good networking capabilities and be willing to travel extensively throughout their specified areas Key Role: Manage an assigned geographic sales area to maximize sales target and meet corporate. Objectives Build Database of key contact persons in the assigned geography. Build and maintain relationships with key client personnel Manage Category leads from qualification to closure

: Paytm is India's leading mobile payments and financial services distribution company. Pioneer of the mobile QR payments revolution in India, Paytm builds technologies that help small businesses with payments and commerce. Paytm’s mission is to serve half a billion Indians and bring them to the mainstream economy with the help of technology. Expectations/ 1. Must have Smart Phone, Bike & Helmet 2. Candidate must have a zeal for Growth 3. Candidate should have good market knowledge 4. Must have done a Channel Sales Role before with 5 Member Sales Team handled before 5. Must understand concepts of distribution, expansion, metrics 6. Must have experience in getting team earn Lucrative Incentives Education Graduate or above / Post Graduation preferred. s- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective customers , Handle the Team Members and motivate them for better sales , Ensure the team members are in market where enrollments & usage are done regularly. Should have good networking capabilities and be willing to travel extensively throughout their specified areas Key Role: Manage an assigned geographic sales area to maximize sales target and meet corporate. Objectives Build Database of key contact persons in the assigned geography. Build and maintain relationships with key client personnel Manage Category leads from qualification to closure

: Paytm is India's leading mobile payments and financial services distribution company. Pioneer of the mobile QR payments revolution in India, Paytm builds technologies that help small businesses with payments and commerce. Paytm’s mission is to serve half a billion Indians and bring them to the mainstream economy with the help of technology. Expectations/ 1. Must have Smart Phone, Bike & Helmet 2. Candidate must have a zeal for Growth 3. Candidate should have good market knowledge 4. Must have done a Channel Sales Role before with 5 Member Sales Team handled before 5. Must understand concepts of distribution, expansion, metrics 6. Must have experience in getting team earn Lucrative Incentives Education Graduate or above / Post Graduation preferred. s- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective customers , Handle the Team Members and motivate them for better sales , Ensure the team members are in market where enrollments & usage are done regularly. Should have good networking capabilities and be willing to travel extensively throughout their specified areas Key Role: Manage an assigned geographic sales area to maximize sales target and meet corporate. Objectives Build Database of key contact persons in the assigned geography. Build and maintain relationships with key client personnel Manage Category leads from qualification to closure

Role & responsibilities - Due Diligence - Document Indexing & Management - Sanction Screening - Compliance checks - Premium Bordereaux Processing - Knowledge of insurance systems like Acturis, Applied Epic/Eclipse will be added advantage - Experience in the insurance sector, preferably with brokers or MGAs, will be an added advantage - Familiarity with Lloyds systems integration (XIS, XCS, ICOS/IPOS) is a plus - Updating the process documents - Providing supporting documents during various internal/external audits - Advance excel knowledge Preferred candidate profile Need Fresher or who have experience into claims and settlement Must be fluent with communication

Firstsource HIRING for Claims Adjudication !! HR SPOC: Aiswarya HR / 8072289336 Job Title: CSA & Senior CSA Grade: H1/H2 Job Category: Associate Function/Department : Operations Reporting to: Team Lead 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: Preferred educational qualifications: Graduation (Any discipline - 3 years) without arrears. Preferred work experience: Minimum 1 year of experience in Claims processing Skills and Competencies: Good Communication Skills Listening & Comprehension About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, and India. Our rightshore delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies 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 Aiswarya.Mmm@firstsource.com.

