595 Claims Adjudication Jobs - Page 15

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.

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development and implementation of business plans and goals

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak excellent English. CTC – Upto 3.5 LPA.

SUTHERLAND IS HIRING- CLAIMS SPECIALIST Interested candidates can share your resume to lilly.prisicilla@sutherlandglobal.com POC: Lilly WANT A GOOD WORK LIFE BALANCE Fixed shifts and fixed weekend off Collection Voice Process Sutherland is seeking highly proficient * Claims associate in Bangalore. If you have the right experience and expertise, this could be an excellent career opportunity for you. Position Details : " Location: Kundan halli Bangalore Work Schedule: *FIXED SHIFTS AND FIXED Saturday & Sunday off* Compensation: Competitive salary with a significant hike on your last drawn salary, plus attractive incentives and transport allowance Work Mode: On-site Eligibility Criteria: Bachelors degree or college Diploma. Experience in P&C, Healthcare Claims dealing with damage, liability or injury claims. Good knowledge of Insurance claims end-to-end value chain activities, challenges and best practices. Good knowledge of how to evaluate injuries and damage using market tools and technology. General knowledge of the coverages available under the damage protection, liability policy and some common exclusions. Results driven, ability to multi-task, pay attention to detail and follow procedures. Proven leadership and time management skills in a team environment. Good writing, communication and presentation skills. Interested candidates can share your resume to lilly.prisicilla@sutherlandglobal.com POC : Lilly

We are HIRING For Experienced Claims Adjudication Process !! HR SPOC - Priyanka We are looking for Candidate who has around 1 to 2 years of experience into Claims Adjudication & Claims Processing. This is a great oppurtunity to build your career in a dynamic and supportive environment. Key Skills: - Good Communication Skills. - Listening & Comprehension. - Good typing Skills is must. Work Schedule & Location: - Shift: Flexible to work in night shift & Rotational Shift - Work Mode : Work From Office - Job Location : Navallur, Chennai - Cab Boundary Limit - One Way Upto 30kms. Direct Walk-in: - Walk - in Time: 10:30 AM - 1PM - Walk - in Date: Monday to Friday Mega Walk-in Drive Location: 5th floor, 4th block, Bayline Infocity, OMR Rajiv Gandhi Salai, Navallur, near to AGS Bus Stop, Chennai, Tamil Nadu 603103. Note: Bring you Resume, Pan card Or Aadhar card (original and Xerox) & Transfer certificate Mandatory (original) Contact Person: HR Recruiter - Priyanka N / 9884022260 Interested candidates share your resume to priyanka.narayanamoorthy@firstsource.com Mention reference name as Priyanka HR in top of your resume. 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 priyanka.narayanamoorthy@firstsource.com

The Admissions Manager is responsible for driving the admissions process, working closely with the Head of Admissions to implement data-driven strategies that enhance student enrollment. This role focuses on analyzing application trends, improving conversion rates, and fostering relationships with prospective students and their families. Closely working with HOD to deliver best. Strong leadership, creativity, and analytical skills are essential for success in this dynamic position. Key Responsibilities: Analyze and interpret admissions data to identify trends and opportunities for improvement. Collaborate with the Head of Admissions to develop and execute effective recruitment strategies. Counsel prospective students on programs, admissions procedures, and financial options. Respond to inquiries via direct communication methods, ensuring a professional and informative experience. Organize and participate in recruitment events, open houses, and information sessions. Manage the application review process and coordinate with financial services as needed. Develop and implement innovative communication strategies to engage potential students. Maintain accurate databases of student information and generate reports to inform decision-making. Provide support in preparing presentations and materials for admissions-related events. Assist the Head of Admissions with administrative tasks and strategic initiatives as required. Strong data analysis skills with the ability to leverage insights to drive enrollment success. Excellent communication and interpersonal skills to effectively engage with diverse audiences. Organized, self-motivated, and capable of meeting deadlines in a fast-paced environment. Commitment to professional development and alignment with the institution's core values. This role is vital for enhancing the admissions process and ensuring the recruitment of high-quality candidates who align with SOIM's mission. Additional Responsibilities: 1. Travel Requirements: o Travel as needed for education events, trade shows, and promotion. Qualifications: Education: Requirements: Education Bachelors degree in Marketing, Business Administration, Communications, or a related field. A Masters degree is a plus. Experience: 3-5 years of experience, preferably in an international environment These additional responsibilities will support the marketing manager in creating dynamic and engaging content that resonates with target audiences while enhancing the overall marketing strategy. By fulfilling these responsibilities, the Marketing Manager will drive brand success and elevate the organizations presence in the digital landscape.

