1575 Claims Adjudication Jobs - Page 18

Retail Claims - Automation & ProjectsKey Responsibilities1 Automate Claims Processes- Design anddevelop automated workflows and business rules to streamline claims processing Integrate with Existing Systems- Integrateautomated claims processing solutions with existing systems and technologies Testing and UAT - Test and validateautomated claims processing solutions to ensure accuracy and efficiency Daily production issue - Troubleshootissues and resolve problems related any day-to-day production issues across allclaim systems for death and health claims5 Collaborate with IT stakeholders, claim team and other requiredstakeholders to understand requirements and implement solutions6 Strong techn...

Downloads deposit files from lock box accounts2 Posts payments, denials, and adjustments from all payers3 Review all remittance advices for accuracy to identify errors or questionable data4 Researches and resolves unapplied/unidentified cash receipts5 Reviews postings to ensure payment is applied appropriately, corrects payment posting errors for the sites, and submits refund requests6 Assists with the follow up requests for medical records, continuing claim reports PRs, and other information related to claims that are on the no activity report7 Prepares and submits check requests to Accounting for payment of invoices

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

Job Summary Clinical claim Review Responsibilities Oversee the claims adjudication process to ensure accuracy and compliance with industry standards. Provide expertise in claims and payer domains to enhance operational efficiency. Analyze claims data to identify trends and areas for improvement. Collaborate with team members to streamline claims processing workflows. Ensure timely resolution of claims issues to maintain customer satisfaction. Develop and implement strategies to optimize claims adjudication procedures. Monitor performance metrics to ensure adherence to service level agreements. Communicate effectively with stakeholders to address claims-related inquiries. Utilize technical sk...

Cavalier IT is looking for Student Enrollment Specialist to join our dynamic team and embark on a rewarding career journey Provide guidance and support to prospective students regarding available programs, admission requirements, tuition fees, and financial aid options. Assist students in completing application forms, gathering necessary documentation, and submitting required materials for enrollment. Respond promptly and professionally to inquiries via phone, email, or in-person meetings, addressing questions related to admissions procedures, program details, and other relevant information. Maintain accurate records of student inquiries, applications, and enrollment status using designated ...

Hiring For Claims Analyst Good communication with experience in managing customer claims in the retail industry Degree in Commerce, Accounting with good analytical skills and high level of accuracy and attention to detail Analyze customer claims and deductions by reviewing supporting documentation such as purchase orders, invoices, and proof of delivery to determine their validity. Should be able to analyse, validate customer claims and deductions Work closely with various internal teams, including sales, accounting, and customer service, to gather information and achieve resolution Research and resolve various types of deductions, including those for shortages, pricing, and other terms of s...

About the Role We are looking for an experienced Assistant Manager Appeals to lead and manage our Appeals team within the RCM function. This role is critical in ensuring denied claims are effectively appealed, maximizing reimbursement, and maintaining compliance with payer guidelines. The ideal candidate has strong leadership skills, deep RCM knowledge, and hands-on expertise in handling appeals across multiple specialties and payers. Key Responsibilities Supervise and manage a team of Appeals Specialists handling insurance claim denials. Review denial trends and develop strategies to improve overturn rates and reduce recurring denials. Draft, review, and submit appeal letters with supportin...

Role: Assistant Manager Company: MediAssist TPA Location: IBC Knowledge Park, Bannerghatta Road, Bengaluru, India (On-site) Employment Type: Full-time Onrole Experience: 5 to 10 years (Minimum 5 years in TPA mandatory ) CTC: 6 LPA TO 7 LPA (based on experience) Role Summary: Lead policy configurations and health insurance claims operations, including internal IR handling, CRM/account management tickets, and policy document rechecks ensuring accuracy, compliance, and timely closures. Key Responsibilities: Policy configuration as per insurer/client guidelines Handle Internal IR and CRM/Account Management tickets within TAT Recheck and validate policy documents; ensure accurate setup Support en...

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

SUMMARY Job Title: Apprentice Apprentice Machine Operator / Computer Operator (Fresher) - Patiala We are inviting fresh ITI candidates to join as Apprentices under NAPS at our CFA in Karnal. This role offers hands-on learning in machine operations, computer operations, and warehouse processes , providing a strong foundation for future career growth. Work Location: Village Kheri Gurna, Tehsil- Rajpura, Patiala, Punjab-140417 Experience: Fresher Only Qualification: ITI- Fitter/Electrician/Computer (COPA) Salary (Stipend): 12,000 Working Days: 6 Days a Week (1 Day Week Off) Shift: Rotational Shift Key Responsibilities Operate and monitor basic machinery or computer systems Support in receiving,...