Please mention Kanchan Maurya on your CV R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work For 2023 by Great Place To Work Institute. We are committed to transforming the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Responsibilities: Follow up with the payer to check on claim status. Responsible for calling insurance companies in the USA on behalf of doctors/physicians and following up on outstanding accounts receivable. Identify the denial reason and work on the resolution. Save the claim from getting written off by timely following up. Candidates must be comfortable with calling on denied claims. Interview Details: Interview Mode: Face-to-Face Interview Walk-in Timings : 1 PM to 4 PM Walk-in Address: Candor Tech Space Tower No. 9, 7th Floor, Plot 20 & 21, Sector 135, Noida, Uttar Pradesh 201304 Desired Candidate Profile: The candidate must possess good communication skills. Only Immediate Joiners can apply & Candidate must be comfortable working for the Gurgaon location. Provident Fund (PF) Deduction is mandatory for the organization. B. Tech/B.E/LLB/B.SC Biotech & Candidates Pursuing Regular Graduation/Post Graduation aren't eligible for the Interview. Undergraduate (People who are not graduates) should have a minimum. 12 Months of experience. Candidate not having relevant US Healthcare experience in AR Follow UP shouldn't have more than 24 Months of experience. Benefits and Amenities: 5 days of work. Both Side Transport Facility and Meal. Apart from development and engagement programs, R1 offers a transportation facility to all its employees. There is a specific focus on female security personnel who work round-the-clock, be it in office premises or transport/ cab services. There is 24/7 medical support available at all office locations, and R1 provides Mediclaim insurance for you and your dependents. All R1 employees are covered under term-life insurance and personal accidental insurance.

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, Aneesha HR Analyst Black and White Business Solutions Pvt Ltd Direct Number : 08067432440| Whats app : 9035128021|aneesha.g@blackwhite.in

UK Health Care Process Nature of Work : Claim Processing/ Backend Candidates should have their own system and internet connection Configuration required Windows 10 Processor - i3/i5 RAM - 4 GB Speed - 10mbps rotational shifts, 5 days working Required Candidate profile Rounds of Interviews - HR - Medical Test - Email Test - Amcat - Ops

Greetings from Alldigi Tech!!! Job Description: HealthCare (non-Voice) Shift: Day Shift (9am to 6pm) Experience: 1 to 3 years Notice Period: Immediate Joiners Connecting with our client's business partners in the US, typically insurance companies to follow up and coordinate on the following activities: Coordinates medical specialty referrals and procedures for patients in a timely, efficient, and equitable manner Utilizes EMR system(s) to track and research urgent requests and keep patient information current and accurate Communicates information, including updates of referral requests, appointment details, and communication preferences vis EMR, email, chat, and patient portal Review patient charts and records to understand what authorizations and documentations need to be pursued Ensures that all barriers to care (such as language, transportation restrictions, or financial needs) are addressed Provides clear, thorough, and accurate documentation of all referral processing steps, in the patient's electronic health records Processes necessary prior authorizations and insurance referrals as needed to complete the referral process Follows organizational guidelines regarding the use of the Electronic Medical Record (EMR) in compliance with HIPAA and patient confidentiality standards Maintains access to the Health Information Exchange (HIN) and other related systems Uses HIN and other related systems to gather information needed to coordinate care and keep patients' electronic health records up to date with the status of care that is being coordinated Maintains surveillance ticklers and/or work with Health Information Technology to proactively identify the need for patient care Navigates patient to care, as assigned. Interested candidates can come for the Direct Walk-In Interview to the office.

Medusind Solutions Openings for AR Callers/ WFO Location : Ahmedabad ( 7th & 8th Floor, Corporate Rd, Makarba, Ahmedabad, Gujarat 380015 ) HR : Rohan 878007771 Role & responsibilities Outbound calls to insurances for claim status and eligibility verification Denial documentation and further action Calling the insurance carriers based on the appointment received by the clients. Working on the outstanding claims reports/account receivable reports received from the client or generated from the specific client software. Calling insurance companies to get the status of the unpaid claims. Willing to work in any process pertaining to voice based on the requirement (Insurance Follow UP, Patient calling, Provider outreach program etc. Maintain the individual daily logs. Performs assigned tasks/ completes targets with speed and accuracy as per client SLAs Work cohesively in a team setting. Assist team members to achieve shared goals. Compliance with Medusind' s Information Security Policy, client/project guidelines, business rules and training provided, company's quality system and policies Communication / Issue escalation to seniors if there is any in a timely manner Punctuality is expected all the time Perks and benefits Any Undergraduate 0.6-2 Years Relevant experience into medical billing Basic knowledge of MS Office Preparing spreadsheets and documents Good Communication skills must be able to fluently converse in English. Must have a neutral accent No stammering Working Day - 5 days working (Sat & sun fixed off ) Shift timing - 5.30 PM to 2.30 AM Drop Available with 25kM office radius Interested candidate can call on 878007771 or Can share their profiles rohan.shaikh@medusind.com

