595 Claims Adjudication Jobs - Page 24

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English - Intermediate 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 model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataYou will be responsible for developing and delivering business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Ability to manage multiple stakeholders,Ability to perform under pressure,Agility for quick learning,Collaboration and interpersonal skills,Commitment to qualityAbility to manage multiple stakeholders,Ability to perform under pressure,Agility for quick learning,Collaboration and interpersonal skills,Commitment to quality Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

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 model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataYou will be responsible for developing and delivering business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Ability to establish strong client relationship Ability to handle disputes Ability to manage multiple stakeholders Ability to meet deadlines Ability to perform under pressure Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

Skill required: Reinsurance - Collections Processing Designation: Claims Management Senior Analyst Qualifications: Any Graduation Years of Experience: 5 to 8 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 model that can meet the unique needs of each market segment.Canceling and rewriting insurance policies and endorsementsThe Collections Operations team focuses on managing collections and disputes such as debt collection, reporting on aged debt, bad debt provisioning, trade promotions, and outperform cash reconciliations. The team is responsible for follow up for missing remittances, prepare refund package with accuracy and supply to clients, record all collections activities in a consistent manner as per client process (tool), delivery of process requirements to achieve key performance targets, and ensure compliance to internal controls, standards, and regulations. What are we looking for? Ability to perform under pressure Problem-solving skills Written and verbal communication Commitment to quality Agility for quick learningKnowledge of German Language would be an added advantage. Roles and Responsibilities: In this role you are required to do analysis and solving of increasingly complex problems Your day to day interactions are with peers within Accenture You are likely to have some interaction with clients and/or Accenture management You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments Decisions that are made by you impact your own work and may impact the work of others In this role you would be an individual contributor and/or oversee a small work effort and/or team Please note that this role may require you to work in rotational shifts Roles & Responsibilities Analyze and process various treaty and facultative premiums statements in the system Ensure cash call refunds are booked on time Maintain adequate trackers for all aspects of SOAs are maintained Analyze and process various types of claims in the system Analyze, Process and track large losses Ensure payment transactions are revied and cash is allocated in timely manner Ensure adequate follow ups are done to ensure to keep unallocated cash to the minimal Ensure outstanding balances are tracked, followed up and reported periodically to the stakeholders. Liaise and work with various stake holders to ensure all queries are addressed on time Initiate process improvements through automation and assist in implementing the same. Actively participate in knowledge sharing and training Taking ownership and be accountable for activities performed Actively get involved in cross departmental activities and show eagerness to learn all activities. Qualifications Any Graduation

Role: Team Lead -Claims Adjudication Position: Non-Technical Skill: Claims Adjudication (US Healthcare Process) Shift: 11:00 AM - 8:00 PM IST Work Location: Chennai Work Mode: Onsite (all 5 days work from office) Venue : SEZ, Ramanujan IT City, 6th Floor Cambridge Tower, SH 49A, Tharamani, Chennai, Tamil Nadu 600113, India Role Summary: This job takes the lead in handling a team of 25-30 team members providing complex claims adjudication services typically as part of Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies. Claims Adjudicators provide general support to maintain TAT, meet SLAs, performance and quality levels required by their customers. Mentor and motivate team members. Essential Responsibilities Adhere to organizational policies Handle a team of 20-25 associates Deliver SLAs and have close traction on Teams performance. Monitor & have governance on potential risks Drive Innovation within team Process claims with the team to understand the updates and business protocols Attrition & retention management talent retention Succession planning & EWS forecast Learning management / Stay compliant with L&D courses (Self Vs. Team) Create, Maintain & share dashboards with leadership Drive employee engagement & team building activities The experience we are looking to add to our team require: Greater than 8 years of experience in US Healthcare Bachelors or Master’s 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 Acquaintance to Six Sigma methodology & tools Business acumen on Adjustments and Offset/Recovery

Will be responsible for driving sales by engaging prospective students, guiding them through the enrollment process, and building long-term relationships Respond to inquiries from prospective students via calls, emails, and in-person visits. Counsel and guide students and parents regarding courses, eligibility, admission procedures, and career paths. Handle the end-to-end admissions process from application to enrollment. Maintain and update student records in the admissions system.

