595 Claims Adjudication Jobs - Page 19

Role & responsibilities Excellent MS Office knowledge, Good Typing speed (35 words per minute). Candidate should be open to work in 24X7X365 environment. Preferred candidate profile Reimbursement billing & Registration, data handling, Error resolve, working on mail and condonation with RM Team. Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Preferred Location Ahmedabad, Bangaluru Chandigarh, Chennai Dehradun, Hyderabad Indore, Kochin Kolkata, Mumbai Nagpur, Noida Surat, Vadodara

Role & responsibilities Excellent MS Office knowledge, Good Typing speed (35 words per minute). Candidate should be open to work in 24X7X365 environment. Preferred candidate profile Reimbursement billing & Registration, data handling, Error resolve, working on mail and condonation with RM Team. Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Preferred Location Ahmedabad, Bangaluru Chandigarh, Chennai Dehradun, Hyderabad Indore, Kochin Kolkata, Mumbai Nagpur, Noida Surat, Vadodara

Role & responsibilities Excellent MS Office knowledge, Good Typing speed (35 words per minute). Candidate should be open to work in 24X7X365 environment. Preferred candidate profile Reimbursement billing & Registration, data handling, Error resolve, working on mail and condonation with RM Team. Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Preferred Location Ahmedabad, Bangaluru Chandigarh, Chennai Dehradun, Hyderabad Indore, Kochin Kolkata, Mumbai Nagpur, Noida Surat, Vadodara

Role & responsibilities Excellent MS Office knowledge, Good Typing speed (35 words per minute). Candidate should be open to work in 24X7X365 environment. Preferred candidate profile Reimbursement billing & Registration, data handling, Error resolve, working on mail and condonation with RM Team. Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Preferred Location Ahmedabad, Bangaluru Chandigarh, Chennai Dehradun, Hyderabad Indore, Kochin Kolkata, Mumbai Nagpur, Noida Surat, Vadodara

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred Location Indore Surat Mumbai Nagpur Chennai Bangalore Kochi Kolkata Noida Hyderabad Vishakapatnam Chandigarh Vadodara

Minimum Mandatory Skill Set Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job Profile Generic job profile includes document processing, Data entry process, Maintaining trackers, Escalate issues as required within organization and follow up to ensure timely resolution. Desired Competencies/ Skill Set Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be open to shift duties. Preferred Industry Health Insurance, TPA, BFSI, Healthcare

Minimum Mandatory Skill Set Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job Profile Generic job profile includes document processing, Data entry process, Maintaining trackers, Escalate issues as required within organization and follow up to ensure timely resolution. Desired Competencies/ Skill Set Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be open to shift duties. Preferred Industry Health Insurance, TPA, BFSI, Healthcare

Minimum Mandatory Skill Set Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job Profile Generic job profile includes document processing, Data entry process, Maintaining trackers, Escalate issues as required within organization and follow up to ensure timely resolution. Desired Competencies/ Skill Set Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be open to shift duties. Preferred Industry Health Insurance, TPA, BFSI, Healthcare

Minimum Mandatory Skill Set Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job Profile Generic job profile includes document processing, Data entry process, Maintaining trackers, Escalate issues as required within organization and follow up to ensure timely resolution. Desired Competencies/ Skill Set Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be open to shift duties. Preferred Industry Health Insurance, TPA, BFSI, Healthcare

Minimum Mandatory Skill Set Computer Operations, Computer proficiency, MS Excel, Communication in English & Hindi, Open to work in shifts. Brief Job Profile Generic job profile includes document processing, Data entry process, Maintaining trackers, Escalate issues as required within organization and follow up to ensure timely resolution. Desired Competencies/ Skill Set Working knowledge of MS Excel with data entry speed and accuracy, ability to communicate in English and Hindi effectively, Insurance / Health Insurance Knowledge. Should be open to shift duties. Preferred Industry Health Insurance, TPA, BFSI, Healthcare

