1508 Claims Adjudication Jobs - Page 3

We are looking for a highly skilled and experienced Administrator to join our team at the University of York Computer Science. The ideal candidate will have a strong background in computer science and administration, with excellent organizational and communication skills. Roles and Responsibility Manage and maintain computer systems, networks, and peripherals. Provide technical support and troubleshoot issues related to computer hardware and software. Develop and implement administrative policies and procedures. Coordinate with various departments to ensure smooth operations. Maintain accurate records and reports. Ensure compliance with university regulations and industry standards. Job Requ...

Job description Role & responsibilities 1. Review First Notice of Loss (FNOL) entries and confirm document completeness 2. Collect supporting documents (e.g., police reports, invoices, photos) from brokers and insureds as required 3. Maintain and update digital records of claim files in internal platforms (FIS, CMS, etc.) 4. Identify missing documents or data inconsistencies and flag them for the onshore team 5. Maintain up-to-date claim checklists and logs 6. Categorize claims based on pre-defined triage criteria (Low, Medium, High exposure) 7. Perform quality checks on document uploads, file naming conventions, and tagging 8. Communicate professionally with brokers and insureds via email o...

As an RPA Developer in this role, you will be responsible for utilizing UiPath to automate repetitive tasks, leading to improved operational efficiency and reduced manual errors. You will execute claims adjudication processes with precision, ensuring adherence to industry standards. Collaborating with cross-functional teams will be crucial in resolving complex claims issues, ultimately enhancing customer satisfaction. It will be your responsibility to implement best practices in claims processing to optimize workflow and resource allocation. Monitoring and reporting on key performance indicators will drive continuous improvement initiatives. Your support in the development and testing of new...

Responsible for calling Insurance companies (in US) on behalf of doctors/physicians and follow up on outstanding Accounts Receivable. Salary upto 49k in hand Min - 1 year of work experience is required. Deepali - 9650092537

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 ...

We are looking for a highly motivated and experienced Telecaller/Counsellor to join our team at Narsee Monjee Institute of Management Studies (NMIMS). The ideal candidate will have 2-5 years of experience in the field. Roles and Responsibility Handle inbound and outbound calls to generate leads and convert them into enrollments. Provide counselling services to prospective students and their parents. Develop and maintain relationships with existing students and alumni. Collaborate with the marketing team to achieve enrollment targets. Maintain accurate records of student interactions and progress. Meet or exceed monthly and quarterly sales targets. Job Requirements Proven experience as a Tele...

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:...

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...

Responsibilities: * Manage AR calls, denials & RCM processes * Ensure timely payment posting & claim submission * Handle medical billing tasks with accuracy * Adhere to HIPAA compliance standards

Key Responsibilities Counsel students through inbound and outbound calls, emails, or in-person meetings. Understand student requirements and suggest suitable academic or professional courses. Provide detailed information on course structures, eligibility criteria, admission procedures, and career outcomes. Follow up with potential leads to convert inquiries into enrollments. Maintain student databases and track communication history. Assist students with application forms, documentation, visa procedures (if applicable), and scholarship guidance. Coordinate with internal departments (faculty, marketing, admin) for smooth onboarding. Participate in seminars, open houses, and education fairs as...

Responsibilities: * Manage the end-to-end RCM process for podiatry clients * Oversee AR follow-ups to reduce outstanding claims and improve collections * Ensure proper coding compliance (CPT, ICD-10) * Handle claim denials identify root causes

Walk-In Drive on 30th October 2025 at Cotiviti -Pune for US Healthcare Audit Walk-In Date: 10-October-2025 (Thursday) Time: 10:00 Am 1:00 Pm Venue: Cotiviti India Pvt Ltd Plot C, Podium Floor, Binarius/Deepak Complex, Opposite Golf Course, Yerwada, Pune- 411006. We are hiring for the US Healthcare Data Audit process at Cotiviti. Please refer to the information below and required skill set for the same. POSITION SUMMARY: Specialist Payment Accuracy position is an Entry level position responsible for auditing client data and validating claims accuracy. A Specialist communicates audit recommendations and outcomes to supervisory auditor for evaluation, verification and continuous learning. POSIT...

Looking for a candidate currently designated as a Team leader on papers in the US Healthcare process. Must have proven experience in operations management, team handling, and process excellence within the healthcare domain. Required Candidate profile Shift - Rotational Shifts Work Location - Gurgaon Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Manager Reejo @ 9886360719 for more details.

Looking for a candidate currently designated as a Manager or Deputy Manager in the US Healthcare process. Must have proven experience in operations management, team handling, and process excellence within the healthcare domain. Required Candidate profile Shift - Rotational Shifts Work Location - Gurgaon Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Manager Reejo @ 9886360719 for more details.