Urgent requirement for BHMS/BAMS/BDS/MBBS-Pune (Vadgaonsheri) Freshers/candidate with clinical or TPA experience Interested candidates can call on 7391042258 (Sneha- HR department) or share their updated resumes to recruitment@mdindia.com Roles and responsibilities: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BAMS / BHMS / BDS/ MBBS graduate. Good Medical & basic computer knowledge Should have completed internship (Provisional /Permanent Registration number is mandatory) Freshers can also apply. Work from office . Interview Timings-11am To 5pm(Monday To Saturday) Venue Details: MDIndia Health Insurance TPA Pvt. Ltd. S. No. 46/1, E-space, A-2 Building, 4th floor, Pune Nagar Road, Vadgaonsheri, Pune 411014

TPA Liaison: Serve as the primary point of contact between the hospital and TPAs, ensuring smooth claims processing and reimbursement. Collaborate with TPAs to verify patient eligibility, approve pre-authorizations, and facilitate smooth discharge procedures. Ensure timely submission of claims, follow up on outstanding claims, and resolve any discrepancies or issues related to TPA reimbursements. Corporate Client Coordination: Act as a liaison for corporate clients, addressing their queries and ensuring employees medical needs are met efficiently. Coordinate with corporate clients to manage employee health programs, including corporate insurance policies, wellness programs, and preventive health check-ups. Assist in the onboarding of corporate clients and ensure smooth setup for hospital services under corporate agreements. Claims Management: Monitor, track, and process claims submitted by patients under TPA and corporate agreements. Ensure all claims meet the required documentation and regulatory standards. Resolve claim issues and disputes in a timely manner, coordinating with both internal departments and external stakeholders. Documentation and Reporting: Maintain accurate records of all communications, claims, approvals, and payments from TPAs and corporate clients. Prepare regular reports on claims processing status, pending approvals, and financial reconciliations for internal and external stakeholders. Ensure all documentation is organized, up-to-date, and compliant with hospital policies and industry regulations. Customer Service: Provide exceptional customer service to patients, TPAs, and corporate clients by addressing inquiries and concerns promptly. Ensure patients and their families understand the process of claiming insurance and managing payments through TPAs or corporate policies. Cross-Functional Collaboration: Work closely with the billing, finance, and medical teams to ensure that patient care is seamless, and claims are processed efficiently. Collaborate with other hospital departments (admissions, discharge, accounts) to resolve any patient-related issues concerning TPA and corporate coverages. Compliance and Regulations: Stay updated with the latest regulations, policies, and procedures related to TPAs, corporate healthcare programs, and insurance claims. Ensure all processes align with the hospitals standards, legal requirements, and industry best practices. Key Skills and Qualifications: Education: Bachelors degree in healthcare management, business administration, or related fields. Experience: 1-2 years of experience in TPA management, corporate healthcare coordination, or insurance claims processing is preferred. Skills: Strong communication and interpersonal skills to interact with TPAs, corporate clients, and internal teams. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and hospital management systems. Ability to handle sensitive and confidential patient information. Attention to detail and strong organizational skills to manage multiple tasks simultaneously. Problem-solving skills to resolve claims and coordination issues. Working Environment: The role typically operates in an office setting within the hospital or remotely, with periodic visits to patient care areas or meetings with external stakeholders. The job may involve working with insurance companies, corporate representatives, and patient families, requiring professional demeanor and strong customer service skills.

