1968 Claims Adjudication Jobs - Page 2

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We e...

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We emb...

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We emb...

AI-processed claims review role: verify bills, policy terms, and ensure compliance. Req: 03 yrs in TPA ops/hospital billing/claims; freshers with healthcare background welcome. Degree in Pharma, Nursing, related; detail-oriented & strong

Job description Team Executive - Claims Adjudication(Prepay/Postpay) Location : Hyderabad Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 9 years of experience in Claims Adjudication(PrePay audit, Postpay audit) . With over 1 year of experience as a Team leader Proven track record in managing processes, streamlining workflows and excellent people management skills. Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals. Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Adhering to various regulatory an...

Looking for US Healthcare Professionals !! Experience : 1- 4 Years Process : Non Voice - Skill : Claims Adjudication!! US Healthcare experience. Work location : Navalur, Chennai Required : Minimum 1year Experience in US Claims Adjudication & Adjustments 1 year Experience in Appeals Experience in Facets tool is added Advantage Education - Any Graduates and Diploma(10+3)can apply. Immediate Joiners preferred!! Willing to work in Night Shift. Interested folks can directly Walk-in to Location: 5th floor, 4th block, Sandhiya Infocity(Bayline Infocity), OMR Rajiv Gandhi Salai, Navalur, near to AGS Bus Stop, Chennai, Tamil Nadu 603103. Walk - in time: 11:00 Am - 2:00 Pm Walk - in date: Monday to Fr...

Job description: We are hiring Claims Adjudication! HR SPOC (Reference): Sam Jeshurin Position: CSA/Sr.CSA Division: Healthcare International Business Job Location: Firstsource Solution Limited, 5th floor ETA Techno Park, Block 4, 33 OMR Navalur, Chennai, Tamil Nadu 603103. Landmark: Near Vivira Mall. Shift Details: Night shift / Flexible to work in any shift and timing Cab Boundary Limit: We provide cab Up to 30 km (One way drop cab | Doorstep only) Minimum Eligibility: Minimum 1 year experienced in Claims Adjudication!!!! Interested candidates Kindly share your resumes to Mobile (Whatsapp): 8825506927 Email: sam.jeshurin@firstsource.com Join us to be part of a dynamic team with career grow...

Job description 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, differentiate 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 deny the claims as ...

MDI NetworX is a global leader in business management solutions, providing innovative services to health plans, benefit administrators, and networks. Our mission is to reduce operational costs, enhance adjudication rates, and elevate customer service. We are committed to delivering high-impact solutions that drive efficiency and quality. Position Overview: MDI NetworX is a dynamic and customer-focused Customer Service Associate to join our US Process International Voice team. The ideal candidate will be responsible for handling customer queries, resolving issues, and providing exceptional support via phone calls. This role requires excellent communication skills, problem-solving ability, and...

PRINCIPLE PURPOSE OF JOB The Audit Support Assistant position is an entry level position responsible for reviewing documents (medical records), analyze data and indexing documents to the appropriate queue. An Audit Support Assistant is required to document relevant facts, information and conclusions drawn to support the work performed in the relevant applications and communicate outcomes to supervisor for evaluation, verification and continuous learning. JOB RESPONSIBILITIES Critical Thinker Demonstrates adeptness in identifying errors and analyze data, identify inconsistencies and formulate workable solutions. Makes logical, well-reasoned and timely decisions. Initiative Taker Shows initiat...

Hiring For Marine and Non-marine claims *Experience in any of the domains, Contract Management/Quoting/Pricing operations/ Invoice/Billing *Research, review and analyze contract terms, documents and events to prepare claim calculations *Active follow up of claims with 3rd Party and issue invoices for Receivable claims *Timely escalation of relevant issues to supervisor and business line as appropriate *Develop and review control reports to ensure receivable claims are submitted to 3rd party/Affiliate within contract limits; monitor additional controls reports, as necessary *Respond to claims questions from customers (3rd Party, Affiliate, Management) *Manage outstanding items and aged claims...

We are looking for a highly skilled and experienced Senior Executive - Claims Facilitator Representative to join our team at Niva Bupa Health Insurance. The ideal candidate will have a strong background in claims facilitation and representation, with excellent communication and problem-solving skills. Roles and Responsibility Manage and facilitate claims processing, ensuring timely and accurate resolution. Represent the company in various forums, including regulatory bodies and external stakeholders. Develop and maintain relationships with key stakeholders, including customers, agents, and partners. Analyze and resolve complex claims issues, providing expert guidance and support. Collaborate...

TCS is hiring for Claims Adjudication Processor role!!! Location - Chennai Job Summary: We are seeking a detail-oriented and analytical Claims Adjudication Processor to join our team. The ideal candidate will be responsible for reviewing, processing, and resolving pending healthcare claims while ensuring compliance with federal, government, and commercial health plan policies. This role requires a strong understanding of medical claims processing, payer regulations, and industry guidelines. Key Responsibilities: Process and adjudicate healthcare claims efficiently and accurately, ensuring compliance with company policies and industry standards. Investigate and resolve pended claims by review...