We are hiring for Senior Claims Adjudication!! HR Recruiter (Reference): Abhilash Position: Senior Customer Support Associate We are looking for Candidate who has around 1 to 2 years of experience into Claims Adjudication & Claims Processing . This is a great opportunity to build your career in a dynamic and supportive environment. Venue: Firstsource Solution Limited, 5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103. Landmark: Near Vivira Mall. Shift: Flexible to work in night shift Key Skills: - Good Communication Skills. - Listening & Comprehension. - Good typing Skills is must. Work Mode: Work From Office Cab Boundary Limit : We provide cab Up to 30 km (One way drop cab | Doorstep only) Walk-In Details: Walk-In Days: Monday To Friday Walk-In Time: 10:30 AM - 2:00 PM Documents to carry: 1. Updated resume 2. Aadhar card 3. Pan card 4. Educational Certificates (1st to 6th marksheet, Provisional marksheet) 5. Previous company's Offer Letter, pay slip (last 3 months), relieving letter NOTE: 1. Mention ABHILASH (HR Recruiter) in top of your resume while walking-in for the discussion. 2. In case if you receive any other call from Firstsource for the job opportunity, be kind enough to inform that you are in touch with ABHILASH HR. 3. Share your resume to the below mentioned WhatsApp Number and Email ID . Contact: Abhilash CB 9994685103 abhilash.cbb@firstsource.com Kindly 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 Abhilash.cbb@firstsource.com

Walk-in interview for Sr Executive - Facets Claims - US Healthcare Skill: Claims Facets (Mandatory) , excellent communication Experience : Minimum 1yr of experience in Claims- Facets is required (Mandatory) Education : Must have regular bachelor's degree Work timings : Night shift - US timings Notice period : Immediate to Max 15 days Note: Candidates with Facets experience from US Healthcare are only eligible for the position. Please carry a hard copy of your CV & original photo ID proof for security check

Walk-in interview for Sr Executive - Facets Claims - US Healthcare Job description: Skill: Claims Facets (Mandatory) , excellent communication Experience : Minimum 1yr of experience in Claims- Facets is required (Mandatory) Education : Must have regular bachelor's degree Work timings : Night shift - US timings Notice period : Immediate to Max 15 days Note: Candidates with Facets experience from US Healthcare are only eligible for the position. Please carry a hard copy of your CV & original photo ID proof for security check

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6 months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

EXL IS HIRING FOR INSURANCE PROCESS ON 20TH JUNE 2025 About EXL EXL Service is a global analytics and digital solutions company serving industries including insurance, healthcare, banking and financial services, media, retail, and others. The company is headquartered in New York and has more than 37,000 professionals in locations throughout the United States, Europe, Asia, Latin America, Australia and South Africa. http://www.exlservice.com ELIGIBILITY - Candidate should be a graduate (any stream). - Candidates with minimum 1+ year of relevant experience in any Insurance /Healthcare Insurance/Claims Insurance/Claims Adjudication would be considered - Candidate should be comfortable with Night shifts. - Candidates should be comfortable with Work from Office (sec- 144 NOIDA). - Good communication skills are required (written and spoken). - Notice Period - Immediate joiners preferred PERKS AND BENEFITS - CTC offered will be between 3.00 LPA-4.00 LPA (depending upon last drawn and experience) - 5 days working - Both Sides transport till further update (within the hiring grid) NOTE- Do not carry any electronic items like Laptop and Pen drive MANDATORY DOCUMENTS - Please carry hardcopy of your Resume(02 copies), AADHAR card, Photocopy of PAN Card and 2 recent passport Size photograph along with you. Entry would not be allowed into the premises without the above-mentioned documents. Please come Please come b/w 11:00 AM-2:00 PM as entries will not be allowed post 2:00 PM Regards, EXL RECRUITMENT TEAM EXL: Empowering Businesses Through Data & AI EXL is a global leader in analytics, AI, and digital solutions for all industries. Let us power your growth with generative AI and digital transformation! EXL: Empowering Businesses Through Data & AI EXL is a global leader in analytics, AI, and digital solutions for all industries. Let us power your growth with generative AI and digital transformation!

