593 Claims Adjudication Jobs - Page 2

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

Job Details: Job Process/Role: Claims Adjudication (US Healthcare) Experience: 1 - 3 Years of Relevant experience in Claims adjudication Skillset: CPT Codes, HIPAA, Co-pay and Co-insurance, Medicaid and Medicare, Denial claims, UB and CMS forms. Shift: Night shift Location: Chennai Mode of Work: Work from the office Notice Period Eligible: Immediate to 30 Days of Notice period is acceptable. Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials. Knowledge in handling authorization, COB, duplicate, pricing, and the corrected claims process. Knowledge of healthcare insurance policy concepts, including in-network, out-of-network providers, deductible, coinsurance, co-pay, out-of-pocket, maximum inside limits, and exclusions, state variations. Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services, and processes performed by the team. Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication, and the adjustment process. Experience in professional (HCFA), institutional (UB) claims (optional). Both undergraduates and postgraduates can apply. Good communication (Demonstrate strong reading comprehension and writing skills). Able to work independently, with strong analytical skills. 1. Required schedule availability for this position is Monday-Friday, 5.30 PM/3.30 AM IST (AR SHIFT). The shift timings can be adjusted according to client requirements. 2. Additionally, resources may have to work overtime and on a weekend basis to meet business requirements.

Candidate should have experience working as a Team Leader OR Quality analyst for US healthcare process. Shift - US rotational shifts Work Location - Hyderabad Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Candidate should be working as a Manager / Assistant Manager on papers in US Healthcare process. Qualification - Graduate Shift - US Shifts Work Location - Hyderabad Immediate Joiners OR Max 1 month notice period candidates can apply Required Candidate profile Call HR Manager Reejo @ 9886360719 for more details.

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend s basis business requirement.

Scope Of WorkPrimary Shared Across Functionally Establish procedures for meeting Health, Safety and Environment standards for project execution Implement policies, systems and procedures and ensuring compliance to standards through all phases of the Project Authorize project-specific deviations to the standard HSE Project Guidelines Prepare monthly HSE MIS for review by RCM & Project Manager Liaise with clients, consultants, and Yard construction teams relating to HSE issues Liaise with statutory bodies, certification agencies and consultants Attend important client meetings where safety is an item on the agenda Investigate all accidents and recommend appropriate corrective action/ measures Keep abreast of ILO safety guidelines and other internationally recognized HSE organizations

Job Title: Insurance Desk Executive TPA Coordination / Claims Specialist Location Options: Cloudnine hospital Sarjapura branch (BLR) BBMP Khata No: 1907/Sy No: 26/1, 26, 2nd Main Rd, Kaikondrahalli, Haralur, Bengaluru, Karnataka 560035 - Sarjapur Cloudnine hospital Thanisandra branch (BLR) Address: Sy No: 86/2 and 86/3, Thanisandra Village, Thanisandra Main Rd, RK Hegde Nagar, Bengaluru, Karnataka 560077 Organization: Ayu Health Hospitals Experience Required: 02 years (Freshers are welcome to apply) Preferred Gender: Male Candidates Preferred Location: Candidates residing near hospital locations will be given preference About Ayu Health: Ayu Health is one of Indias fastest-growing healthcare networks, dedicated to making high-quality healthcare accessible and affordable for all. With a focus on technology-driven solutions, Ayu Health partners with reputed hospitals and clinics across the country to deliver standardized care, transparent pricing, and a seamless patient experience. We are on a mission to build Indias most trusted healthcare brand. Key Responsibilities: Handle insurance/TPA desk operations at the hospital premises Coordinate with TPA and insurance representatives for claim submission and follow-up Manage and organize patient insurance documentation accurately Track approvals, follow up on pending claims, and address rejections effectively Communicate professionally with patients, hospital staff, and insurance partners Support hospital administrative needs and maintain documentation records Multi-task and work collaboratively within the hospital environment Candidate Requirements: 02 years of experience in TPA coordination, insurance desk, or claims processing in hospitals (Freshers with good communication skills can apply) Strong interpersonal and communication skills Basic understanding of hospital processes is a plus Ability to manage documents and work efficiently under pressure Must be reliable, punctual, and a team player Preference will be given to candidates living nearby the hospital location Male Candidates only Immediate Joiners will be preferred

