1627 Claims Adjudication Jobs - Page 44

Clients business problem to resolve : At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our companys growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. Clients Business problem to solve? Our Client is one of Leading Health Plan in US providing services in Florida state , NTT are getting into contract with Client to manage End to End Claims Administration services. Our NTT Business Process...

Looking for doctors who have experience in processing Cashless And Reimbursment Claims (Group or Retail) Experience - 2+ years in claim processing

Claims processing Doctor Job Description: Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance. With the medical expertise ,need to master the various products and to apply the same during claim processing. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. List of Responsibilities: To validate the authenticity and the credibility of the claims. To coordinate with various persons (Claimant, Treating...

Primary Responsibilities: Lead a team of 25 – 30 certified coders. Maintains staff by orienting and training employees; maintains a safe, secure, and legal work environment Performance Management – Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educ...

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledg...

R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, Top 100 Best Companies for Women by Avtar & Seramount, and amongst Top 10 Best Workplaces in Health & Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by...

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledg...

: Job Title: Client On Boarding, NCT Location: Jaipur, India Corporate TitleNCT Role Description The Analyst will be responsible for completion of day-to-day activity as per standards and ensure accurate and timely delivery of assigned production duties. The role is required to verify account opening documents for PWM US client against the KYC. And also ensure correct FATCA reporting to comply with regulatory requirement. Candidate/Applicants would need to ensure adherence to all cut-off times and quality of processing as maintained in SLAs. What well offer you 100% reimbursement under childcare assistance benefit (gender neutral) Sponsorship for Industry relevant certifications and educatio...

Educational Bachelor of Engineering,BCA,BTech,MBA,MTech,MCA Service Line Application Development and Maintenance Responsibilities A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your ...

Educational Bachelor of Engineering,BCA,BTech,MCA,MTech,MBA Service Line Application Development and Maintenance Responsibilities As a ‘Senior Product Manager’ you will be pivotal to creating roadmap, owning release plan for multiple capabilities that is futuristic and meets industry and client needs. You will be responsible for continuous backlog management, prioritizing the backlog considering the needs and objectives of every stakeholder. As a thought leader in your business domain, bring in industry best practices, learnings from client demos and interactions into designing. You will anchor business pursuit initiatives, sales demo. You will have the opportunity to shape the Infosys platf...

Role & responsibilities Claims adjudication, claims approval, TAT, accuracy, productivity, claims cost, fraud and leakage control, client/provider feedback, team training and retention Preferred candidate profile Processing claims, quality check and adherence to TAT, fraud triggers, fraud risk assessment, computer skills. Candidate should be open to work in 24X7X365 environment Microsoft office proficiency Knowledge of Indian Health Care and prior experience in Health Insurance Claim Processing, Good Clinical Acumen Minimum 1-3 Years Preferred Industry Health Insurance/TPA/Hospital / Clinical Practice/heath care/ wellness etc.. Minimum- Medical Graduate (BDS/BAMS/ BHMS/BPT/ BUMS) Preferred L...

We are looking for a performance-driven Team Leader to lead our international voice support team. The ideal candidate should bring 5+ years of total experience in a voice-based BPO setup with at least 1-2 years of hands-on experience in team handling. The role is crucial in maintaining operational excellence improving CSAT scores and ensuring minimal attrition. Key Responsibilities : - Lead and manage a team of voice agents in delivering high-quality international customer support Drive and achieve targets for CSAT (Customer Satisfaction)" AHT (Average Handling Time) FCR (First Call Resolution) and Quality Scores Actively monitor and improve customer experience through coaching and root caus...

Looking for an Accounting Receivable Specialist with 1+ year of U.S. medical billing experience, knowledge of EOBs, denials, CPT codes, and U.S. insurance. Must work U.S. shifts from Pune. Healthcare experience required. Provident fund

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the cl...

Role & responsibilities Shift timings (01:30 PM - 10 PM ) Hybrid Mode- Work from office. Looking for Immediate joiner. What will you do? Review complex claims and estimates for completeness and follow processes for incomplete information on claims Assess and adjudicate complex claims and estimates Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision Meet production and quality standards set for individuals, teams and department (timeliness, quality and service) Handle external and internal inquiries vi...

Create the future of e-health together with us by becoming a Manager Credentialing. As one of the Best in KLAS RCM organization in the industry we offer a full scope of RCM services as well as BPO services, our organization gives our team members the training and solutions to learn and grow across variety of technologies and processes. As an innovator and leader in the e-health services we offer unparalleled growth opportunities in the industry. What you can expect from us: A safe digital application and a structured and streamlined onboarding process. An extensive group health and accidental insurance program. Our progressive transportation model allows you to choose: You can either receive...

Career Club Consultancy and Management Services is looking for Customer Service Representative- Only For Nashik Candidates Freshers to join our dynamic team and embark on a rewarding career journeyResponsible for handling customer inquiries and complaints, providing information and resolving issues in a prompt and friendly manner. Act as the first point of contact for customers and play a critical role in building and maintaining customer loyalty. The primary duties of a CSR include answering phone calls, responding to emails and chat requests, troubleshooting problems, and processing orders or returns. Good communication, interpersonal, and problem-solving skills are essential for this role...

Analyst Claims- Review and process property insurance claims, including analyzing policies, assessing damage, and determining coverage and settlements. Work with insurance adjusters, clients, and third-Frty vendors to gather necessary information and documentation for claims processing. Collation of data and information of claims for reporting purposes Investigate and evaluate claims to ensure accuracy and completeness. Prepare and present reports and recommendations to management regarding claims status, trends, and outcomes. Involvement in subrogation requests and required follow-ups. Communicate with clients and stakeholders regarding claims status and resolution. Provide support to other...

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...

About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, and India. Our rightshore delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 compan...

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 Chennai Educational Qualification Shift BHMS, , BAMS , BDS, B.Sc Nursing. Rotational Shift (for female employee shift ends at 7:30 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 admissibility ...

We are hiring medical officers for cashless claims processing. Ideal candidates have 0-2 years in TPA/insurance with BAMS/BHMS. Strong medical knowledge and understanding of health policy terms are required.

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 year 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.accenture.com What would you do We help insurers redefine their custom...

Skill required: Group Core Benefits- Claims Case Mgmt. Group Disability Insurance Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years 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.accenture.com What would you do We help insurers redefine their customer ...

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years 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.accenture.com What would you do We help insurers redefine their customer expe...