1604 Claims Adjudication Jobs - Page 37

Join our dynamic team as a Claims Processing Specialist where you will play a crucial role in ensuring the accuracy and efficiency of claims adjudication. With a focus on Medicare and Medicaid claims, you will contribute to the seamless processing of claims enhancing our service delivery. This hybrid role offers the flexibility of working both remotely and on-site during night shifts. Responsibilities Process claims with precision ensuring adherence to Medicare and Medicaid guidelines. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Utilize claims adjudication software to enhance processing ...

Join our team as a Subject Matter Expert in Claims HC where you will leverage your expertise in Facets Claims and Claims Adjudication to optimize our claims processing systems. With a focus on Dental and Commercial Claims you will play a pivotal role in enhancing operational efficiency and ensuring compliance with industry standards. This office-based role offers the opportunity to work in a dynamic environment contributing to impactful projects that benefit both the company and society. Lead the analysis and optimization of claims processing workflows to enhance efficiency and accuracy. Oversee the implementation of Facets Claims and Claims Adjudication systems to ensure seamless integratio...

As a Dental Claims Processor at MetLife, you will be responsible for scrutinizing dental claim documents and settlements, ensuring accurate processing of claims according to healthcare guidelines and HIPAA regulations. Your role will involve handling escalations, meeting quality and productivity targets, and complying with internal policies, external regulations, and information security standards. You will need to have a good understanding of claims adjudication fundamentals, ICT & CPT Codes, and be able to learn, adapt, and implement process guidelines effectively. To qualify for this position, you should hold a Bachelor's degree in any stream or a diploma with a minimum of 15 years of edu...

Arzion RCM is looking for Arzion Business Solutions - Trainee AR Caller in Chennai to join our dynamic team and embark on a rewarding career journeyAssisting experienced employees with their daily tasks and responsibilities.Observing and gaining hands-on experience in various aspects of the job.Receiving feedback and guidance from supervisors and mentors.Completing assigned projects and tasks under the supervision of experienced employees.Collaborating with team members and contributing to team projects.Demonstrating a strong work ethic, positive attitude, and a willingness to learn and grow.

- Offer comprehensive support through both phone and email communications. - Address complaints effectively, delivering suitable solutions and alternatives within established timeframes. - Conduct follow-ups to guarantee resolution. - Supply accurate and relevant information utilizing the appropriate tools. - Document and update notes for each call or email interaction. - Exceed expectations to prevent any inconvenience.

- Offer comprehensive support through both phone and email communications. - Address complaints effectively, delivering suitable solutions and alternatives within established timeframes. - Conduct follow-ups to guarantee resolution. - Supply accurate and relevant information utilizing the appropriate tools. - Document and update notes for each call or email interaction. - Exceed expectations to prevent any inconvenience.

Primary Responsibilities: Be able to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines Be able to review and analyze medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation Be able to extract and code various screening CPT codes and HCPCS codes from the documentation Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity Under general supervision, organizes and prioritiz...

Primary Responsibilities: Be able to implement all the updates of AMA guidelines, AHA guidelines, and CMS guidelines Be able to review and analyse medical records and add/modify CPT codes for minor surgical procedures, vaccines, and laboratory CPT codes as per documentation Be able to extract and code various screening CPT codes and HCPCS codes from the documentation Be able to check NCCI edits and LCD & NCD coverage determinations and modify ICD-10-CM codes, CPT codes, and modifiers accordingly Be an ideal team player who can work in a large group and provide inputs to the team for betterment of the team in terms of quality and productivity Under general supervision, organizes and prioritiz...

Book your interview slot WhatsApp your profile @ 9623462146 / 7391077622 or Dipika@infiniteshr.com ******Hiring for P & C Insurance Team Manager / Sr TM , Salary upto 14.00L*** ****Hiring Team Manager Insurance process**** Salary upto 10 LPA Exp: 6 to 15 Yrs Salary : Upto 14 Lacs Regards Dipika Sharma 9623462146 7391077622 8888850831

Job Title: Motor Insurance Claims Handler (Bodily Injury Focus) Location: Bangalore Employment Type: Full-Time Department: Claims / Insurance Operations Reports To: Claims Team Lead / Claims Manager Job Summary: We are seeking a skilled and detail-oriented Motor Insurance Claims Handler with experience in bodily injury claims . The successful candidate will be responsible for managing and processing motor insurance claims efficiently and fairly, with a specific focus on bodily injury liability, third-party damages, and personal injury claims. This role requires strong analytical skills, empathy, and knowledge of motor insurance policies, local legislation, and medical terminology. Key Respon...