Role:Team Lead Insurance Voice Exp:7-10 Years with 1- or 2-years experience in Team Lead on paper Team Size 15+ Skills:P&C Insurance- Claims/Underwriting/Policy Administration/Underwriting Loc:Pune & Bangalore Naman 8890377950/naman@genesishrs.com

Book your interview slot WhatsApp your profile @ 9623462146 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 8888850831

We are Hiring hybrid wfh Back office Process Backoffice Marine/Motor Claims Insurance (Min 3yr To 9yrs BPO),Sal 8.00 LPA ( Pune / Mumbai /Kochi Location) Fenkin Empire off no 404, 4th Floor, Thane West, 400601. Land Mark: Bhanushali Hospital, Station Road. Walkin Distance from Thane Railway Station. Meet Ali : 8888850831 Regards Dipika 9623462146

Responsibilities: * Manage revenue cycle from claims submission to payment posting. * Ensure timely credentialing and denial handling. * Process claims, manage AR, and post payments. * Handle denials through appeals process.

Candidate should have experience working as a Process Training in Claims adjudication process for US Healthcare Shift - US rotational shifts Work Location - Chennai / Bangalore Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Rhea @ 7411697700 for more details.

Role & responsibilities Review First Notice of Loss (FNOL) entries and confirm document completeness Collect supporting documents (e.g., police reports, invoices, photos) from brokers and insureds as required Maintain and update digital records of claim files in internal platforms (FIS, CMS, etc.) Identify missing documents or data inconsistencies and flag them for the onshore team Maintain up-to-date claim checklists and logs Categorize claims based on pre-defined triage criteria (Low, Medium, High exposure) Perform quality checks on document uploads, file naming conventions, and tagging Communicate professionally with brokers and insureds via email only for the purpose of gathering documents. Preferred candidate profile Prior experience in administrative support for an offshore company, preferably in insurance or claims (35 years) Strong attention to detail and ability to follow structured workflows Excellent organizational and time management skills Familiarity with document management systems is a plus Proficient in Excel, Outlook, and internal claim platforms (training provided) Strong written communication skills Ability to work within a team and under supervision

Team Management:Supervise and mentor a team of customer service/financial advisors, ensuring high engagement and performance. Process Oversight:Monitor day-to-day operations of the BFSI process, ensuring adherence to SLAs, compliance call 7697428237 Required Candidate profile Prior exp in healthcare in Claims process Experience: Minimum 3 years in a BPO Healthcare process, with at least 1 year as a Team Lead.

Cognizant is hiring Senior Process Executive with Claims Facets experience. Skill: Claims Facets Experience : 1 Year to 4 Years Notice: Immediate to 15 days preferred Shift - Night Shifts (US Shift) Preferred Locations: Hyderabad, Chennai, Bangalore, Coimbatore, Pune, Noida Desired Profile: Minimum 12+ months of experience in Claims-Facets (Mandatory) Graduation is a must Should be willing to work in Night shift - US Shifts It is a WFH opportunity (temporary) but should be flexible to work from office if required Note: Candidates with Claims Facets experience from RCM-US Healthcare’ are only eligible for the position. Applicants with relevant experience can forward the cv to: Naga.SatyaTanujaSri@cognizant.com

Minimum of 8 years of experience in a management roleProven track record of successful leadership and team managementAbility to develop and implement strategic plansExcellent communication and interpersonal skillsStrong problem-solving and decision-making abilitiesExperience in budget management and financial analysisKnowledge of Motor Claims industry trends and best practicesBachelors degree in business administration or a related fieldMasters degree in business administration or a related field preferredProfessional certifications such as CII, PMP, Six Sigma, or CFA are a plusStrong leadership and management skillsExcellent analytical and critical thinking abilitiesAbility to work well under pressure and meet deadlines Qualifications Graduate with Motor Claims certification preferable Job Location

