1508 Claims Adjudication Jobs - Page 2

Key Responsibilities: Handle inbound and outbound calls to assist US-based customers. Address customer inquiries, resolve complaints, and provide appropriate solutions. Maintain professionalism and empathy while interacting with customers. Document all call details and follow-up actions accurately in the CRM system. Meet quality standards and key performance indicators (KPIs) such as call handling time, customer satisfaction, and first-call resolution. Adhere to company policies, compliance guidelines, and standard operating procedures. Work in rotational shifts, including night shifts, as per business requirements Required Skills & Qualifications: Education: Minimum High School Diploma or B...

Key Responsibilities Medical Review Claims Adjudication: Assess and validate medical claims based on clinical documentation and policy coverage. Interpret diagnostic reports, treatment plans, and prescriptions to determine claim eligibility. Coordinate with internal medical teams to ensure accuracy in claims decision-making. Customer Interaction Support: Communicate with policyholders, hospitals, and third-party administrators (TPAs) to explain claim decisions in a clear and professional manner. Handle escalated or complex customer service issues involving medical claims. Offer support and guidance on claim submission processes and documentation requirements. Compliance Documentation: Ensure...

Preferred candidate profile Hiring for SME and TL Role Kochi location- walkin interviews Minimum experience of 4+ years into claims adjudication in US Healthcare Facets exposure is added advantage Budget upto 6.4 LPA for SME and 8.5 LPA for team lead Team lead on papers experience is mandatory with good team management skills US Shifts For more details, contact on below Aslam Khan 88909 36366. aslam@manningconsulting.in Chhavi Bhatt 8955611211 Chhavi.bhatt@manningconsulting.in

Adjudicate claims activities like setting up new claims, making payments, refunds, updating reserves, adding vendor details, etc. in Legacy as well as a new environment called Global Claim System (GCS). Liaising with Claim handlers onshore, brokers, and underwriters. Manage all administration aspects of the claim Attention to detail you will need to make sure that all conditions of a claim are met to make sure that the claim can be processed and validated. Performing quality checks on tasks performed by colleagues. Constantly elaborating existing processes and looking for improvement opportunities. Getting involved in testing and sharing results. Looking to engage in projects and opportuniti...

Role & responsibilities Adjudicate claims activities like setting up new claims, making payments, refunds, updating reserves, adding vendor details, etc. in Legacy as well as a new environment called Global Claim System (GCS). Liaising with Claim handlers onshore, brokers, and underwriters. Manage all administration aspects of the claim Preferred candidate profile Graduate / Postgraduate with relevant years of experience within Insurance/Reinsurance industry. Positive, innovative, and make it better mindset to bring operational efficiencies. Experience in MS Excel and PowerPoint is required support segment KPI and management reporting.

Greetings From Scorelabs Inc ! Validate medical necessity and check eligibility Ensure accurate claim coding for inpatient, outpatient, and day-care procedures. Qua - BAMS , BHMS & MBBS Freshers Are also Welcome ( If they Interested in Claims) Required Candidate profile Handle claim resubmissions, rejections, and audits from insurance providers. Collaborate with physicians, billing teams, and insurance officers for clarification or denials. Hr Mounika - 8688334476

Cognizant Walk-in drive for Freshers -US healthcare Process at Kochi location. Interview Date : 1st Nov 2025 (Saturday) Interview Time : 10:00 AM to 1:00 PM Venue - Cognizant, Infopark Phase 2, Kakkanad, Kochi, Kerala 682303 Building Details: 12th floor MPH POC:Raguvaran Preferred candidates Profile: Eligible --Arts Graduates B.Com/B.Sc/BBA/BA/BCA/B.Arch (2023/2024/2025 passed out only) Not Eligible -- BE/B.Tech/MBA/MCA Shift : US Night shift (5:30 PM IST 3:30 AM IST) Work Mode: only Work from Office (Kochi location) US Healthcare Non-Voice BPO process Candidates must have good communication. Interested candidates can walk-in to the Venue with the following documents : 1. Updated resume (2 h...

We are looking for a highly motivated and enthusiastic individual to join our team as a Guest Service Associate in the F&B service department. This role is suitable for candidates with 0-2 years of experience, providing an excellent opportunity to learn and grow with our company. Roles and Responsibility Provide exceptional customer service to guests, ensuring their needs are met and concerns addressed promptly. Manage front-of-house operations, including reception, concierge, and bell captain duties. Coordinate with other departments to ensure seamless guest experiences. Maintain high standards of cleanliness and hygiene in all areas. Develop and implement effective communication strategies...

Cognizant Walk-in drive for US Healthcare -Claims Process at Kochi location. Interview Date : 1st Nov 2025 (Saturday) Interview Time : 10:00 AM to 1:00 PM Venue - Cognizant, Infopark Phase 2, Kakkanad, Kochi, Kerala 682303 Building Details: 12th floor MPH POC: Raguvaran Preferred candidates Profile: Experience range required - 2 to 4 years Minimum 2 to 4 Years of experience in US Healthcare Claims adjudication Notice Period : Immediate to 30 days Preferred Education: Graduation is Must Must have good communication skills Should be ready to work in Night shift (US Shift) Mode of Work : Complete Work from Office Interested candidates can walkin to the Venue with the following documents : 1. Up...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

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...

