1627 Claims Adjudication Jobs - Page 48

R1 is a leading provider of technology-driven solutions that help hospitals and health systems to manage their financial systems and improve patients experience. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, Al, intelligent automation and workflow orchestration. R1 is a place where we think boldly to create opportunities for everyone to innovate and grow. A place where we partner with purpose through transparency and inclusion. We are a global community of engineers, front-line associates, healthcare operators, and RCM experts that work t...

About US: R1 is a leading provider of technology-driven solutions that help hospitals and health systems to manage their financial systems and improve patients experience. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, Al, intelligent automation and workflow orchestration. R1 is a place where we think boldly to create opportunities for everyone to innovate and grow. A place where we partner with purpose through transparency and inclusion. We are a global community of engineers, front-line associates, healthcare operators, and RCM experts t...

R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work For TM 2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore , and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities . Designation S r. Analyst /Lead Associate Repo...

Experience with customer interaction, requirements gathering, gap analysis and sound understanding of the software development lifecycle is a must Familiarity with the business processes of at least one of the verticals like Financial Services, Banking is a must Contributing best practices Ideas to the product road map. Create the test scenarios and conduct functional validation. Excellent problem solving, presentation, written and oral communication skills Interact with clients during project kick-off, requirement gathering, gap analysis workshops, end user training and product delivery Create epics and user stories Mandatory Competencies BA - BA BA - Business Knowledge BA - Client Interact...

Educational Bachelor of Engineering,BCA,BSc,MTech,MCA,MSc Service Line Enterprise Package Application Services Responsibilities A day in the life of an Infoscion As part of the Infosys consulting team, your primary role would be to actively aid the consulting team in different phases of the project including problem definition, effort estimation, diagnosis, solution generation and design and deployment You will explore the alternatives to the recommended solutions based on research that includes literature surveys, information available in public domains, vendor evaluation information, etc. and build POCs You will create requirement specifications from the business needs, define the to-be-pr...

Educational Bachelor of Engineering,BCA,BTech,MTech,MBA,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,BTech,BCA,MBA,MTech,MCA 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...

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 : Financial Processes Good to have skills : NAMinimum 3 year(s) of experience is required Educational Qualification : 15 years full time education Summary :This role involves providing comprehensive functional helpdesk support and system administration for financial and compliance control systems like Blackline and Auditboard. Key responsibi...

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS- 8951865563 Whatsapp CV mail id -sarika.pallap@mediassist.in

SME Responsibilities: 1. Provide expert knowledge and guidance in medical billing procedures, coding, and compliance standards. 2. Process Improvement: Analyze existing billing processes and systems to identify opportunities for improvement in efficiency and accuracy. 3. Training and Development: Develop training materials and conduct training sessions for staff on medical billing best practices, new regulations, and software updates. 4. Audit and Compliance: Conduct regular audits to ensure billing practices comply with regulatory requirements and internal policies. 5. Quality Assurance: Implement quality assurance measures to maintain high standards of accuracy and completeness in billing ...

Review and validate claims as per hospital MOU terms. Ensure accurate mapping of pricing, packages, inclusions, and exclusions. Coordinate with internal teams for issue resolutions Eligibility: BDS, BHMS, BAMS, BPT graduates. Work Type: Remote

Job Summary We are seeking a highly skilled Test Lead with 8 to 12 years of experience to join our team. The ideal candidate will have expertise in PLM Functional Knowledge and Windchill with a preference for experience in the Provider domain. This is a work-from-home position with day shifts and no travel required. The Test Lead will play a crucial role in ensuring the quality and reliability of our products contributing to the companys success and societal impact. Responsibilities Lead the testing efforts for PLM systems ensuring all functionalities meet the required standards. Oversee the development and execution of test plans and test cases for Windchill applications. Provide guidance a...

To ensure that all underwriting placement/ client service requirements of clients are met as per Company defined TATs Structuring and sourcing quotes for fire, marine, property, engineering, liability, motor and other miscellaneous insurance policies of clients Ensuring optimal product coverage & premium pricing Negotiating with insurers for best rates terms Vetting policy documents received from insurers in terms of terms, coverage, etc., Timely reconciliation of each account Ensuring timely updation of data details in appropriate tools solutions Effectively coordinating between client insurers for any document collection handover Effectively coordinating with the TPA for daily service requ...

We are seeking a dedicated and detail-oriented Appeals & Grievances Processor with a strong background in the US healthcare payor sector. This role involves working as part of a team to resolve complex member and provider issues related to appeals and grievances, ensuring compliance with Medicare, Medicaid, and health plan standards. Minimum Qualifications: 2+ years of experience in the US healthcare payor sector. 1+ year of experience in processing appeals and grievances. Strong understanding of denial management and claims adjudication. Experience with Medicare and Medicaid from the payor side. Responsibilities: Analyze and resolve member and provider appeals, grievances, and disputes in c...

Job Summary - A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Appeals and Grievances Managed Services (AGMS) team will provide you with the opportunity to act as an extension of our healthcare clients' business office. We specialize in appeal and grievances functions and addressing member complaints for health plans and their business partners. We leverage our clients customized workflows and associated automations in conjunction with clients data advanced data analysis and quality assurance proc...

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...

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 365 Operations Functional Good to have skills : NAMinimum 5 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 ...

Interacting with patients in a compassionate and empathetic manner, explaining the purpose of the sleep test, and providing clear instructions on how to use the device properly Setting up the sleep testing device at the patient's home, ensuring it is functioning correctly, and providing thorough instructions on how to operate it safely and effectively Troubleshooting and Repairs: Diagnose technical issues with medical devices, identify root causes, and implement timely repairs to minimize downtime

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Looking for voice process only. Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : kowsalya.k HR (8122343331)

Graduate 7-8 years of relevant exp Responsible for end-to-end claims adjustor Flexible with rotational shifts Excellent communication skills

To be liaison between the patient, the hospital, and TPA, managing claim processing by coordinating with the TPA to facilitate timely claim settlements and patient billing, all while adhering to insurance guidelines and regulations.

Primary Responsibilities: Achievement of individual productivity and quality standards Contribute to working on Volumes when required and asked by the Management or Stakeholder Examining and identifying overpayments in claims, securing savings through recovery, and communicating effectively (in both written and spoken forms) to confirm and retrieve overpayments. Keeping recovery records updated with accurate information and documentation is also required Be able to learn and adapt to various claim system platforms and analyze claim payments for validation of potential other payor liability Comply with the terms and conditions of the employment contract, company policies and procedures, and a...

Job description R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work Fo2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Responsibilities: Follow up with the...

As a Claim Adjudication Manager you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator. Role Supervise claim adjudication staff to ensure claims are processed efficiently and accurately. Review complex or escalated claims and make final decisions on approvals or denials. Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers). Monitor team performance using KPIs (turnaround time, accuracy rate, etc.). Collaborate with medical coding, billing, provi...

As a Claim Adjudication AGM you are responsible for overseeing the review and processing of insurance claims to ensure they are accurate, compliant with policy terms, and resolved in a timely manner. This role is common in healthcare, insurance, and third-party administrator.Role Supervise claim adjudication staff to ensure claims are processed efficiently and accurately. Review complex or escalated claims and make final decisions on approvals or denials. Ensure compliance with regulatory and payer-specific guidelines (like Medicare, Medicaid, commercial insurers). Monitor team performance using KPIs (turnaround time, accuracy rate, etc.). Collaborate with medical coding, billing, provider r...