We are looking for a motivated and enthusiastic analyst with an unwavering 'can-do' attitude to join the Commercial Engineering team. As a part of the Commercial Engineering team you will contribute to the design, prototyping, testing, deployment, performance, security, and enhancement of Thomson Reuters' Commercial Engineering systems/applications. You will also participate in a wide range of business analysis, project management, strategic planning, product management, and escalated support activities. About The Role: Bachelor's degree in accounting, business, or computer science Unyielding attention to detail Highly organized with strong analytical andproblem-solvingskills Ability to collaborate and brainstorm with developers, other departments, and product users in a highly dynamic environment Strong planning and time management skills, with a proven track record of managing multiple concurrent projects with time-sensitive milestones Must be able to work independently with minimal direction and guidance to achieve established goals and objectives Excellent verbal and written communication skills Ability to deliver high quality work on time in a high-energy, rapidly changing environment About You: Formulate and define complex information systems scope and objectives through research, analysis, and testing combined with a basic understanding of business needs, industry requirements, and best practices. Translate internal and external feedback to design solutions that satisfy user and business needs while managing expectations and relationship risks. Resolve problems of complex and diverse scope where the effective analysis of data often requires an accurate evaluation of identifiable and/or contributing factors Analyze and communicate extensive research findings into relevant and applicable insights Exercise independent judgment and resourcefulness within the scope of generally defined practices and policies in selecting the most appropriate methods and techniques for obtaining optimal solutions. #LI-KP2 Whats in it For You Hybrid Work Model Weve adopted a flexible hybrid working environment (2-3 days a week in the office depending on the role) for our office-based roles while delivering a seamless experience that is digitally and physically connected. Flexibility & Work-Life Balance: Flex My Way is a set of supportive workplace policies designed to help manage personal and professional responsibilities, whether caring for family, giving back to the community, or finding time to refresh and reset. This builds upon our flexible work arrangements, including work from anywhere for up to 8 weeks per year, empowering employees to achieve a better work-life balance. Career Development and Growth: By fostering a culture of continuous learning and skill development, we prepare our talent to tackle tomorrows challenges and deliver real-world solutions. Our Grow My Way programming and skills-first approach ensures you have the tools and knowledge to grow, lead, and thrive in an AI-enabled future. Industry Competitive Benefits We offer comprehensive benefit plans to include flexible vacation, two company-wide Mental Health Days off, access to the Headspace app, retirement savings, tuition reimbursement, employee incentive programs, and resources for mental, physical, and financial wellbeing. Culture: Globally recognized, award-winning reputation for inclusion and belonging, flexibility, work-life balance, and more. We live by our valuesObsess over our Customers, Compete to Win, Challenge (Y)our Thinking, Act Fast / Learn Fast, and Stronger Together. Social Impact Make an impact in your community with our Social Impact Institute. We offer employees two paid volunteer days off annually and opportunities to get involved with pro-bono consulting projects and Environmental, Social, and Governance (ESG) initiatives. Making a Real-World Impact: We are one of the few companies globally that helps its customers pursue justice, truth, and transparency. Together, with the professionals and institutions we serve, we help uphold the rule of law, turn the wheels of commerce, catch bad actors, report the facts, and provide trusted, unbiased information to people all over the world. Thomson Reuters informs the way forward by bringing together the trusted content and technology that people and organizations need to make the right decisions. We serve professionals across legal, tax, accounting, compliance, government, and media. Our products combine highly specialized software and insights to empower professionals with the data, intelligence, and solutions needed to make informed decisions, and to help institutions in their pursuit of justice, truth, and transparency. Reuters, part of Thomson Reuters, is a world leading provider of trusted journalism and news. We are powered by the talents of 26,000 employees across more than 70 countries, where everyone has a chance to contribute and grow professionally in flexible work environments. At a time when objectivity, accuracy, fairness, and transparency are under attack, we consider it our duty to pursue them. Sound excitingJoin us and help shape the industries that move society forward. As a global business, we rely on the unique backgrounds, perspectives, and experiences of all employees to deliver on our business goals. To ensure we can do that, we seek talented, qualified employees in all our operations around the world regardless of race, color, sex/gender, including pregnancy, gender identity and expression, national origin, religion, sexual orientation, disability, age, marital status, citizen status, veteran status, or any other protected classification under applicable law. Thomson Reuters is proud to be an Equal Employment Opportunity Employer providing a drug-free workplace. We also make reasonable accommodations for qualified individuals with disabilities and for sincerely held religious beliefs in accordance with applicable law. More information on requesting an accommodation here. Learn more on how to protect yourself from fraudulent job postings here. More information about Thomson Reuters can be found on thomsonreuters.com.