You would be responsible for managing the end-to-end claims process for clients, ensuring seamless handling from claim intimation to settlement follow-ups. You will be the key point of contact for clients and AMCs regarding claim processes. You should be strategic and detail-oriented, ensuring timely documentation, filing, and resolution of claims while also contributing to business growth through lead generation and upselling. Requirements You have a bachelors degree in administration, commerce, or a related field. 2-3 years of hands-on experience in insurance claims processing. Ability to communicate correctly and clearly with all customers. Maintain a positive attitude with a focus on customer satisfaction. Documentation and organizational skills.

HIRING For Motor Claims & Body Injury Claims Location - Whitefiled 5 days working & Sat sun fixed off Graduates salary - 6.5LPA CONTACT Gopika - 7411782490

Role & responsibilities Must have atleast1 year of experience in Claim adjudication. Immediate joiner Preferred. Please share your CV to ramkumar12.r@nttdata.com TA: Ramkumar Rajarajan

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Quality Patient Care: They play a crucial role in maintaining and improving the quality of patient care. This includes ensuring that patients receive the appropriate care, medications, and treatments based on their conditions. Nursing Protocols and Standards: Implementing and enforcing nursing protocols and best practices within the healthcare facility, making sure that nursing staff follows proper procedures and adheres to medical guidelines. Budget Management: Managing the budget for the nursing department, including resource allocation, procurement of supplies, and cost control. Patient and Family Relations: Interacting with patients and their families, addressing their concerns, and providing information about patient care and treatment plans. Training and Education: Organizing training and professional development programs for the nursing staff to keep them updated with the latest medical advances and best practices. Regulatory Compliance: Ensuring that the nursing department complies with all healthcare regulations and accreditation standards. Emergency Response: Coordinating and leading the response to nursing-related emergencies within the healthcare facility, such as medical crises or staffing shortages.

