1968 Claims Adjudication Jobs - Page 8

Role & responsibilities 1. Claim File Review Conduct end-to-end review of closed claim files (cashless & reimbursement). Verify correctness of claim adjudication, coding, documentation, and decision rationale. Ensure all required documents (policy, KYC, bills, prescriptions, investigations) are present and valid. Check medical necessity, line of treatment, and adherence to standard treatment guidelines. 2. Compliance & Quality Checks Ensure claim decisions comply with IRDAI regulations and company SOPs. Identify any potential non-compliance, financial leakage, or process discrepancy. Validate adherence to TAT norms and communication standards. 3. Fraud, Waste & Abuse (FWA) Indicators Identif...

Need min 5 yr exp. in international (1.5 year as TL on Paper) (from P& C /insurance & mortgage or must have managed Complex process) Package upto 8 L Graduate us shift 1 side cab immediate joiner 7289094130 / yashika.imaginator@gmail.com Required Candidate profile Should have good decision making skills,experience to handle complex processes, should know about Analytical and logical processes. Need Excellent communication skills

Role & responsibilities Preferred candidate profile Hiring for SME-Claims adjudication US Healthcare Good communication skills Flexible to work US shifts Two way cab provided Work location: Kochin

As an Insurance TPA Claim Specialist, your role involves working in a Hospital Insurance desk, providing medical opinions for Health Insurance Claims, processing Cashless Requests and Health Insurance Claim Documents, and demonstrating proficiency with medical terms and systems. You will be required to understand Policy terms, various Protocols, and Guidelines, as well as Claims adjudication and Processing. It is essential to maintain and ensure Standard Operating Procedures and Protocols, perform Ailment Wise ICD and Procedure Coding, manage volumes effectively to maintain Turnaround time, process VIP Claims efficiently, and manage Claim Case and Cost effectively. Qualifications Required: -...

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...

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 te...

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...

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...

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...

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...

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...

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 te...

US Healthcare – Claims Adjudication Process Voice Process Team Leader – Operations Quality Specialist Subject Matter Expert (SME) Process Trainer Location : Bangalore Mode of Interview : Fact to Face US Shift / 5 Days Working HR Hari : 7618776218

As a Process Analyst– Insurance (Claims), you will be involved in the Processing of Life and Annuity Insurance, Claims processing. You should be flexible to work in shifts. Your primary responsibilities include: Handling claims investigation, processing, and payments Claims document validation, calculating benefit amount, and releasing same to the beneficiary Meet productivity and quality targets on a daily, weekly, and monthly basis Required education Bachelor's Degree Preferred education Master's Degree Required technical and professional expertise Graduate (except B.Tech/Technical Graduation/Law) with a minimum of 1.5 years of experience in Life/Annuities products in Claims Good Communica...

Processing life and annuity insurance claims involves investigating, processing, and disbursing payments, including validating documents, determining claim actions, and calculating benefit amounts for beneficiaries. Work well with Onshore /Offshore customers encouragingly and professionally via email and on calls. Meet productivity and quality targets on a daily, weekly, and monthly basis. Render overtime whenever requested by the Supervisor including rest day. Use expertise to evaluate the work of others and assist in process calibration. Facilitate team huddles and teach-back sessions as scheduled. Complete certification on the identified process and developmental training. Participate in ...

Experience Required 7+ years' experience in Quality assurance of claim adjudication process. Strong expertise in healthcare claim adjudication Accountable for functional, operational, and/or program management. Achieves goals through the work of others. Manages performance appraisals and pay reviews. Identify and manages trainings for the team Manages hiring and termination actions. Maintain good Client Relationship Ability to prioritize and perform under pressure in fast-paced environments Six Sigma (Good to have) Role & responsibilities Evaluates the performance of the team. Educates to enhance capabilities of soft skills, technical skills, and business Domain Knowledge to the team. Identi...

Team Management Participate in recruitment process to identify the right talent within the function. Guide and direct the team in efficiently achieving their targets. Establish individual performance expectations and regularly review individual performance of the team. Identify and create development opportunities for team members to enhance functional knowledge. 2. Non Motor Claims and Network Management Implement Claims SOP within the team and service network and ensure adherence of the same. Claims forecasting and workload distribution within the team and service providers based on claims volume, seasonality and ASP skill sets Claim processing an monitoring day to day claims activities an...

Job description Team Executive - Payment Integrity Location : Chennai Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 9 years of experience in Claims Adjudication(Payment Integrity, PrePay audit, Postpay audit) . With over 1 year of experience as a Team leader Proven track record in managing processes, streamlining workflows and excellent people management skills. Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals. Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Adhering to various regulatory and...

We are seeking candidates with a minimum of 1 year of experience in Indian health Insurance/TPA who have strong communication and along with good medical knowledge in Claims Adjudication.

Job Profile Summary To provide administrative and operational support to the claims team and carry out other assigned office tasks in alignment with the requirements of the client program. Primary Purpose: To assist in the creation and maintenance of Auto Liability (AL), General Liability (GL), and Property loss claims in the client system. Essential Functions and Responsibilities Must be available to work in a 24/7 rotational shift schedule, including nights, weekends, and public holidays, as per business needs. Willingness to work from the office in either a hybrid or fully on-site setup based on client or organizational requirements. Accurately sets up and enters new claims into the claim...

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About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Specialist Qualifications: Any Graduation Years of Experience: 7 to 11 years What would you do? We are seeking an experienced and dynamic Team Manager to lead a team of 30-40 professionals in the Property and Casualty (P&C) claims domain. The ideal candidate will have hands-on expertise in First Notice of Loss (FNOL) and Claims Payment Processing, strong client and people management skills, and the ability to drive operational excellence through reporting, stakeholder communication, and effective team leadership.Oversee end-to-end P&C claims lifecycle, focusing on FNOL inta...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Manager Qualifications: Any Graduation Years of Experience: 14 Years to 16 Years What would you do? We are seeking a highly experienced and results-driven Claims Associate Manager with a strong background in Property & Casualty (P&C) insurance claims operations. The ideal candidate will have a minimum of 14 years of experience, including proven leadership in managing large teams (~40 FTEs) across First Notice of Loss (FNOL), claims adjudication, and payment processing functions.This role demands strong capabilities in people leadership, client relationship managem...

About The Role Skill required: Reinsurance - Collections Processing Designation: Claims Management Manager Qualifications: Any Graduation Years of Experience: 13 to 18 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the uniq...

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 What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.The business ...