Job Title : Reporting Analyst Location: Kochi Terms: Full Time Requirement : Need to work in nightshift and Weekend if applicable About the Role : Medical Underwriting is the process wherein underwriter decides whether or not to insure risks for which request has been submitted Underwriter s task is to evaluate a risk on the basis of his/her medical history by referring medical guidelines Responsibilities : Assign tasks need to finish within deadline Maintain the quality in each task Need to be flexible to work on Saturday during high volume

Desirable SkillsAbility to read and comprehend English language in clear and precise mannerReasoning SkillsProblem SolvingEye for detailTechnical SkillsGood computer navigation skillsTyping speed of 25 Words per Minute with 95% Accuracy Basic knowledge of Microsoft Office, Outlook and ExcelProcess Specific SkillsCandidate should preferably have knowledge of US Life and Annuity InsuranceKnowledge of processing claims transactionsAbility to navigate multiple systems and applications Ability to produce high quality outcomes in a highly productive environmentSoft skillsAbility to work independentlyAbility to understand and question established process guidelines for possible process improvements...

Job Description_ Contingency _Data Mining Job Name: Senior Executive - Datamining Position Title: Senior Executive Band: A2 ERP Full Position ID: Reporting to: Assistant Manager Location/Site: EXL India Overview Candidates should have minimum 3+ years of experience and must have knowledge in claims adjudication process and its processing methods. Qualifications: Graduation is Mandatory Claims adjudication experience is Mandatory Prefer candidates with experience in Post adjudication/overpayment projects (Not mandatory) Experience: Claims Adjudication experience: Minimum 3 years Overpayment experience (Optional) Communication: Strong written (documentation) and oral communication skills Worki...

Role: Back End Operations -US Health Insurance Work Location: 2-15+ years' work experience in back-office US Health Insurance/Retirement pension domain /BFSI can apply Location: Wipro Elcot SEZ, Survey No. 602/03, Elcot Sez, Shollinganallur, Chennai, Tamil Nadu Shift Timing- 5.30pm to 3am Cab Facility- One way drop Work from Office: From Day 2 Onwards (Work from office ) Permanent work profile with Wipro Education - B.com, BA, BBA, Any B.sc (graduates only)/ NO BE/B TECH will be eligible for this hiring Job Summary Strong understanding of client plan provisions/product & processing guidelines and SLA metrics Able to manually perform Benefit processes and complex tasks/calculations that requi...

Looking for a candidate currently designated as Manager or Deputy Manager in the US Healthcare process. Must have proven experience in operations management, team handling, and process excellence within the healthcare domain. Required Candidate profile Shift - Rotational Shifts Work Location - Gurgaon Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Manager Reejo @ 9886360719 for more details.

Role & responsibilities Conduct timely follow-up on outstanding payments with customers, corporates, insurance companies, and third-party administrators (TPAs). Manage part-payment and short-payment reconciliations, ensuring accurate tracking and proper accounting entries. Prepare and maintain outstanding reports (daily, weekly, and monthly) for management review. Monitor aging analysis and escalate long-pending dues for resolution. Coordinate with billing, finance, and customer service teams to ensure smooth payment flow and dispute resolution. Maintain accurate documentation and communication records related to payment follow-ups. Assist in month-end closing activities, ensuring proper pos...

Designation: Senior Medical Officer Function: Claims PA/RI Approver Reporting to: Assistant Manager/Manager Location: Andheri East, Mumbai Educational Qualification: BAMS, BHMS, BPT, MBBS, BSc. Nursing Additional Qualification: None Specialization: General Medicine Related courses attended: None Management Level: Junior Management Level Industry Type: Hospital/TPA/Healthcare/Insurance Roles and Responsibilities : Check the medical admissibility of a High Value claim, scrutinize and process it as per terms & conditions of insurance policy. Handle escalations, customer queries and responding to mails accordingly Effectively manage the team so that the targets are met while reducing the no. of ...

Role & Responsibilities: Claims Specialists are responsible for accurately reviewing and processing claims for Flexible Spending Accounts and Health Reimbursement Arrangements in accordance with IRS regulations and specific employer plan rules. Claims Specialists spend their entire day working through the automatically fed claims queues within OnBase in the designated order to ensure turnaround times are met for our clients. Preferred Candidate Profile A candidate with claims adjudication experience is preferred. Freshers are also encouraged to apply. (Should have provisional / Consolidated certificate) The candidate should be flexible with working in 24-hour rotational shifts. "Sutherland n...

Overview 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 wi...

WE ARE CONDUCTING MEGA JOB FAIR FOR TOP 10 COMPANIES WITH IMMEDIATE JOINING, CANDIDATES WITH BELOW SKILL SET CAN APPLY FOR THE ROLE. Mandatory Skill sets & Non-Negotiable (Need to have) Working knowledge of Insurance Domain (P&C or Life) Must possess strong English comprehension skills to effectively engage in client-led training sessions and understand process documentation. A minimum typing speed of 25 words per minute is required to ensure timely and efficient responses during live chat interactions. Clear, confident, and spontaneous communication both written and spoken is essential to manage real-time customer queries and deliver high-quality support. Basic computer literacy is expected...

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more expe...