1627 Claims Adjudication Jobs - Page 43

Role Description: As a Revenue Cycle Management (RCM) Associate / Senior Associate at PDA E-Services Pvt Ltd , you will be an integral part of our US healthcare operations team, responsible for managing the end-to-end revenue cycle process for dental practices in the United States. Your primary focus will be to ensure accurate billing, efficient payment processing, timely insurance follow-ups, and effective resolution of revenue-related discrepancies. Company Profile: PDA E-Services Pvt Ltd is a dynamic and fast-growing Global Capability Centre (GCC) for Piccadilly Dental Alliance (PDA) , a leading dental healthcare organization in the United States. Established in 2022 , we provide operatio...

We are Hiring Candidates who are experienced in AR Calling specialized in end to end RCM (International Voice only) for Medical Billing in US Healthcare Industry. *Roles and Responsibilities* Reviews the work order. must have work experience in worker compensation or auto insurance or claim adjudication Follow-up with insurance carriers for claim status. Follow-up with insurance carriers to check status of outstanding claims. Receive payment information if the claims has been processed. Analyze claims in-case of rejections. Ensure deliverables adhere to quality standards. *Candidates with excellent communication and strong knowledge in end to end RCM can apply.* ONLY IMMEDIATE JOINERS PREFER...

Review the claim allocated and check status by calling the payer or through IVRWeb Portal Ask a series of relevant questions depending on the issue with the claim and record the responses Prepare call notes, initiate or execute the corrective measures by sending necessary documents to Payers Record the actions and post the notes on the clients revenue cycle platform Us e appropriate client specific call note standards for documentation Adhere to Companys information, HIPAA and security guidelines Be in the center of ethical behavior and never on the sidelines Job Profile: Should have worked as an AR Caller for at least 2 years to 4 years with medical billing service providers Good knowledge ...

• 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 and raise an IR in case of an insufficiency. • Coordinate with the LCM team in case of higher billing and with the provider team in case of non- availability of tariff. • Approve or deny the claims...

Experience in BPO Industry- International Voice only Team Leader - Healthcare process voice (MUST) Medical billing AR Excellent Comms

About The Role Vault functionEnsure timely opening of vault and availability of cash to cash van officers.To ensure Proper cash dispensing branch wise with no errors. Adjudication of Notes as per RBI norms & Rules-Updation of bin register and card on time and ensuring proper signatures.-Managing cash inflows and out flows from chest vault and periodical balancing during the day. -Ensuring constant supply of ATM Counter issuable cash. Ensure enough fresh cash availability in all denominations.-To keep the vault clean of any un wanted stuff.Must have knowledge to pass notes as per RBI refund rules and to get full value during RBI inspections. -Proper scrutiny and upkeep of key registers and ke...

About The Role Vault functionEnsure timely opening of vault and availability of cash to cash van officers.To ensure Proper cash dispensing branch wise with no errors. Adjudication of Notes as per RBI norms & Rules-Updation of bin register and card on time and ensuring proper signatures. -Managing cash inflows and out flows from chest vault and periodical balancing during the day. -Ensuring constant supply of ATM Counter issuable cash. Ensure enough fresh cash availability in all denominations.-To keep the vault clean of any un wanted stuff.Must have knowledge to pass notes as per RBI refund rules and to get full value during RBI inspections. -Proper scrutiny and upkeep of key registers and k...

Overview Roles & Responsibilities: 1) Candidates Should have worked in hospital Insurance desk 2) Provide Medical opinion for health Insurance claims 3) Processing of cashless requests & Health Insurance claims document 4) Proficient with medical terms & system 5) Understanding of policy terms & system. 6) Understanding of Claims adjudication/ Claims Processing Tagged as: insurance Before applying for this position you need to submit your online resume . Click the button below to continue. Related Jobs RELATIONSHIP OFFICER IN BANK Bank Jorhat Full Time 2024-01-19

Claims Executive Responsibilities: Receiving and answering emails, telephone calls related to claims Advice policyholders on claim procedure Ensure fair settlement of a claim with TAT Manage all administration aspects of the claim Adhere to legal requirements, industry regulations and customer quality standards set by the company. Handle any complaints associated with a claim Claims Executive Requirements: A bachelor's degree in any discipline. At least 2-4 years' experience as a claims handler or a similar role. Excellent time management skills and organizational abilities. Top-notch client interaction skills. Ability to work in a high-pressure environment. A general understanding of insura...

We are looking for an experienced CGHS Billing Executive with a minimum of 2 years of experience in hospital billing, specifically handling CGHS (Central Government Health Scheme) processes.

Job Title: Sr Manager Health Insurance Claims Location: Bangalore (Hybrid) Company: Pazcare Type: Full-time About Pazcare Pazcare is transforming employee healthcare and wellness for 2000+ companies including Mamaearth, Chaayos, Mindtickle, and more. We simplify health insurance and wellness benefits, giving HR teams superpowers through real-time claim tracking, analytics, and stellar employee experiences. Role Overview As a Claims Manager, you will be the frontline owner of ensuring claims are settled within the agreed turnaround time (TAT) across TPAs. You will play a critical role in driving TPA performance, resolving escalations, and advocating on behalf of our clients to ensure no valid...

