1604 Claims Adjudication Jobs - Page 34

Experience Required 7+ years' experience in Quality assurance of claim adjudication process. Strong expertise in healthcare claim adjudication Accountable for functional, operational, and/or program management. Achieves goals through the work of others. Manages performance appraisals and pay reviews. Identify and manages trainings for the team Manages hiring and termination actions. Maintain good Client Relationship Ability to prioritize and perform under pressure in fast-paced environments Six Sigma (Good to have) Role & responsibilities Evaluates the performance of the team. Educates to enhance capabilities of soft skills, technical skills, and business Domain Knowledge to the team. Identi...

Veradigm Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information. We are an Equal Opportunity Employer. No job applicant or employee shall receive less favorable treatment or be disadvantaged because of their gender, marital or family stat...

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...

Arzion RCM is looking for Arzion Business Solutions - Patient Caller in Chennai to join our dynamic team and embark on a rewarding career journey Tellecaller is responsible for various tasks including planning, execution, and management of related duties They should possess relevant skills and experience to excel in this role Duties include teamwork, problem-solving, and achieving organizational goals Candidates must have strong communication and technical abilities Responsibilities include project management, strategy execution, and performance optimization (More details as per role requirements )

The Performance Management Analyst will be responsible for collecting, creating, utilizing reporting, data and analytics to assess solutions that will achieve optimal RCM performance and financial objectives of our clients Raj 8377993148

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

Role & responsibilities : Policy Evaluation: Review and assess insurance policy applications to ensure accuracy and compliance. Risk Assessment: Use data and software tools to evaluate risks and determine appropriate coverage and premiums. Claims Investigation: Conduct investigations into insurance claims, which may include site visits, evidence collection, and coordination with law enforcement. Data Analysis: Analyze customer data to identify trends, improve underwriting processes, and support decision-making. Customer Interaction: Communicate with clients, insurers, and other stakeholders to clarify policy details and resolve issues. Regulatory Compliance: Ensure adherence to state and fed...

- Assist in validating and processing health insurance claims in accordance with Hong Kong Insurance Authority (IA) guidelines. - Ensure accurate data entry and documentation of claim details in the claims management system. - Support the review of claims for completeness and compliance with policy terms and conditions. - Coordinate with internal departments to gather missing documentation or information. - Flag potential discrepancies or anomalies for further review. - Maintain confidentiality and data protection standards in handling sensitive health information. - Respond to basic inquiries from policyholders regarding claim status and documentation requirements. - Ensure timely processin...

Eurofins Assurance India Pvt Ltd is a leading certification body providing Audit & Certification , Inspections , and other services covering the broad spectrum of sustainable supply chain. Eurofins will help the customers to mitigate risks in their supply chain and to ensure the benchmarking performance with operations, processes, systems, people or capabilities. Whether you are in Food, Cosmetics, Consumer products or Health care sector, our global auditor and technical expert network will help to mitigate/eliminate your risks against supply chain and distribution flows: Regulatory and Industrial standards . We have accreditations for a number of different industry standards/memberships to ...

Eurofins Assurance India Pvt Ltd is a leading certification body providing Audit & Certification , Inspections , and other services covering the broad spectrum of sustainable supply chain. Eurofins will help the customers to mitigate risks in their supply chain and to ensure the benchmarking performance with operations, processes, systems, people or capabilities. Whether you are in Food, Cosmetics, Consumer products or Health care sector, our global auditor and technical expert network will help to mitigate/eliminate your risks against supply chain and distribution flows: Regulatory and Industrial standards . We have accreditations for a number of different industry standards/memberships to ...

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...

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...

Warm Greetings from Rivera Manpower Services! We are hiring for the role of Senior Analyst (Service Support Associate) in the US Healthcare Insurance process. Location: [Bangalore] Shift: US Shifts Experience: Minimum 4+ years in International Voice with specific experience in Insurance / Healthcare (mandatory) Qualification: Graduate (15 years of education 10+2+3) Requirements: Minimum 4 years of international voice experience in Insurance / Healthcare domain Strong client servicing and stakeholder management background Excellent verbal & written communication skills In-depth knowledge of US Healthcare Insurance regulations Proactive and self-driven with strong problem-solving skills Advanc...

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...

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...

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...

The Role & Key Responsibilities: Benchmark Comp/Benefits data to ensure appropriate positioning in market whilst achieving global harmonisation where possible by developing cost-effective recommendations Support in developing timely, cost-effective and innovative solutions in response to business needs aligned with HR strategy Support the review and negotiation of benefit plan renewals Assist with benefit due diligence for various projects such as mergers & acquisitions, supporting key stakeholders to ensure complete comparisons are made and any issues/risks are highlighted Support with the annual salary & bonus review process, liaising with local HR teams and senior managers Act as first po...

About The Role Project Role : Business Analyst Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Must have skills : Microsoft Dynamics CRM Functional Good to have skills : NAMinimum 3 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As a Business Analyst, you will engage in a variety of tasks that involve analyzing organizational processes and systems. Your typical day will include assess...

About The Role Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations Specialist Qualifications: Any Graduation Years of Experience: 7 to 11 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.The business pr...

Role: Claims Adjudicators/Sr. Claims Adjudicators Location: Noida Key Skills: Knowledge of US Health Insurance domain, Claims Adjudication, Providers and Members Enrolment, MS Office and good keyboard skills. Experience: 3 + years in Claims Adjudication or in relevant field Job Description: We are seeking a detail-oriented and analytical Claims Adjudicator to review, evaluate, and process insurance claims in accordance with policy guidelines and regulatory standards. The ideal candidate will have a strong understanding of claims procedures, excellent decision-making skills, and a commitment to accuracy and compliance. Prior experience in claims processing or adjudication preferred. Familiari...

Job Summary Clinical claim Review Responsibilities Oversee the claims adjudication process to ensure accuracy and compliance with industry standards. Provide expertise in claims and payer domains to enhance operational efficiency. Analyze claims data to identify trends and areas for improvement. Collaborate with team members to streamline claims processing workflows. Ensure timely resolution of claims issues to maintain customer satisfaction. Develop and implement strategies to optimize claims adjudication procedures. Monitor performance metrics to ensure adherence to service level agreements. Communicate effectively with stakeholders to address claims-related inquiries. Utilize technical sk...

Job Summary Join our dynamic team as a Specialist in Provider Credentialing where you will leverage your expertise in healthcare products and credentialing processes to ensure compliance and efficiency. With 4 to 6 years of experience you will play a crucial role in maintaining the integrity of our provider network. This hybrid role offers the flexibility of night shifts allowing you to balance work and personal commitments effectively. Responsibilities Oversee the credentialing and re-credentialing processes for healthcare providers to ensure compliance with industry standards and regulations. Collaborate with cross-functional teams to streamline credentialing workflows and improve operatio...

Company: Casagrand Builder Private Limited Location: Thiruvanmiyur, Chennai Experience Required: 1 - 3 years About Casagrand: Casagrand Builder Private Limited is a leading real estate developer in South India, known for delivering high-quality residential projects that cater to the aspirations of homebuyers. With a strong presence in Chennai, Bengaluru, and Coimbatore, Casagrand is committed to excellence and customer satisfaction. Key Responsibilities: Query Resolution: Serve as the first point of contact for employees' queries related to medical insurance, benefits, and policies. Communication: Effectively communicate with employees to understand their concerns and provide timely and accu...

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...

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...