Position Overview: MDI NetworX is seeking a Deputy Manager / Manager Payer Operations to oversee end-to-end healthcare payer processes, drive operational excellence, and ensure compliance with US healthcare standards. This leadership role requires expertise in process optimization, stakeholder management, and team development Key Responsibilities: Lead and manage payer operations, ensuring efficiency and quality in service delivery. Develop and implement strategies to optimize claims processing, enrollment, and provider data management. Drive team performance, coaching, and professional development initiatives. Conduct salary negotiations and oversee talent acquisition for the department. Ensure compliance with HIPAA, ACA, and other payer regulations. Manage escalations, resolve critical process issues, and implement continuous improvement initiatives. Collaborate with senior leadership, clients, and cross-functional teams to enhance operational effectiveness. Monitor key performance indicators (KPIs) and generate actionable reports. Required Skills & Qualifications: Bachelors degree or equivalent experience. 8-12 years of experience in US healthcare payer operations. Strong expertise in claims adjudication, enrollment, and provider data management. Proven experience in leadership, stakeholder management, and process optimization. Proficiency in MS Office, healthcare payer systems, and data analytics. Excellent strategic thinking, communication, and problem-solving skills. Preferred Qualifications: Experience with Medicare, Medicaid, and commercial payer processes. Knowledge of EDI transactions (837, 835, 834). Prior experience in a BPO or shared services environment

We are Conducting Mega Job fair for Top 10 Companies for AR calling. Chennai, Noida, Bangalore & Hyderbad. Job Title: AR Caller (Accounts Receivable Caller) Department: Revenue Cycle Management / Medical Billing Location: Bangalore / Hyderabad / Chennai / Noida Job Type: Full-Time. Experience: 0 to 10 years Job Summary: We are seeking an AR Caller to follow up on outstanding insurance claims and ensure timely reimbursement. The ideal candidate will be responsible for calling insurance companies (payers) to verify claim status, resolve denials, and secure payment for services rendered. Key Responsibilities: Call insurance companies and follow up on pending claims. Understand and interpret Explanation of Benefits (EOB) and denial codes. Identify reasons for claim denials or delays and take appropriate actions. Resubmit claims or file appeals when necessary. Document all call-related information accurately and clearly. Work with billing teams to resolve billing issues. Meet daily productivity and quality targets. Stay updated on payer policies and healthcare regulations. Required Skills: Excellent communication skills (verbal and written) in English. Basic knowledge of the US healthcare system and insurance claim process. Attention to detail and analytical thinking. Familiarity with denial management and RCM workflow is a plus. Experience using billing software like Athena, NextGen, eClinicalWorks, or similar is a bonus. Qualifications: Bachelors degree preferred, but not mandatory. Prior experience in AR calling/medical billing is an advantage. Willingness to work night shifts (for US clients). contact Hiring Manager : Mallik - 9900024951 / 7259027282 / 7259027295 / 7760984460.