Job Track Description: Requires experience in a professional, sales, or technical area through formal education. Performs technical-based activities. Contributes to and manages projects. Uses deductive reasoning to solve problems and make recommendations. Interfaces with and influences key stakeholders. Leverages previous knowledge and expertise to achieve results with teams and can complete work self-guided. A college or university degree required. General Profile Requires in-depth knowledge and experience. Uses best practices and understanding of business issues to improve products and services. Solves complex problems. Takes a new perspective using existing solutions. Works unaided and receives minimal guidance. Acts as a resource for colleagues with less experience. Functional Knowledge Understands and applies concepts in the field of expertise. Basic knowledge of related disciplines. Business Expertise Has knowledge of best practices and team integration. Is aware of the competition and what makes them different in the market. Impact Impacts a range of customer, operational, project, or service activities in teams. Works within broad guidelines and policies. Leadership Acts as a resource for colleagues with less experience. May guide small projects with manageable risks and resource requirements. Problem Solving Solves complex problems. Takes a new perspective on existing solutions. Exercises judgment based on reviewing many sources of information. Interpersonal Skills Explains difficult or sensitive information. Works to build consensus within a team. Responsibility Statements Serves as liaison between end-users and product development teams. Manages and communicates deliverable status to development teams. Reviews, defines, and documents project requirements. Examines requirements and defines technology solutions. Defines a go-to approach for system construction. Produces component specifications and translates these into detailed designs for implementation. Directs a small project team of business analysts across client portfolio projects. Helps prepare technical plans to ensure resources are available. Provides advice on technical aspects of system development and integration. Applies relevant technical strategies, policies, standards, and practices. Performs other duties as assigned. Complies with all policies and standards. Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded:click here to access or download the form. Complete the form and then email it as an attachment toFTADAAA@conduent.com.You may alsoclick here to access Conduent's ADAAA Accommodation Policy. At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.

Job Track Description Requires relevant expertise through formal education in a professional, sales, or technical area. Performs technical-based activities. Contributes to and manages projects. Uses deductive reasoning to solve problems and make recommendations. Interfaces with and influences key stakeholders. Leverages previous knowledge and expertise to achieve results. Able to complete work self-guided. College or university degree required or equivalent work experience. General Profile Performs routine assignments. Exposure to fundamental theories and concepts. Develops skills by performing structured work assignments. Uses existing procedures to solve routine or standard problems. Receives instruction, guidance, and direction from others. Functional Knowledge Requires a conceptual understanding of theories, practices, and procedures. Business Expertise Applies general knowledge of business developed through education or experience. Impact Works self-guided with no supervisory responsibilities. Follows standardized procedures and practices to achieve objectives and meet deadlines. Leadership No supervisory responsibilities. Responsible for developing technical contributions. Problem Solving Uses existing procedures to solve standard problems. Examines information and standard practices to make judgments. Interpersonal Skills Exchanges information and ideas effectively. Asks questions and checks for understanding. Responsibility Statements Serves as liaison between end-users and product development teams. Partners with senior BA's to examine, define, and document project requirements. Communicates project requirements to development teams. Supports analyzing requirements and defines tech solutions. Defines a go-to approach for system construction. Performs other duties as assigned. Complies with all policies and standards. Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded:click here to access or download the form. Complete the form and then email it as an attachment toFTADAAA@conduent.com.You may alsoclick here to access Conduent's ADAAA Accommodation Policy. At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.

Minimum Mandatory Skill Set Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Brief Job Profile Claims adjudication, Fraud and leakage control, Client/provider feedback, Team training and retention, Investigation Desired Competencies/ Skill Set MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry Health Insurance, TPA, Hospitals, Healthcare

Minimum Mandatory Skill Set Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Brief Job Profile Claims adjudication, Fraud and leakage control, Client/provider feedback, Team training and retention, Investigation Desired Competencies/ Skill Set MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry Health Insurance, TPA, Hospitals, Healthcare