Key Responsibilities: Claim Submission Insurance Verification Payment Processing Patient Communication Record Keeping Claim Follow-up Compliance Revenue Cycle Management Accessible workspace Flexi working Cafeteria Work from home Annual bonus Performance bonus

Role & responsibilities Allocates and delegates takes amongst employees. Provides operational support to employees on all phases of transaction processing. Interacts with clients and internal departments to solve issues. Identifies and resolves issues around pending transactions. Performs quality audit on accounts . Preferred candidate profile Skills Required 3-5 years of experience in claims adjudictaion. Demonstrated client interaction skills. Ability to analyze reasons behind incomplete transactions. Understands process interdependencies • Possesses deep domain knowledge in Healthcare and Insurance domain Interested please share your resume to pushpa.shanmugam@nttdata.com

In this Role you will be Responsible For The candidate is responsible to read and understand the process documents provided by the customer. Analyse the insurance request received from the customer and process as per standard operating procedures. Stay up to date on new policies, processes, and procedures impacting the Familiarize, navigate multiple client applications and capture the necessary information to process customer request. Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Associate need to report to work from office mandatory Requirements for this role include Candidate should have min 6months – 1year experience Display good analytical skills Should have basic insurance knowledge Possess excellent communication skills Should have typing speed with minimum 21WPM. Ready to work in complete Night Shift. Should be flexible & adopt to situations Should extend support to the team during crisis period Ready to relocate as per the business requirement. Should be confident, aggressive and result oriented Preferences- Ability to communicate (oral/written) effectively to exchange information with our client. Any Graduate with English as a compulsory subject Required schedule availability for this position is Monday-Friday (6.00 PM to 4.00 AM IST). 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.

Company: 91 Springboard Business Hub Private Limited Designation: Guest Relations Executive Position description: A Guest Relations Executive will be responsible for creating a welcoming and professional environment for members, visitors, and clients. Have to ensure a seamless customer experience by managing front-desk operations, addressing member needs, and coordinating with internal teams to enhance workplace satisfaction. Primary Responsibilities: Front Desk & Customer Service: Greet and assist guests, members, and visitors professionally. Handle inquiries via phone, email, and in-person regarding memberships, facilities, and services. Maintain a friendly and engaging environment to enhance member satisfaction. Member Support & Engagement: Address and resolve member concerns and requests efficiently. Assist with onboarding new members and provide hub tours to prospective clients Build relationships with members to foster a strong community. Business & Growth: Actively seek seat expansion opportunities with the existing teams. Price escalation upon renewal of team contracts. Drive ancillary revenue such as meeting room, day passes etc. Facility & Operations Support: Ensure that meeting rooms, common areas, and workspaces are clean and well-maintained. Coordinate with housekeeping, IT, and maintenance teams to resolve facility-related issues. Monitor and restock office supplies, beverages, and amenities. Events & Community Building: Assist in organizing and promoting networking events, workshops, and community activities. Encourage collaboration and engagement among members. Support marketing efforts for events and special initiatives. Requirements: 2-3 years of relevant experience. Excellent communication and interpersonal skills. Customer service experience, preferably in hospitality or co-working spaces. Strong problem-solving abilities and a proactive approach. Ability to multitask and work in a fast-paced environment. Knowledge of office management tools (CRM, booking systems) is a plus.

Level-SME/TL Experience in Claims adjudication CTC-ME-6.5LPA TL-9.2LP Location-Bangalore Hybrid US Shifts share resume on-archi.g@manningconulting.in contact-8302372009

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: 3-8 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 Candidate Please share me your Resume to Ganga.Venkatasamy@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 Required Candidate profile Prior exp in healthcare in Claims process Experience:Minimum3 yearsin a BPO Healthcare process, with at least1 year as a Team Lead.

Investigate health insurance claims, verify medical records, detect fraud, conduct field visits, and prepare detailed reports. Coordinate with hospitals and ensure compliance with TPA policies and IRDAI guidelines. Medical background preferred.

Candidate should be working as a Team leader OR Quality analyst on papers in US Healthcare for Claims adjudication process. Qualification - Graduate Shift - US rotational shifts Work Location - Chennai Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.