Job Summary We are seeking a skilled professional with 1 to 6 years of experience in Claim Management to join our team in Insurance Claims. The ideal candidate will have strong expertise in MS Excel and excellent English language skills. This role requires working from the office during night shifts. Responsibilities Analyze and process annuity claims efficiently to ensure timely settlements. Utilize MS Excel to manage and organize claim data effectively. Collaborate with team members to resolve complex claim issues. Communicate clearly with stakeholders to provide updates on claim status. Ensure compliance with company policies and industry regulations. Identify opportunities for process improvements in claim management. Maintain accurate records of all claim transactions and communications. Provide exceptional customer service to claimants and beneficiaries. Conduct thorough investigations to validate claim authenticity. Prepare detailed reports on claim activities and outcomes. Support the team in achieving departmental goals and objectives. Stay updated with industry trends and best practices in claim management. Contribute to the company's mission by ensuring fair and accurate claim processing. Note Candidates with experience in insurance claims are preferred. Candidates with a notice period of 0 to 30 days are preferred. Candidates should be willing to work in night shift and work from office. This drive is only for experienced candidates and not for freshers.

Dear Aspirants, Greeting from Sagility!! Immediate hiring for AM-Process Training in Bangalore-Work from office Job description: Role and Responsibilities The resource would be part of a dynamic team. Would be working with the other members of the training, operations and the quality teams to manage conduct of new hire training, while also being responsible for the quality performance of the newly trained resources by planning and executing various interventions during the on the job training phase. An approximate list of responsibilities is appended below (but not limited to): Should have experience working in Claims, PB, PDM & Credentialing Managing attrition and ensuring the batch throughput is as per the business targets and maintain healthy first pass yield (as per defined targets) Managing batch productivity & batch quality till the 90 days post classroom training Establishing and leading a review cadence, create performance benchmarks to measure and report to management Managing & working with clients, internal teams to drive content updation, effectiveness and availability Identifying and managing stakeholders by establishing requirements, performance reviews, collating feedback and drafting improvement plans where necessary Investing a substantial amount of time into self & team/ people development, by way of upskilling, cross skilling and formalized individual development plans Initiating or being a part of major improvement initiatives towards betterment of training practices, measurement and overall process improvement Leading a team of trainers & master trainers towards achieving laid down team goals & objectives Responsible for driving constant content review, analysis and improvements where necessary Implementing cost control through optimization of resources such as trainer availability, batch handover timelines, return on investment etc. Qualifications and Education Requirements Any graduate can apply for this position, however, should have a minimum of 5 years of U.S. Healthcare experience either in the Payor or Provider line of business, in a similar position (with people management being a key KRA). Two Way Cab will be provided. Interested candidates can share their profile to below mentioned mail ID. anitha.c@sagilityhealth.com Thanks & Regards, TA Team Sagility

Process cashless and reimbursment claims (Should have knowledge of processing retail policies of National/United/New India/Oriental insurance companies.

Role & responsibilities Ensure team members are visiting the customers place as per the schedule Monitor the team members activity in terms of volumes (documents collected) Review the queries received from the customer and the responses from the team members Help team members in resolving escalationsfrom customers Review the reports sent by the team members and take necessary actions (issues with respect to claim registrations) based on the report. Coordinate with front end team and help in getting the claims registered Conduct weekly/monthly one on one review with the team membersto understand their concerns and help simplify the process Review the claims dump along with front end team and take necessary action for IR raised, reopening the claims, dummy claims as appropriate Review the feedback received from the customers. Rework on the low ratings and identify the areas of improvement and implement process improvements Team management Review on the low C-SAT/D-SAT to improve the communication quality or process gap if any as per the clients understanding/requirement. Coordinate with internal/external stakeholders and other regions on the support needed for the client requirements, like helpdesk , wellness-related activity and more. Preferred candidate profile 3-5 years of experience in people management and customer service & 7-8 years of overall experience in service industry

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.

Check the medical admissibility of claim by confirming diagnosis and treatment details Verify the required documents for processing claims and raise an information request in case of an insufficiency Approve or deny claims as per T&C within TAT