Accurately code medical records using relevant codes and guidelines.Ensure compliance with regulatory requirements and industry standards.Collaborate with healthcare professionals to clarify coding discrepancies. Required Candidate profile Strong knowledge of medical terminology and coding principles. Experience with electronic health records (EHR) systems. Familiarity with coding software and tools.

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? We are seeking a dedicated and detail-oriented Workmen Compensation Claims Adjuster to manage and resolve Workmen Compensation (WC) claims end-to-end. The ideal candidate should have in-depth knowledge of applicable labor laws, a strong grasp of claim computation methodologies, and experience handling claims related to permanent disability, temporary disability, medical reimbursement, and death benefits. This role requires excellent analytical skills and the ability to interpret medi...

Conduct thorough analysis of clinical trial data to identify potential safety risks and trends.Develop and implement effective safety protocols and procedures to mitigate identified risks.Monitor and report adverse events Required Candidate profile Strong understanding of clinical safety principles, regulations, and standards (e.g., GCP). Experience working with medical devices or pharmaceuticals is preferred.

Develop high-quality medical documents, including reports, notes, and correspondence.Review and edit medical records for accuracy, completeness, and compliance.Provide training and support to junior staff members on document writing Required Candidate profile Minimum 3 years of experience in medical document writing or review, preferably in an employment firm or recruitment services firm. Strong knowledge of medical terminology, regulations,

Develop and maintain detailed documentation of business processes and procedures. Work closely with stakeholders to understand their needs and provide training and support. Required Candidate profile Identify areas for process improvement and implement changes to increase efficiency. Develop and maintain relationships with key stakeholders and vendors.

Conduct thorough analysis of clinical trial data to identify potential safety risks. Develop and implement effective safety protocols to mitigate adverse events. Collaborate with cross-functional teams. Required Candidate profile Strong knowledge of clinical trials, medical devices, and regulatory requirements. Excellent analytical and problem-solving skills. Ability to work effectively in a fast-paced environment.

Interested Candidates may connect with Ms.Tanya Singh-9259503718 (11am-5pm) About the Role: We are seeking a highly motivated and experienced individual with a medical background to join our dynamic team as a Medical Claims Call Center Representative. In this role, you will be the frontline of our customer service, handling inbound calls related to medical claims and rejections. Your primary focus will be to provide exceptional customer service while resolving inquiries and concerns effectively, ensuring a positive experience for every Niva Bupa member. Key Responsibilities: Answer incoming customer calls promptly and professionally. Assist customers with navigating medical claims, including...

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Conduct thorough analysis of clinical trial data to identify potential safety concerns. Develop and implement effective safety protocols to mitigate risks associated with medical devices. Collaborate with cross-functional teams Required Candidate profile Strong understanding of clinical trials, medical devices, and regulatory requirements. Excellent analytical and problem-solving skills. Ability to work effectively in a fast-paced environment.

Medical Officer - Claims Processing Job Title: Medical Officer Claims Processing Location: IBC Knowledge Park, Bangalore (Work from Office) Department: Central Claims Operations Control Room Job Type: Full-time Salary: 3,00,000 3,60,000 per annum About the Role We’re hiring Medical Officers (Claims Processing) for our Control Room team at IBC, Bangalore. The role involves end-to-end medical claim processing with focus on accuracy, coordination, and timely resolution. You’ll work closely with multiple departments to ensure smooth claim operations and compliance with TAT standards. Key Responsibilities Process medical claims accurately within defined timelines. Review and validate claim docume...

Department: Health Claims (Cashless) Location: Hyderabad 1, Indore 1 Reporting To: Chief Manager Health Management Team Key Responsibilities: Claims Assessment: Evaluate and process health insurance claims in accordance with policy terms and conditions. Medical Review: Identify and flag potential cases of medical abuse or discrepancies in treatment protocols. Admissibility Decision: Determine claim eligibility based on thorough review of medical documentation and policy guidelines. Tariff Adjudication: Review and authorize cashless approvals, ensuring alignment with applicable tariffs and negotiated rates. Stakeholder Coordination: Liaise effectively with internal teams, network hospitals, a...

Manager / Assistant Manager Account Management - MediAssist Job Title: Manager / Account Management Company: Medi Assist Location: Bangalore CTC: 9 to 12 LPA Experience: 11 to 15 years Industry: Health Insurance / TPA / Healthcare Key Responsibilities:- Client Relationship & Strategy: Build and maintain long-term partnerships with insurers, corporate clients, and healthcare providers. Lead high-level review meetings and ensure strong relationship governance. Operations & Service Delivery: Oversee end-to-end account operations including claims, customer service, and issue resolution. Ensure compliance with TATs and SLAs. Performance Analysis & Reporting: Monitor KPIs, analyze client data, and...