Dear Candidate, Greetings from NTT DATA. We are happy to take your profile for a wonderful career with NTT DATA. Job Title: HC & Insurance Senior Associate (Claims Adjudication/Processing) Experience: 3 - 5 Years of relevant experience in Claims adjudication Skillset: HIPAA. ICD, CPT Codes, Medicare, Medicaid, Copay & Coinsurance Shift: Night Shift Work Location: Chennai - DLF Cybercity Mode of Work: Work From Office 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 busine...

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 processin...

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check the medical ...

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai/Bangalore Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and Check th...

Davies is seeking a highly organised and self-motivated professional to join our Life & Health team as an Administrator Team Leader. In this role, you will provide leadership, guidance, and direction to a dedicated team, ensuring the achievement of key results and operational excellence. Your responsibilities will include overseeing document indexing, imaging, quality audits, data entry and the review of Proof of Loss (POL), as well as processing policy documents and claims. You will play a critical role in handling sensitive files and processing essential documents to support our US operations. This is an excellent opportunity for a proactive and detail-oriented individual looking to make a...

I am hiring for this position for one of our Life Insurance clients. Role & responsibilities Prudent claim Assessment and management of end-to-end claim settlement /repudiations, including Life, Group claims Coordinate with Reinsurers /sales/customers for closure of claims within the regulatory framework and timelines Direct and oversee the maintenance of complete and accurate claim management records. Managing the claim teams on day-to-day claims transactions, guidance on claims philosophy, regulatory, and audit procedures Ensuring daily claim deliverables are met and claims decisions within prescribed SLA with quality Ensure customer centric approach while delivering sensitive area of deat...

Finance Analyst Accounts Receivable Client Finance - JLL Business Service (Gurugram) 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 ...

Job description: We are hiring Claims Adjudication Experienced HR Recruiter (Reference): Sam Jeshurin Job Location: Firstsource Solution Limited, 5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103. Landmark: Near Vivira Mall. Shift Details: Night shift / Flexible to work in any shift and timing Cab Boundary Limit: We provide cab Up to 30 km (One way drop cab | Doorstep only) Minimum Eligibility: 1. Minimum 1 year experience in Claims Adjudication Process. Note: This is not for Freshers and Direct walk-in interview (No Virtual) Walk-In Details: Walk-In Days: Monday To Friday Walk-In Time: 10:30 AM - 2:00 PM Documents to carry: 1. Updated resume 2. Aadhar card 3. P...

Understand the US P&C Insurance / Claims function end to end. FNOL Pre-Adjudication like Coverage Verification, Indexing Subrogation and Salvage Document Management Loss Run Should have a basic understanding of the insurance policy and Claim life cycle. Good to have knowledge of end-to-end Claims function/Insurance life cycle Must have good knowledge of insurance terms premium, deductibles, claim etc Good written and verbal communication, and a team player Strong analytical skills Analyses and synthesizes information/makes decisions based on policies. Responsible and dedicated to meet the clients expectations. Prioritizes tasks in order of importance. Key Responsibilities: › Review requests ...

The candidate must have completed BHMS, BAMS, or BUMS from a reputed university." Experience : 0 to 2 years Locations : Bangalore, Chennai and Mumbai / Pune Role & responsibilities To give Claims & Cashless/preauthorization, and scrutiny Medical Reimbursement Claims, and to Process Claims Third Party Administration (Health) services (TPA) Claims and Preauthorization Processing HealthCare Assistance Services High Ratio Claims Management in coordination with Networking and Empanelment Department Monitoring the overall operations of Claims and Preauthorization. Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT. Ensure adherence to processes and control...

Designation/ Role: Trainee Department: Accounts Receivable Work Timing: Night Shift Qualifications: Minimum HSC/10+2 Equivalent (Any Graduate Preferred) Skills: Good verbal and written communication Skills. Able to build rapport over the phone. Strong analytical and problem-solving skills. Be a team player with positive approach. Good keyboard skills and well versed with MS-Office. Able to work under pressure and deliver expected daily productivity targets. Ability to work with speed and accuracy. Medical billing AR or Claims adjudication experience will be an added advantage. Experience 01-year experience US calling process will be an added advantage. Job Description The job involves an ana...

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 : GuideWire Integration Good to have skills : NAMinimum 2 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 assessing the curr...

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...

Manager Membership Location-Noida Designation-Membership Manager Experience-6- 12 Years Job Details/ Criteria Basic Functions/ Job Responsibility: Will be responsible for a portfolio of key members, building strong relationships and acting as a single point of contact for their requirements. Proactively manage and nurture member relationships, understanding their specific requirements and challenges to deliver exceptional service and engagement. Develop trusted relationship with senior leaders and CXOs of the organizations. Develop and implement strategies to drive member engagement with nasscom initiatives, events, and programs. And execute planned initiatives. Track and analyse key member ...