Job description Job Title: GB P&B Job Location : Thane Experience : 0 to 3 Years Work Style :Hybrid Shift Timing: 6:30AM to 3:30PM and 1:30PM to 10:30PM Note: No gap in education . 2025 Pass out Candidates whose online results are out welcomed. Job Summary: P&B team plays an integral part in the end to end servicing of an account. We act as the documentation and billing team for our brokers, enabling them with information to service an account in a timely manner. Placing and Billing relates to - creation of documents before and after placing the business, generating invoices on behalf of the broker and providing the final policy document. Principal Duties/Responsibilities KPI Management Deliver as per the KPI's defined for the role. To always maintain set SLA Accuracy/quality, TAT standards prescribed by the Business Unit. Manage work load/ volumes and delivery expectations as per business requirement Develop a sound understanding of the business process. Update work tracker and time tracking tools accurately and on real time basis Complete ad-hoc tasks as directed by Team Leader. Ensure adherence to compliance and operate within the guidelines of internal and external regulators. Ensure that all statutory and company procedures are followed while processing work to protect clients, colleagues and the business interests of the company. Operations Management/Operational Effectiveness Participate and contribute in team huddles. Proactively support key initiatives that have been delivered to implement change. To ensure any feedback (including breach/errors) found in the process is informed to the team Manager instantly. Relationship management Ensure ongoing, effective relationships with stakeholders (Internal/external) Required Qualifications, Skills, Knowledge, Experience Qualifications: Minimum bachelors degree required. Preferred Commerce or Insurance background Functional Competencies: (Skill levels are for managerial reference only) Analytical : Analytical skills refer to the ability to research, collect, interpret, analyze and problem solve information (includes numerical and graphical). Attention to Detail : Attention to detail is the ability to achieve thoroughness, accuracy and completeness when accomplishing a task. MS Office : Having the requisite knowledge level and understanding of MS Office. Communications Skills : Communication skills refer to the ability to comprehend, articulate and respond effectively to information in a logical manner through verbal and written mediums. Preferred candidate profile

Hiring for US Healthcare company Grad with 7 months exp in RCM can apply UG/Btech with 12 months RCM can also apply Salary upto 3.60 LPA to 5.50 LPA Fixed Sat-Sun off Fixed nght shifts Loc- Gurgaon / Noida Snehal@9625998099 Required Candidate profile Candidate should have good knowledge on RCM. Candidate should be comfortable with night shifts. Candidate should have decent typing speed. Perks and benefits Both side cabs One time meal

Job Description Position: Auto Claim Adjuster Job Title: Auto Claims Adjuster Department: Claims Reports to: Claims Manager Location: Bangalore Employment Type: Full-time Roles & Responsibilities : Dealing with Insurance Companies for Auto claims only Dealing with Location Managers for paper formalities Maintaining In-House location, Insurance companies etc. Coordinating with parent company representatives Skills & Qualifications : 1 - 3 years SOLID experience with insurance company Claims Dept or Brokerage dealing with AUTO claims / Auto Insurance only Knowledge of LOCAL Auto insurance regulatory laws Good Communication & Negotiation Skills (writing and speaking) Time flexibility requirement, and should be self-motivated Hands-on capabilities Room to Grow Bachelors degree in a related field or equivalent work experience Compensation: Fixed Salary + Incentive 2 Rounds of interviews and joining would be immediately after the 2nd round of interviews.Background check and verification is required. Shift - Night shift ( Canadian Timings ) 6 Days working - Sunday Off Location - Serene Building No.106, 4th Floor, 4th C Cross Rd, 5th block, Koramangala Industrial Layout, S.G. Palya, Bengaluru, Karnataka 560095 If Interested directly visit to our office location for F2F Interview Notes: If interested in auto claims then only Please apply - US/Canada process Open to freshers with strong English communication skills. Notes: If interested in auto claims then only Please apply If You have Auto claims experience, Apply Please

Skill required: Claims Services - Payer Claims Processing Designation: Health Operations New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.Business solutions that support the healthcare claim function, leveraging a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims. What are we looking for? Good process knowledgeGood process knowledge Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation