1604 Claims Adjudication Jobs - Page 40

Job Summary Join our dynamic team as a PE-Ins Claims specialist where you will leverage your expertise in the Life and Annuity domain to process and manage insurance claims efficiently. With a focus on accuracy and customer satisfaction you will play a crucial role in ensuring smooth operations and contributing to the companys success. This position requires working from the office during night shifts providing an opportunity to collaborate closely with team members and enhance your skills in a supporti Responsibilities Process insurance claims with precision and ensure compliance with company policies and regulations. Analyze claim documents and assess the validity of claims based on Life a...

Job Summary Join our dynamic team as a PE-Ins Claims specialist where you will leverage your expertise in the Life and Annuity domain to enhance our claims processing efficiency. With 1 to 3 years of experience you will work from our office during night shifts contributing to the seamless operation of our insurance services. Your role will be pivotal in ensuring accurate and timely claims management directly impacting customer satisfaction and company success. Responsibilities Analyze and process insurance claims within the Life and Annuity domain to ensure accuracy and compliance with company policies. Collaborate with team members to identify and resolve discrepancies in claims documentati...

We are Hiring hybrid wfh Back office Process Backoffice Marine/Motor Claims Insurance (Min 3yr To 9yrs BPO),Sal 10.00 LPA ( Pune / Mumbai /Kochi Location) Process : Back office Process /UK Insurance Process Min 1yr to 4yrs exp. International BPO !!!Easy Selection and Spot Offer!!! Salary upto 4.5 Lacs + Incentives. Walk in at Infinites HR Services, Cerebrum IT Park, B3, 1st Floor, Kalyani Nagar Pune 411014. Call : Call : WhatsApp call only Dipika- 9623462146 / 7391077623 / 7391077624 Fenkin Empire off no 404, 4th Floor, Thane West, 400601. Land Mark: Bhanushali Hospital, Station Road. Walkin Distance from Thane Railway Station. Meet Ali : 8888850831 / 8888850831 Regards Dipika 9623462146

Dear Applicant, Hiring for US Healthcare - Operations Manager(OM) Role: Operations Manager I DESIGNATION: Operations Manager I LOCATION: Pune Qualification : Any Graduate PACAKAGE : 13LPA YEARS OF EXPERIENCE: 10-12 years Key Role and Responsibilities: Managing a team of 150 associates with the help of aligned 5 to 7 TLs Meet and exceed SLA targets Understand operational metrics & have governance to ensure no misses Drive performance and exceed the expectations Attend weekly and monthly reviews with Internal Stakeholders and Client Actively involved in client calls & manage client needs Monitor production, efficiency, and schedule adherence tool to ensure high levels of efficiency Establish c...

Hiring for US Healthcare (B2B) Voice / Blended Process Graduate with 1 year customer service exp can apply Salary upto 3.30 LPA Location- Uppal 5 Days working Both side cab Fixed shifts (6:30 pm - 3:30 am) Contact Vanshita- 9910807579 Required Candidate profile Candidate must have good communication Skills. Candidate should have good typing speed. Candidate should be comfortable to work in fixed night shifts. Perks and benefits Incentives

Prepare ILAs, Final Survey Reports, and requirement letters Maintain updated records of claim intimation, surveyor visits, document status, and report submissions Follow up with insured parties to minimize TAT Enter claims info in CMS software Health insurance Provident fund

Experience in BPO Industry- International Voice only Team Leader - Health and welfare process voice (MUST) Health and welfare - Medicare Hippa Cobra Excellent Comms

We are looking for a highly skilled and experienced PDI Associate to join our team at Ekya Schools. The ideal candidate will have 2-5 years of experience in the field. Roles and Responsibility Collaborate with cross-functional teams to design and implement effective learning solutions. Develop and maintain high-quality educational content and materials. Provide training and support to teachers and staff on new technologies and methodologies. Evaluate student progress and provide feedback to improve outcomes. Participate in professional development opportunities to stay current with best practices. Foster positive relationships with students, parents, and community members. Job Requirements S...

Company: Marsh Description: Ensures timely and accurate production/processing of complex documents/information (includes report preparation) Maintains a basic understanding of the core aspects of relevant Insurance and related legislation (customer awareness) and strengthen established relationships Adheres to Company policies and performance standards Contributes to the achievement of Operations team Service Level Agreements (SLA) , Key Performance Indicators (KPI) and business objectives Marsh, a business of Marsh McLennan (NYSE: MMC), is the world s top insurance broker and risk advisor. Marsh McLennan is a global leader in risk, strategy and people, advising clients in 130 countries acro...

Desired Candidate profile Good communication skills Fresh Nursing Graduates Analyze and process US medical claims and billing records Basic computer literacy Flexible with shift timings Benefits

We are looking for a skilled Payment Posting and Charge Entry - Rcm Executive to join our team at Prodat IT Solutions, with 1-6 years of experience in the field. Roles and Responsibility Manage payment posting and charge entry processes for accurate and timely payments. Coordinate with clients and internal teams to resolve payment-related issues. Develop and implement process improvements to increase efficiency and reduce errors. Analyze data to identify trends and areas for improvement in payment posting and charge entry. Collaborate with cross-functional teams to achieve business objectives. Ensure compliance with company policies and procedures. Job Requirements Strong knowledge of paymen...