SUMMARY Job Title: Apprentice Apprentice Machine Operator / Computer Operator (Fresher) - Jammu We are inviting fresh ITI candidates to join as Apprentices under NAPS at our CFA in Karnal. This role offers hands-on learning in machine operations, computer operations, and warehouse processes , providing a strong foundation for future career growth. Work Location: Kikri Morh, Birpur Parmandal Road, Birpur, Jammu-181133, Jammu and Kashmir Experience: Fresher Only Qualification: ITI- Fitter/Electrician/Computer (COPA) Salary (Stipend): 12,000 Working Days: 6 Days a Week (1 Day Week Off) Shift: Rotational Shift Key Responsibilities Operate and monitor basic machinery or computer systems Support i...

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 and Hindi CTC – Upto 3.5 LPA

SUMMARY Retail Staff Job Description Our client, a UAE-based multinational conglomerate headquartered in Dubai, is seeking freshers to join their retail staff team. The group is involved in the retailing of various products such as apparel, footwear, consumer electronics, cosmetics & beauty products, home improvement, and baby products. Additionally, the group focuses on hospitality & leisure, healthcare, and mall management. Responsibilities: Folding and stacking at a basic table. Timely display of received stocks. Upkeep of section. Ensuring a carton-free floor. Maintaining display standards, including signage. Merchandise clearance from the trial room. Ensuring the right product is displa...

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 The European Union (EU) is an economic and political partnership between 27 European countries It plays an important role in international affairs through diplomacy, trade, development aid and working with global organizations Abroad, the EU is represented through more than 140 diplomatic representations, known also as EU Delegations, which have a similar function to those of an embassy, The EU Delegation to Vietnam works in close coordination with the Embassies and Consulates of the 27 EU Member States We are a full-fledged diplomatic mission and represent the European Union in dealings with the Vietnamese government in areas that are part of the EUs remit, We offer The post of Offic...

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 ...

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...

We are conducting Mega Job fair for top 10 companies with immediate joining! We have excellent openings for candidates with excellent communication for Freshers & Experience! Qualification : Graduates / Undergraduates / Post Graduates Can Apply. Experience: 0 to 8 years Any Bpo experience. Process: Banking / Financial Services / Insurance / Mortgage / Technical / Networking Etc. Salary: 1.75 Lacks to 7. 5 Lacks Ctc. Shifts: Us / UK / Australian / Day shift Rounds of Interview: Hr Voice & Accent Operations Note: Candidates should be flexible working in Shifts all the rounds are conducted on the same day. Feel Free to Call on Below No / Walk in @ Hr : Mallik - 7259027282 Hr : Deepa - 990002481...

QR & Soundbox is one of Paytms business tools to help merchants grow and manage their business through simplicity and data driven technology. Expectations/ Requirements 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. Job Descriptions- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective ...

QR & Soundbox is one of Paytms business tools to help merchants grow and manage their business through simplicity and data driven technology. Expectations/ Requirements 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. Job Descriptions- Responsible for the Sales enrollments/Sales in the city. Do the market race and prepare the list of prospective ...

Expectations/ Requirements 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. Job Descriptions- 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 d...

Expectations/ Requirements 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. Job Descriptions- 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 d...

Calling Insurance companies (in US) and follow up on outstanding Accounts Receivable. Calls to insurances for claim status and eligibility verification Denial documentation and taking further action Required Candidate profile Get the status of the unpaid claims 1+ year experience in USA AR calling experience /US healthcare Ready to work in night shift Completes targets with speed and accuracy as per client SLAs

In this Role you will be Responsible For : Read and understand the process documents provided by the customer. Entry-level administrative operations support performing various basic tasks (mail, file services, reporting, project support, and general account support activities). Analyze the insurance request received from the customer and process as per standard operating procedures. Familiarize, navigate multiple client applications and capture the necessary information to process customer request. Provides basic-level of support on programs, projects, reporting, filing (electronic and hard-copy), confidential materials handling, and issue resolution. Scope of work is routine and decision ma...