Role : Senior Analyst-Claims Adjusting Work Mode : Hybrid Experience : 3+ Yrs Location : Pune, Mumbai, Bangalore, Kochi ******************************************************************************************* *IMMEDIATE JOINERS ALERT!* We're looking for candidates who can *join immediately*. If you're available, please *send your CV via WhatsApp only* to: * 9152808909* Please note: *No calls* will be entertained. ******************************************************************************************* Must Have : End to End Marine Claims Position Summary: Our company is seeking to hire a Senior Analyst-Claims Adjusting for Claims vertical. As the Senior Analyst - Claims Adjusting, you will be responsible for handling and execute all allocated claims in accordance with the company's documented service standards. Your role will involve investigation, evaluation, processing, disposition and settlement of claims. You will be responsible for fostering a culture of collaboration, continuous improvement, and customer focus within the shared services team. You will be interacting with the team who are present in any of the onshore locations. Exposure to Insurance regulations and laws, claims handling procedures and Risk management principles is a definite plus. ESSENTIAL RESPONSIBILITIES: Importance Major Action and Support Actions Investigate the circumstances surrounding marine incidents, such as collisions, groundings , or cargo damage. Assess the extent of damage to vessels, cargo, or freight, and estimate the cost of repairs or replacement. Appropriately document information on claim file Maintain effective and ongoing communication with various internal and external contact. Learn and follow best practices of clients as well as claims requirements, standards and practices as required by applicable state statutes. Ensure compliance with relevant maritime law and regulations Ensure adherence to regulatory requirements, industry standards, and company policies. Mitigate organizational risk, maintaining compliance and reputation Competency Description Technical 1. Insurance regulations and laws 2. Claims handling procedures 3. Risk management principles 4. Industry standards 5. Maritime law and regulations Soft Skills 1.Communication (verbal and written) 2. Negotiation and conflict resolution 3. Analytical and problem-solving 4. Planning & Prioritizing 5. Customer service and relationship-building 6. Collaboration and teamwork 7. Adaptability and flexibility Behavioral 1. Integrity and ethics 2. Results-driven and accountable 3. Customer-focused and empathetic 4. Competitive 5. Patient 6. Innovative Collaboration 1. Collaborative mindset 2. Effective communication 3. Adaptability and flexibility 4. Constructive feedback and conflict resolution 5. Commitment to team success EDUCATION AND EXPERIENCE Minimum Required Degree: Bachelor Preferred Degree: Bachelors degree in insurance or related field Certificate(s)/Special Training: Insurance industry certifications AIC, AINS, Cert CII or any other relevant Insurance certification Experience ( Career Level Guide) Minimum 2-3 years of experience in insurance claims handling Proven track record of successful claim resolutions and customer satisfaction. Strong knowledge of insurance regulations, policies, and procedures. KNOWLEDGE, SKILLS AND ABILITY: Knowledge, Claims Handling Ability: Investigate and analyze claims documentation Determine coverage and liability Negotiate settlements and resolve disputes Communicate effectively with insureds, claimants, suppliers and brokers Apply industry-standard claims handling procedures. Skills Claims investigation and analysis Effective communication and interpersonal skills Time management and organization Customer service and relationship-building Collaboration and teamwork Remarks This position is in a temperature-controlled office environment. The noise level in the work environment is usually light to moderate. This position is to work in a Hybrid model and depending on the need must be flexible to work from office/home/shift timings as required to accomplish their role. This job description is not intended to be an exhaustive list of the duties and responsibilities of this position. Additional duties not included on this job description may be assigned by management at any time, based upon the business needs of the Company. Employees must perform all such duties assigned to them as a condition of employment. Likewise, this job description does not alter the at-will nature of employment at the Company. The Company may review and update this job description from time to time, as deemed necessary or appropriate in its sole discretion.