Job Summary We are seeking a Process Specialist for our Healthcare division with 0 to 1 year of experience. The ideal candidate will have expertise in Advanced Excel and Claims Adjudication. This role involves working in a hybrid model with night shifts. The candidate should be proficient in English and have a keen interest in healthcare claims processing. Responsibilities Analyze healthcare claims data to ensure accuracy and compliance with regulatory standards. Utilize Advanced Excel skills to manage and manipulate large datasets for reporting and analysis. Perform claims adjudication tasks to determine the validity and accuracy of claims. Collaborate with team members to resolve discrepan...

Choosing Capgemini means choosing a company where you will be empowered to shape your career in the way you'd like, where you'll be supported and inspired by?a collaborative community of colleagues around the world, and where you'll be able to reimagine what's possible. Join us and help the world's leading organizations?unlock the value of technology and build a more sustainable, more inclusive world. Job Description Core Responsibilities: Claims adjudication and providing benefits to providers on behalf of the Insurance company Competencies: Good in verbal and written communication skills Analytical skills Proficiency in MS Office Attention to detail and quickly absorb trainings Flexible ab...

Roles & Responsibilities: Work remotely and report to the Team Lead. Review, verify, and correct information in patient progress notes. Schedule and manage patient appointments efficiently. Maintain quality communication with patients regarding reminders, follow-ups, and inquiries. Handle incoming and outgoing patient referrals over calls. Manage backend tasks: faxes, prior authorizations, lab reports, chart preparation, etc. Maintain patient records while ensuring confidentiality. Assign and encode billing codes as per insurance guidelines. Ensure proper documentation of procedures in progress notes. Review posted results and report discrepancies. Collaborate with healthcare professionals t...

Overall 12+ years of Healthcare experience with 8+ year of Account Handling experience (Leadership role) in a Back Office or Shared Services Environment Exp in managing payor Ops (Provider and Member services) Must have experience in managing a large team 500 to 1000 FTEs, multi-channel support ( Non Voice) Understanding of evolving tech in BPM like AI and Gen AI implementation Experience in driving Value added Transformation projects focused on NPS, CSAT Education Minimum Graduate. Skills Required Works independently, demonstrates initiative and innovative thinking, clear and concise communication skills. Managing account P&L & Supports the learning environment. Ability to work on Outcome b...

Greetings from CIEL HR! 1. Claims Processing Executive (6+ months US/UK BPO experience) 2. Senior Claims Processing Executive (2-3 years of US/UK BPO experience) We would like to conduct the Walk in interviews by 21st February 2025 (Friday) . Timeline - Immediate Joiner, 1st March 2025 Joiners. Work Location: Greams Rd, Thousand Lights, Chennai Perks - Travel reimbursement/allowance, dinner and snacks, attractive performance bonus, great team environment & work culture, mentoring and career progression. Cab: Return Cab Facility available (one way cab) Required Skills - Excellent verbal communication, positive and upbeat attitude, computer literacy and typing skills. The following screening t...

Job Description Associate Claims (Non-Medical) Job Title: Associate Claims Non-Medical Location: Bangalore 5 Days working Role Overview We are seeking a dedicated and empathetic Associate Claims Executive (Non-Medical) to join our health insurance team. The role involves evaluating claims, reviewing documentation, determining coverage, and ensuring smooth and transparent claim settlement. The ideal candidate should have strong analytical skills, attention to detail, and excellent communication abilities to deliver a positive experience for policyholders. Key Responsibilities Claims Evaluation: Review and assess insurance claims to determine validity and payment eligibility. Documentation Rev...

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...

Role & responsibilities To Process reimbursement claims (retail and Group). They would be processing Claims of the customers making decisions whether the Claim is genuine, right and in line with policy and medical documents evaluation whether the treatment is right. To Process cashless claims in real time. They would be processing Claims of the customers making decisions whether the Claim is genuine, right and in line with policy and medical documents evaluation whether the treatment is right, 6 Week offs in a month. Shift Timings - 2 pm to 11 pm Preferred candidate profile Candidate should have sound medical knowledge Candidate should be comfortable working in the shift timings of 2 pm - 11...

Preferred : 1-3 years Exp in QA(AR-RCM). Knowledge of Revenue Cycle Management (US Medical Billing) Provider/Hospital 2+ years of experience as an AR caller and at least 1 year of experience as Quality Analyst in US healthcare. Location - Gurgaon Required Candidate profile Knowledge of:- RCM processes like Billing, Cash Posting, Credit Balance, Accounts Receivables, Denial Management Correspondence review RCM metrics like Ageing above 90 days, Collections, and bad debt

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Noida Sector 3 Role - Medical officer Exp : 0-3 years WORK FROM OFFICE ONLY. Job description : 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 ...

Your role and responsibilities About the team - Engineering at HashiCorp On the HashiCorp engineering team, we build the Infrastructure Cloud which allows enterprises to take a unified approach to Infrastructure and Security Lifecycle Management: Infrastructure Lifecycle Management: Build / Deploy / Manage Terraform allows you to use infrastructure as code to provision and manage any infrastructure across your organization. Packer standardizes image workflows across cloud providers, allowing teams to build, govern and manage any image for any cloud. Waypoint makes infrastructure easily accessible at scale, enabling platform teams to deliver golden patterns and workflows with an internal deve...

Manage cashless & reimbursement claims,verify coverage Coordinate with TPAs & insurers, handle approvals, update billing records Resolve discrepancies,support patient insurance queries,ensure compliance with hospital & insurance guidelines.