Greetings from NTT DATA, Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Role & responsibilities Contribute to renewal portfolio expansion through relationship building with the insurance companies and surveyors to ensure optimum claim settlement in the minimum time. During the processing of the claim analyze the following and communicate to underwriters: adequacy of coverage wrt. location specifications e.g.. Earthquake /flood etc. adequacy of the sum insured anomalies in the policy scope of additional policies other related information Control expenses Business Process Facilitate proper settlement of the claim in the shortest possible time to the satisfaction of the client by ensuring the following: Obtain complete information of loss from the client after initial intimation Submit intimation to the insurance company for Registration of claim, Allocation of surveyor. Follow up for deputation of surveyor In case of big losses, ensure Salasar representative accompanies the surveyor to understand the nature and extent of loss and give the client an indication of documents required. Intimate documents requirement for the client. Obtain LOR (List of requirements) from Surveyor Match LOR with Salasar's requirement already taken from the client and take the rest of the documents. Once documents are received, check exclusions in fine print and prepare the draft reply from the client submitted to the insurance company Follow up with a client for repair and reinstatement for early completion and help in documentation of estimate, contractor details, expenses, etc. so that the surveyor gets structured inputs for preparation of the survey report Follow up with surveyor for completion of assessment Communicate surveyor comments to the client in terms of estimate and exclusion and arrange a meeting between the surveyor and client to resolve differences to obtain client assessment Ensure surveyors report is submitted at the earliest Follow up with insurance company for early settlement of claim Obtain settlement voucher from insurance company and forward to client Get discharge of client (signoff) and submit to the insurance company for disbursement Update each step in SAIBA on real time basis and ensure due IRDA compliance Ensure resolution of all complex technical issues in claims and timely escalation of the same for quick disposal of the claim Customer Support the marketing department in obtaining new business and ensuring the best possible coverage for clients, talk to the technical dept of the client to understand which risks need to be covered, type of production (continuous/ batch) Reopen claims in case of new businesses and follow up to obtain claims after reopening of the file by the insurance company if the repudiation is not time-barred. Participate in fortnightly meetings to give updates to the business development and client servicing teams on the status of claims in order that they are updated about the same before meeting clients for renewals Interface with clients to reinforce relationships with existing clients Prepare and submit daily/monthly reports on the status of claims. People Growth Acquire product knowledge and always keep yourself updated with the latest variations in product offerings Attend training sessions (external/ internal) and work on on-job assignments to implement new learning Conduct training sessions for the marketing team as well as underwriting and claims teams to build product knowledge across functions Set objectives, review and evaluate performance periodically, and give feedback Review pending work and initiate action Perform all such duties which are required to be performed by this position in an insurance broking house in general course and to perform all such duties and carry out all such responsibilities so delegated or asked to be performed by the Designated Authority from time to time External Interface: Internal interface: Existing clients Prospective clients Insurance companies Surveyors Employees Preferred candidate profile a) Functional Competencies Demonstrates domain knowledge in own area of operation Understands product offerings Understands service standards as per Organisation ethos Learns continuously and keeps self-updated b ) Leadership Competencies: Relationship Building Networks effectively with both external and internal customers Focuses on building long-term sustainable relationships Delivers on commitment every time Creative & Analytical Problem Solving Understands the strategic objectives of the Organisation, unit, function Collates data and analyses them objectively Takes objective decisions based on data to achieve the strategic objective of the Organisation Goes the extra mile to achieve creative solutions Customer Focus Designs solutions that meet the requirements of the customer (external/ internal) Demonstrates a sense of urgency to resolve all external and internal customer concerns and responds to queries and requests within defined timelines and processes Educates customers (external/ internal) about changes in processes, policies, and offerings Creates long-term relationships with customers (external/ internal) through continuous interface Obtains customer (external/ internal) feedback to improve processes Promotes loyalty and converts customers to brand ambassadors Achieves customer delight with respect to both internal and external customers Is sensitive to code of conduct in office and customer establishments Perseverance Makes all possible efforts to understand the viewpoints of external and internal customers Takes all possible steps to resolve issues Understands the importance of deadlines, proactively removes roadblocks, and delivers as per requirement Tries alternatives to achieve the target Does not give up in the face of adversity Explains own point of view assertively to get necessary support and approval Is patient and persistent towards following up on all leads and prospects generated during the past towards new client acquisition Achievement Orientation Understands the strategic objectives of the Organisation, unit, function Aligns individual and team targets with strategic goals Plans and deploy appropriate resources to meet targets in the short and long term Goes the extra mile to achieve targets as per committed timelines and enable the team to do so Achieves and motivates excellence irrespective of circumstances Shares best practices across businesses Benchmarks with the best and continuously raises the bar Upgrades competencies of self and team to achieve excellence. Share your resume at susweta@salasarservices.com

Cognizant conducting Walk-In Interview for US Healthcare process (PDM/Claims) in Chennai Location. Skill(s): Payer Healthcare, PDM, Claims for Sourcing Interview Date: 26-July-2025(Saturday) Interview Time: 10:00 AM to 12:30 PM Venue : Cognizant Office. SEZ Ave, Elcot Sez, Sholinganallur, Chennai Building Details - Cafeteria block 1st floor A wing, Contact Person - Babu Anand Experience - 1+ Year to 4 Years Job Location - Chennai Shift - Night Shift (US Shifts) Work Mode - Work from Office Desired Profile: Minimum 1+ year to 4 years of experience in US Healthcare Domain . Must have experience in US Healthcare PDM process or Payer healthcare Should be willing to Work from Office Should be willing to work in Night shift (US Shifts) Interested candidates please walk-in with the following documents to the venue for the Face to Face interview. Mandatory Documents: 2 copies of resume (Hard Copy) Recent Passport Size photograph - 2 (Soft copies) 10, 12, UG Semester marksheets and Provisional certificate (soft copy) Aadhar, PAN, Voter or passport (soft copy) Experience documents: offer letter, relieving letter and compensation documents Venue: Cognizant Office. SEZ Ave, Elcot Sez, Sholinganallur, Chennai Building Details - Cafeteria block 1st floor A wing, Contact Person - Babu Anand