: 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

Job Title : Medical officer Open Positions: 2 Vacancies Location: Konankunte cross Job Summary: We are seeking candidates with a minimum of 1 year of experience in Indian health Insurance/TPA (Added Advantage) who have strong communication and along with good medical knowledge in Claims Adjudication. Qualifications : Degree in BAMS, BHMS, BSMS, or MBBS (strictly required). Candidates who can join immediately or within 15 days are preferred. Roles & Responsibilities: Ensuring accuracy and compliance in medical claims adjudication. Knowledge & Skill Requirements: Technical Competencies: Claims processing Preauthorization, Cashless, Reimbursement, Medical Adjudication, and Billing experience. Understanding of GIPSA/MA packages, SOC, and Tariff deviations. Identifying bill inflations in insurance billing. Knowledge of surgeries, advanced treatments, and procedure costs. Behavioral Competencies: Strong communication skills (verbal & written). Teamwork and collaboration. Time management and multitasking.

We are hiring freshers or experienced medical officer to process the health insurance claims in TPA or Insurance companies. Educational Qualification: MBBS / BAMS / BHMS / BPT / MPT / BDS / Pharm D.

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 If candidates are interested please drop your update resume/CV on varsha.kumari@mediassist.in Thanks & Regards Varsjha Kumari Email - varsha.kumari@mediassist.in

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * 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 Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS mail id - varsha.kumari@mediassist.in Thanks & Regards Email: varsha.kumari@mediassist.in

We are Hiring hybrid wfh Back office Process Backoffice Marine/Motor Claims Insurance (Min 3yr To 9yrs BPO),Sal 10.00 LPA ( Pune / Mumbai /Kochi Location) Process : Back office Process /UK Insurance Process Min 1yr to 4yrs exp. International BPO !!!Easy Selection and Spot Offer!!! Salary upto 4.5 Lacs + Incentives. Walk in at Infinites HR Services, Cerebrum IT Park, B3, 1st Floor, Kalyani Nagar Pune 411014. Call : Call : WhatsApp call only Dipika- 9623462146 / 7391077623 / 7391077624 Fenkin Empire off no 404, 4th Floor, Thane West, 400601. Land Mark: Bhanushali Hospital, Station Road. Walkin Distance from Thane Railway Station. Meet Ali : 8888850831 / 8888850831 Regards Dipika 9623462146

Urgent requirement for BHMS/BAMS/BDS doctors-Pune (Vadgaonsheri) Candidate with clinical or TPA experience Interested candidates can call on 7391042258 (Sneha- HR department) or share their updated resumes to recruitment@mdindia.com Roles and responsibilities: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BAMS / BHMS / BDS graduate. Good Medical & basic computer knowledge. Should have completed internship (Permanent Registration number is mandatory) Preferred -TPA or insurance sector Experience. Work from office . Interview Timings-11am To 5pm(Monday To Saturday) Venue Details: MDIndia Health Insurance TPA Pvt. Ltd. S. No. 46/1, E-space, A-2 Building, 4th floor, Pune Nagar Road, Vadgaonsheri, Pune 411014

Skills Skill Medical Coding Healthcare CPT ICD-9 EMR Medical Billing Healthcare Management Revenue Cycle ICD-10 HIPAA Education Qualification No data available CERTIFICATION No data available Role Description Overview: Coder is accountable to manage day to day activities of coding the Patients chart & Diagnosis report. Responsibility Areas: Coding or auditing charts, based on requirements Updating/Clearing the production/pending reports To work closely with the team leader. To review emails for any updates Identify issues and escalate the same to the immediate supervisor Strict adherence to the company policies and procedures. Sound knowledge in Medical Coding concept. Should have 6 months to 3 Yrs of Coding Experience. Understand the client requirements and specifications of the project. Meet the productivity targets of clients within the stipulated time (Daily & Monthly) Applying the instructions/updates received from the client during production. Coding or auditing charts, based on requirements. Prepare and Maintain reports

Skills Skill Medical Coding Healthcare HIPAA CPT ICD-9 EMR Medical Billing Healthcare Management Revenue Cycle ICD-10 Education Qualification No data available CERTIFICATION No data available Responsibility Areas: Coding or auditing charts, based on requirements Updating/Clearing the production/pending reports To work closely with the team leader. To review emails for any updates Identify issues and escalate the same to the immediate supervisor Strict adherence to the company policies and procedures. Sound knowledge in Medical Coding concept. Should have 6 months to 3 Yrs of Coding Experience. Understand the client requirements and specifications of the project. Meet the productivity targets of clients within the stipulated time (Daily & Monthly) Applying the instructions/updates received from the client during production. Coding or auditing charts, based on requirements. Prepare and Maintain reports