Senior Finance Analyst Accounts Receivable Client Finance - JLL Business Service (Gurugram) What this job involves: Conduct a comprehensive analysis of bank deposits and execute precise application of deposits to designated tenant accounts Perform in-depth analysis of tenant ledger histories to identify and resolve discrepancies in payment transactions Performing quality checks to ensure all the deposits are correctly applied against each tenant's accounts Query handling working upon all queries received and keeping a close tab on any pending queries that could be resolved, and following up on the rest Collaborate with Accounting and Property Management professionals to facilitate appropriat...

Review Google for missing data elements. Initiate request for medical via system. Ability to prioritize and maintain quality. Clear and accurate written and verbal communication (Scripted and Templatized) with stateside Required Candidate profile Knowledge about the Insurance industry in US Knowledge about US Culture Knowledge of Insurance principles Knowledge of Disability domain interpret business documents. Good verbal comms

FHRM is looking for Credentialing Specialist to join our dynamic team and embark on a rewarding career journey Credential Verification: Credentialing Specialists collect and verify all relevant documents and information from healthcare providers, including medical licenses, certifications, education, training, work history, and references. Provider Enrollment: They facilitate the enrollment of healthcare providers in insurance networks and government healthcare programs by ensuring that all necessary paperwork and credentials are in order. Compliance: Credentialing Specialists ensure that healthcare providers comply with legal and regulatory requirements, as well as with the organization's p...

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...

What this job involves: Analysing cash/amount received in the bank deposits and making the application against the tenant accounts Analyse and research tenant ledgers history against the over/short payments. Query handling working on all queries received and keeping a close tab on any pending queries that could be resolved and following up on the rest. Contact accountants and Property teams whenever necessary to determine the proper payment application. Research and analyse duplicate and erroneous payments. Escalate unresolved issues/concerns. Assist in training new employees as needed. Working on different process-related and ad-hoc reports Keeping all the process-related documents intact o...

Graduate from recognized universities. (B Tech CSE/IT not eligible). Freshers and experienced candidates from 2.5 to 4 years are eligible Preferred candidates with Claims/Claims Adjudication Experience with BPO sector/ domain are preferrable Possess strong Problem solving skills, analytical knowledge and communication skills- both written and verbal. Collaborative, high-energy and diligent work ethics to be displayed at all times. Strong ability to multi-task and support different functions based on business requirements. Complete tasks according to the established standards with limited instruction and supervision. Should possess team-based working style coupled with the zeal to expand the ...

About the Team The Claims team at Navi is responsible for delivering a fast, transparent, and customer-first claims experience. From initial intimation to final settlement, whether cashless or reimbursement, they manage the end-to-end process with a strong focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and use data-driven insights and process automation to improve claim resolution speed and customer satisfaction. About the Role The role involves end-to-end medical claims adjudication, including reviewing treatment records, verifying eligibility, identifying potential fraud, and making informed claim decisions. It r...

About The Role Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(International) - Intermediate About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accent...

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development pr...

Roles and Responsibilities : Review and process claims from receipt to payment, ensuring accuracy and timeliness. Conduct thorough provider data management, including verification of provider information and eligibility checks. Collaborate with internal stakeholders to resolve claim discrepancies and ensure compliance with regulatory requirements. Maintain accurate records of all interactions with providers, patients, and insurance companies. Job Requirements : 1-4 years of experience in US Healthcare Claims Adjudication or related field. Strong understanding of PDM (Provider Data Management) systems and processes. Proficiency in reviewing medical records, diagnosis codes, and treatment plan...

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...

TATA AIG General Insurance Company Limited is looking for Manager - Commercial Claims to join our dynamic team and embark on a rewarding career journey Delegating responsibilities and supervising business operations Hiring, training, motivating and coaching employees as they provide attentive, efficient service to customers, assessing employee performance and providing helpful feedback and training opportunities. Resolving conflicts or complaints from customers and employees. Monitoring store activity and ensuring it is properly provisioned and staffed. Analyzing information and processes and developing more effective or efficient processes and strategies. Establishing and achieving business...

""" 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. """

Job Summary Join our dynamic team as a Claims Processing Specialist where you will play a crucial role in ensuring the accuracy and efficiency of claims adjudication. With a focus on Medicare and Medicaid claims you will contribute to the seamless processing of claims enhancing our service delivery. This hybrid role offers the flexibility of working both remotely and on-site during night shifts. Responsibilities Process claims with precision ensuring adherence to Medicare and Medicaid guidelines. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Utilize claims adjudication software to enhance ...

Davies is looking for an experienced Processing Specialist to join our growing team! As a Processing Specialist, you will assist the claims departments with general clerical functions. Reporting to the Processing Supervisor, you will open and scan mail documents, including attaching scanned documents in the claims system.