Looking to onboard a highly motivated and detail-oriented AR Associate with 0-1 years of experience to join our team in Bengaluru. The ideal candidate will have excellent communication skills and the ability to work effectively in a fast-paced environment. Roles and Responsibility Manage accounts receivable, including processing payments and resolving billing issues. Coordinate with clients to ensure timely payment and resolve any discrepancies. Maintain accurate records of all transactions and reports. Collaborate with internal teams to resolve account-related issues. Develop and implement effective strategies to improve cash flow. Analyze data to identify trends and areas for improvement. ...

Cashless Executive, TPA Executive, Insurance Executive Responsibilities: Patient Eligibility Verification: Claim Processing: Pre-authorization and Approvals: Coordination: Status Tracking and Follow-up: Cashless Admission Facilitation:

Vidal is hiring for claim Processor Designation: Executive-Claims Location: Gurgaon, Key Responsibilities: Review and validate claim documents submitted by hospitals or insured members Scrutinize medical records and bills for completeness and accuracy Apply policy terms, conditions, and exclusions to adjudicate claims Perform ICD and procedure coding as per ailment and treatment Coordinate with medical officers for clinical opinion when required Maintain claim logs and update CRM systems with claim status Ensure adherence to defined SLAs and minimize processing errors Flag suspicious or potentially fraudulent claims for investigation Communicate with stakeholders for clarifications or missin...

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through d...

Job Title: Business Analyst (Candidate must have experience in to US Healthcare Domain Adjudication System) Job Summary: We are seeking a motivated and detail-oriented Business Analyst with 3+ years of experience, preferably in the US healthcare domain , to join our dynamic team in Pune. This is a full-time, on-site position ideal for someone who thrives in a collaborative environment and is passionate about driving process improvement and delivering value through data-driven insights. The ideal candidate will work closely with cross-functional teams including operations, technology, and client stakeholders to understand business needs, analyze processes, and contribute to high-impact health...

Key Roles : Ensure accurate documentation and timely claim settlement Follow up with TPA and Govt. bodies for approvals/payments Strong knowledge of Govt. healthcare panels (ECHS, CGHS, ESIC, etc.) Experience in hospital billing & claim processing Annual bonus Provident fund Health insurance

Managing CGHS, ECHS, CAPF and Ayushman Bharat Government Portals: Claim Processing Audit Uploading Query Management Reconciliation and Recovery Management. Annual bonus Provident fund Health insurance

Hiring for US Healthcare (B2B) Voice / Blended Process Graduate with 1 year customer service exp can apply Salary upto 3.30 LPA (23k in hand) Location- Uppal 5 Days working Both side cab facility Fixed Sat-Sun off Fixed shifts (6:30 pm - 3:30 am) Required Candidate profile Candidate must have good communication Skills. Candidate should have good typing speed. Candidate should be comfortable to work in fixed night shifts. Perks and benefits Incentives Meal facility

Role & responsibilities Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication. Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial. Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information. Utilize claims processing systems and software to enter, update, and retrieve claims information accurately. Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse. Ensure timely processing of claims to meet internal and external dea...

Positions, General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & 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 Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processi...

Job Description Experienced in AR calling, Denial Management, checking eligibility and Authorization verification. Must be familiar with MDLand and Athena . Calling Insurance companies on behalf of physicians and carryout further examination on outstanding Accounts Receivables. Prioritize unpaid claims for calling according to the length of time it has been outstanding. Call insurance companies directly and convince them to pay the outstanding claims. Check the relevance of insurance info offered by the patient. Evaluate unpaid insurance claims. Call insurance companies and check on the status of claims and verifying authorization. Transfer the outstanding balance to the patient of he/she do...

Business Analyst The Business Analyst will work closely with Salesforce and Sales Operations team. You will be responsible for providing operational and strategic level analytical support to various Business Units at Zeta Global. The successful applicant will be able to demonstrate excellent judgement, work well under pressure, prioritize effectively, and work collaboratively with stakeholders across the company. Primary Job Duties & Responsibilities Update Financials Models that bring together: Closed Won sales to Income Statement Revenue and other sales driven metrics to understand the trends in the sales organization Ability to interpret data and turn it into insights for the business (tr...

What this job involves: Responsibilities: Daily Cash Application. Handle mailbox for request and query management Perform daily transactions as per standard operating procedures Allocating work to the team and ensuring service delivery as agreed norms and SLAs Creation of Statement of Accounts and Refund Packets Update process documents and capture the exceptions while processing as and when required Provide support during internal/ external audits Provide new hire orientation and process training Ability to multi-task and work in a dynamic and fast paced environment Team player and yet able to work independently Perform other duties assigned as and when required i.e. process improvement ini...

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 ...