Vidal is hiring for claim Processor Designation: Executive-Claims Location: Gurgaon, Key Responsibilities: Review and validate claim documents submitted by hospitals or insured members Scrutinize medical records and bills for completeness and accuracy Apply policy terms, conditions, and exclusions to adjudicate claims Perform ICD and procedure coding as per ailment and treatment Coordinate with medical officers for clinical opinion when required Maintain claim logs and update CRM systems with claim status Ensure adherence to defined SLAs and minimize processing errors Flag suspicious or potentially fraudulent claims for investigation Communicate with stakeholders for clarifications or missing documents Support audit and compliance teams with documentation and reports Shortfalls & Queries Required Skills & Competencies: Strong understanding of health insurance policies and TPA workflows Familiarity with medical terminology and coding (ICD, CPT) Attention to detail and analytical thinking Proficiency in claims processing software and MS Office tools Good written and verbal communication skills Ability to manage high volumes under pressure Commitment to confidentiality and data protection norms Qualifications & Experience: Graduate in any discipline (preferably life sciences or healthcare) 1-3 years of experience in claims processing within a TPA or insurer

Candidate should have experience working as a Process Trainer in Claims adjudication process for US Healthcare Shift - US rotational shifts Work Location - Hyderabad Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Location : Ahmedabad Process: International Voice Support( US Healthcare ) Salary: Up to 4.2LPA Immediate joiners Freshers and Experience Both can apply Shift: Night Shift Working Days: 5 days/week

Job Details: Job Process/Role: Claims Adjudication (US Healthcare) Experience: 1 - 3 Years of Relevant experience in Claims adjudication Skillset: CPT Codes, HIPAA, Co-pay and Co-insurance, Medicaid and Medicare, Denial claims, UB and CMS forms. Shift: Night shift Location: Chennai & Coimbatore Mode of Work: Work from office Notice Period Eligible: Immediate to 30 Days of Notice period is acceptable. Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials. Knowledge in handling authorization, COB, duplicate, pricing, and the corrected claims process. Knowledge of healthcare insurance policy concepts, including in-network, out-of-network providers, deductible, coinsurance, co-pay, out-of-pocket, maximum inside limits, and exclusions, state variations. Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services, and processes performed by the team. Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication, and the adjustment process. Experience in professional (HCFA), institutional (UB) claims (optional). Both undergraduates and postgraduates can apply. Good communication (Demonstrate strong reading comprehension and writing skills). Able to work independently, with strong analytical skills. 1. Required schedule availability for this position is Monday-Friday, 5.30 PM/3.30 AM IST (AR SHIFT) . The shift timings can be adjusted according to client requirements. 2. Additionally, resources may have to work overtime and on a weekend basis to meet business requirements.

operations of the healthcare claims processing team (Mediclaim, RCM, and denial management) Ensure claims, including verification, validation, coding .Monitor & manage denials, rejections, and appeals in accordance with Payer & Provider guidelines. Required Candidate profile knowledge of healthcare claims, RCM workflows, & denial management. Should have Team Management , Client Management. Analyze RCM data to identify trends, gaps, & opportunities for process improvement

Greeting from Gainwell! JD 5+ years of experience as a Product Owner or in a related product management role. Strong knowledge of US healthcare systems, pharmacy workflows, and regulatory requirements (e.g., Medicaid, Medicare, PBMs, e-prescribing, and pharmacy claims processing). Experience working in Agile environments (SAFe, Scrum, or Kanban) with expertise in backlog management tools like Azure DevOps (ADO), Jira, or Rally. Proven ability to translate complex business needs into clear, actionable user stories. Experience collaborating with engineering, QA, business, and compliance teams. Strong analytical and problem-solving skills, with the ability to manage competing priorities. Excellent communication and stakeholder management skills, with experience engaging executive leadership, clients, and development teams. SAFe Product Owner/Manager(POPM) certification or equivalent experience is a plus. Preferred Qualifications Exposure on drug data base such as FDB & Medispan Experience with healthcare data interoperability (HL7, FHIR, EDI 837/835). Familiarity with cloud-based healthcare applications (AWS, Azure, or GCP). Understanding of drug pricing models, formulary management, and pharmacy benefits administration. Knowledge of prior authorization, claims adjudication, and medication therapy management

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-3 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement. Interested please share resume to pushpa.shanmugam@nttdata.com

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 Assistant Manager.

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation 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 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

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation 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 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