Role : Senior Analyst-Marine Claims Work Mode : Hybrid Experience : 3+ Yrs Location : Pune, Mumbai, Bangalore, Kochi ******************************************************************************************* *IMMEDIATE JOINERS ALERT!* We're looking for candidates who can *join immediately*. If you're available, please *send your CV via WhatsApp only* to: * 9152808909* Please note: *No calls* will be entertained. ******************************************************************************************* Must Have : End to End Marine Claims Position Summary: Our company is seeking to hire a Senior Analyst-Claims Adjusting for Claims vertical. As the Senior Analyst - Claims Adjusting, you will be responsible for handling and execute all allocated claims in accordance with the company's documented service standards. Your role will involve investigation, evaluation, processing, disposition and settlement of claims. You will be responsible for fostering a culture of collaboration, continuous improvement, and customer focus within the shared services team. You will be interacting with the team who are present in any of the onshore locations. Exposure to Insurance regulations and laws, claims handling procedures and Risk management principles is a definite plus. ESSENTIAL RESPONSIBILITIES: Importance Major Action and Support Actions Investigate the circumstances surrounding marine incidents, such as collisions, groundings , or cargo damage. Assess the extent of damage to vessels, cargo, or freight, and estimate the cost of repairs or replacement. Appropriately document information on claim file Maintain effective and ongoing communication with various internal and external contact. Learn and follow best practices of clients as well as claims requirements, standards and practices as required by applicable state statutes. Ensure compliance with relevant maritime law and regulations Ensure adherence to regulatory requirements, industry standards, and company policies. Mitigate organizational risk, maintaining compliance and reputation Competency Description Technical 1. Insurance regulations and laws 2. Claims handling procedures 3. Risk management principles 4. Industry standards 5. Maritime law and regulations Soft Skills 1.Communication (verbal and written) 2. Negotiation and conflict resolution 3. Analytical and problem-solving 4. Planning & Prioritizing 5. Customer service and relationship-building 6. Collaboration and teamwork 7. Adaptability and flexibility Behavioral 1. Integrity and ethics 2. Results-driven and accountable 3. Customer-focused and empathetic 4. Competitive 5. Patient 6. Innovative Collaboration 1. Collaborative mindset 2. Effective communication 3. Adaptability and flexibility 4. Constructive feedback and conflict resolution 5. Commitment to team success EDUCATION AND EXPERIENCE Minimum Required Degree: Bachelor Preferred Degree: Bachelors degree in insurance or related field Certificate(s)/Special Training: Insurance industry certifications AIC, AINS, Cert CII or any other relevant Insurance certification Experience ( Career Level Guide) Minimum 3 years of experience in insurance claims handling Proven track record of successful claim resolutions and customer satisfaction. Strong knowledge of insurance regulations, policies, and procedures. KNOWLEDGE, SKILLS AND ABILITY: Knowledge, Claims Handling Ability: Investigate and analyze claims documentation Determine coverage and liability Negotiate settlements and resolve disputes Communicate effectively with insureds, claimants, suppliers and brokers Apply industry-standard claims handling procedures. Skills Claims investigation and analysis Effective communication and interpersonal skills Time management and organization Customer service and relationship-building Collaboration and teamwork Remarks This position is in a temperature-controlled office environment. The noise level in the work environment is usually light to moderate. This position is to work in a Hybrid model and depending on the need must be flexible to work from office/home/shift timings as required to accomplish their role. This job description is not intended to be an exhaustive list of the duties and responsibilities of this position. Additional duties not included on this job description may be assigned by management at any time, based upon the business needs of the Company. Employees must perform all such duties assigned to them as a condition of employment. Likewise, this job description does not alter the at-will nature of employment at the Company. The Company may review and update this job description from time to time, as deemed necessary or appropriate in its sole discretion.

Hiring Payment Posting specialists with 3–6 yrs of exp in US healthcare RCM. Location: Perambur, Chennai. Immediate joiners only. Must have hands-on experience in ERA/EOB posting. Night shift. Join our dynamic team today!

We are Conducting Mega Job fair for Top 10 Companies for AR calling. 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 : Aditya - 9900024811 / 7259027295 / 7760984460 / 7259027282 9900024951

