1575 Claims Adjudication Jobs - Page 22

Quality executive is responsible to perform activities outlined in the Service Quality Plan and identify agent / program level improvement opportunities. Executive is required to work closely with the production resource to ensure adherence to the client and process specific requirements. Ensure that regular feedback and error sharing sessions are conducted to avoid repetition of errors and help improve overall performance. Other activities of the quality executive include reporting, calibrations, process analysis and attending client and internal meetings. Responsibilities: Responsible for call/data quality monitoring. Provide feedback to agents using prescribed feedback model. Mentoring an...

BA profile with experience in Payment including hands on GPF application Experienced in Capital Markets, specifically Risk (Market, Credit) and Regulatory implementation Experienced in Capital Markets product types and asset classes Well-versed in creating BRD & FRD Experienced in SQL; you are able to deal with large volumes of data Familiar with financial security elements such as stocks, bonds, mutual funds, etc. Experience on Payments domain preferred, great communication should be able to engage with business users Mandatory Competencies BA - Business Knowledge BA - Client Interaction BA - Communication - Verbal, Written BA - Create Specifications / BRD/ FRD BA - Create Specifications / ...

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...

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 Title: TPA Manager Location: Miri Piri Institute of Medical Science & Research, Shahabad Markanda, Kurukshetra (Haryana) Hospital Strength: 420+ bedded upcoming super-specialty hospital & upcoming medical college (100 MBBS seats) Position Overview We are seeking an experienced and detail-oriented TPA Manager to lead and manage all Third-Party Administrator (TPA), insurance, CGHS, ECHS, and Ayushman cases. The role involves overseeing pre-authorization, billing, claims settlement, and ensuring smooth coordination between patients, TPAs, and hospital departments while maintaining compliance and accuracy. Key Responsibilities Handle end-to-end TPA, Insurance, Ayushman, CGHS, and ECHS cases....

Mega Walk-in Drive US Healthcare (Claims Adjudication) Date: 19th & 20th September 2025 Time: 11:30 AM 4:00 PM Venue: Sagility, KCT Tech Park, Thudiyalur Rd, Saravanampatti, Coimbatore, Tamil Nadu 641049 We Are Hiring Experienced Professionals! Join our growing team in US Healthcare Claims Adjudication Minimum Requirement 3.6+ years of experience in US Healthcare (Claims Processing & Adjudication) Additional Opportunities in Sagility : We have openings for WFM & Training functions Also for Internal Contact Center Operations (Inbound calls) Open Positions Team Leader Operations Quality Specialist Subject Matter Expert (SME) Process Trainer Quality Team Leader Assistant Manager Operations Depu...

Role & responsibilities We are looking for an accomplished Doctors with significant ICU experience and a strong ability to manage both clinical and non-clinical responsibilities. The ideal candidate will excel in patient care, clinical documentation, and possess in-depth knowledge of medical documentation essential for insurance claims processing. Key Responsibilities: Patient Documentation: Manage patient medical history and progress notes with precision. Claims Processing: Handle preauthorization and reimbursement claims, including validation and processing. Clinical Records: Maintain accurate clinical documentation in compliance with healthcare standards. Collaboration: Work closely with ...

Bpo Hiring For Health Care Domain Voice Process 6.5 LPA Location Gurugram Only Graduates. No B.E./Btech/UG''s Minimum 1 Year of Voice Experience With International BpO MUST Pls Cal Dipankar @ 9650094552 Email CV @ jobsatsmartsource@gmail.com

We are seeking candidates with a minimum of 1 year of experience in Indian health Insurance/TPA who have strong communication and along with good medical knowledge in Claims Adjudication •Degree in BAMS, BHMS, BSMS, or MBBS (strictly required)

Positions General Duties and Tasks: Process Insurance Claims timely and qualitativelyMeet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and custome...