Thryve Digital Health LLP is looking for a Business Analyst with Claims along with FEP(Mandatory) experience. If your profile suits for the below opportunity. Share your interest by applying Or you can InMail to rubhashree.madhavan@thryvedigital.com Role Summary: This job provides expertise for standard to moderately complex problem solving and in-depth understanding of system functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs. May troubleshoot errors, conduct impact analyses, and/or solve data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. May provide guidance to Associate level employees. Job Role : Business Analyst - Claims Adjudication with FEP Experience - 6-9 Years Work Location - Chennai/Hyderabad Work Mode - Hybrid Shift - 3PM - 12AM Essential Responsibilities Analyze Claims Tickets : Research/analyzes provider/Claims issue at hand Determines if provider/claim specific or global issue Actions taken could be ticket submissions to HMHS, pricing updates, provider file updates, collaboration with various internal stakeholders or Provider Relations, communications sent to Operations on global issues Requests cleanup report once issue is corrected, if required Follows cleanup through completion and notifies Provider Relations Facilitate process improvement meetings and/or discussions. Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and document current and future state business processes. Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies Assist in the development of desktop procedures and/or training material. Coordinate, monitor, and report on the progress of clean-up projects to ensure adherence to defined project schedule Communicate effectively with customers and colleagues. Successfully articulate issues, problems, and solutions. The experience we are looking to add to our team require: 6-9 years experience in Claims and Adjustments in Federal Employee Program (FEP) business Business Analyst with minimum 2 years of experience in FEP . Claims and Adjustment subject matter expertise Can adjudicate and adjust the claims BlueCard Home and Host knowledge Strong claims research skills are a must High level of systems and business knowledge Knowledge of INSINQ, Oscar, OCWA, CPBRE (Oscar Benefits), FEP Direct Business Process Improvement Collaborative Problem Solving Excellent analytical and problem-solving skills Bachelors or masters degree in any discipline Good verbal and written skills Good analytical and interpersonal skills Exceptional people management Good to have: AHM or any equivalent certification Additional quality/operational certifications Business acumen on Adjustments and Offset/Recovery

Job Title: Team Leader-Provider configuration- Coimbatore & Claims Adjudication (US Healthcare) Experience: 5-8 years Qualification: Bachelors degree Shift: Night shift Transportation: Pick up and drop would be provided Job Summary: Team Leader - Provider configuration- Coimbatore and Claims Adjudication will oversee a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, client-specific guidelines, and quality standards. The role ensures efficient workflow, team performance, process improvement, and client satisfaction. Key Responsibilities: Team Management & Leadership: Lead, mentor, and manage a team handling enrollment, Provider configuration- Coimbatore and claims adjudication processes. Monitor team productivity, quality, and adherence to service level agreements (SLAs). Provide training, coaching, and development opportunities to team members. Conduct regular team meetings, performance reviews, and provide constructive feedback. Resolve escalations and complex issues promptly and professionally. Enrollment Management: Oversee new member enrollment, renewals, terminations, and updates in healthcare plans. Ensure data accuracy for member eligibility, coverage, and benefits. Collaborate with clients and internal teams to resolve enrollment discrepancies or queries. Claims Adjudication Oversight: Supervise the processing of healthcare claims ensuring accuracy and compliance with policies, provider contracts, and regulatory guidelines (HIPAA, CMS, etc.). Ensure proper review of claims for eligibility, benefits coverage, coding, and payments. Monitor claim denials and implement corrective action plans to reduce errors and rework. Process & Compliance: Ensure compliance with US healthcare regulations, privacy laws (HIPAA), and client-specific guidelines. Identify process improvement opportunities and work with quality teams to implement best practices. Prepare and analyze reports related to team performance, quality audits, and operational metrics. Liaise with clients and stakeholders for updates, process changes, or reporting needs. Required Skills and Qualifications: Bachelors degree or equivalent work experience in healthcare operations. Minimum 5-6 years of experience in US healthcare processes, with 1-2 years in a team leadership role. SMES and Quality analysts are eligible to apply Strong knowledge of US healthcare insurance, including enrollment, eligibility, Provider configuration, claims processing, and adjudication rules. Familiarity with CMS, Medicaid, Medicare, ACA, and HIPAA regulations. Proficient in claims platforms Excellent analytical, problem-solving, and decision-making skills. Strong communication and interpersonal skills. Ability to multitask and work under pressure. Interested candidates can share your resume to anitha.c@sagilityhealth.com

Candidates with experience in US Healthcare (Medical Billing) are encouraged to share their resumes at avni.g@crystalvoxx.com or send a WhatsApp message to +91 75670 40888.

He will be deployed in working season in stages for cumulative duration of period mentioned in Enclosure-A for obtaining his expert opinion on emerging contractual issues. His key responsibilities will be to guide and assist Team Leader/Employer in all aspects of contract management in proper implementation of contract provisions including controlling the project cost of the construction package. He will also be required to offer his advice on contractual complications arising during the implementation as per the request of the employer. He will be required to prepare manuals/schedules for the consultants team/employer based on the provisions of the contract document. He will be responsible for giving appropriate suggestions in handling claims of the contractors and any dispute arising thereof.