Checks for completeness and appropriateness of source data. Involved in fact finding, information search and data gathering. Verifies and compiles data. Identifies and resolves routine and recurring problems. Skills Required Ability to analyze and process transactions based on rules. Able to integrate knowledge as a skilled specialist. Possess strong domain knowledge in Healthcare and Insurance domain.

Roles and Responsibilities: 2-3 years of experience in processing claims adjudication and adjustment process Experience in professional (HCFA) and institutional (UB) claims Knowledge in handling authorization, COB, duplicate and pricing 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 Audit claims as outlined by Policies and Procedures. Utilize appropriate system-generated reports applicable for specialty claims. Document, track findings per organizational guidelines for reporting purpose. Based upon trends, determine ongoing Claims E...

Process & Manage Insurance Claims. Provide support to Policy Holder, to manage & maintain the accurate data. To insure timely settlements of the claims. Co-ordinate with Companies of Insurance & Healthcare providers.

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development ...

TATA AIG General Insurance Company Limited is looking for Senior Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Analysis for the current business practice. Find out the different operational strategies. Work on developing the current operational strategy applied to the company with the most recent technology. Coordinate with the operations manager to take the required steps after brainstorming and research. Optimize the operations in the company. Put the suitable operational strategy to fit with the companys culture. Implement the operational strategy in the different departments of the company. Supervise the strategy, and make sure that all the emp...

Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accurate trade accruals, contract approvals and verification. Manage exception through verbal and written interactions with Sales and Sales Finance. Responsibilities Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accura...

Role- Medical Coder: We are looking to hire an experienced Coder / Sr. Coder with active coding certifications (CPC / CPC-A / CIC / CCS / COC). With strong domain expertise in CPT and ICD (diagnosis) coding, the incumbent should be able to validate the coding after reviewing all relevant medical records ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations. Working in an evolving healthcare setting, delivering innovative solutions using our shared expertise. Using opportunities to learn and grow through rewarding interactions, collaboration, and the freedom to explore professional interests. Giving priority always to what is best for our ...

Medcare Hospitals Medical Centres is looking for Senior Executive.Revenue Cycle Management to join our dynamic team and embark on a rewarding career journey Leading the full audit cycle by checking tax compliance, verifying financial records, and inspecting accounts. Analyzing the results of the audit and presenting possible solutions for ineffective financial practices to management. Evaluating company accounting procedures, payroll, inventory, and tax statements to guide financial policymaking. Conducting risk assessments to recommend aversion measures and cost savings. Following up with management to ensure remediations are implemented into the company's financial practices. Supervising j...

Medcare Hospitals Medical Centres is looking for Associate to join our dynamic team and embark on a rewarding career journey 1 Customer service: Associates in Insurance serve as the primary point of contact for customers, providing them with information about policies, handling claims and addressing any concerns or issues they may have 2 Risk assessment and analysis: They help assess risks associated with insuring different clients, analyze data and make recommendations to senior-level professionals 3 Claims processing: Associates in Insurance handle claims processing, by gathering information, reviewing policies, assessing damage and negotiating settlements 4 Compliance: They help ensure th...

Overview The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools. This will require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website Responsibilities Performs follow-up with market locations to research and resolve payer enrollment issues Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment iss...

In this Role you will be Responsible For Review and process insurance claims. Validate Member, Provider and other Claims information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per 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 guidelin...

1. Handle Provider Chat queries and meet client SLA 2. 5-10 Operation during weekdays 3. Should have a valid degree & good in communication 4. Adhere to client shift time and break hours 5. Customer holidays are followed and hence need to work on India Holidays 6. Should have experiance in handling Microsoft excel, words

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

Positions General Duties and Tasks: Process Insurance Claims timely and qualitativelyMeet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and custome...

Position's General Duties and Tasks In these roles you will be responsible for: Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables. Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met Analyzing medical insurance claims for quality assurance Resolving moderately routine questions following pre-established guidelines Performing routine research on customer inquiries. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Requirements for this role include: Ab...