1508 Claims Adjudication Jobs - Page 8

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development pr...

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development pr...

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development pr...

Allianz is looking for Claims Analyst to join our dynamic team and embark on a rewarding career journey. Oversee the claims processing department and ensure timely settlements. Verify and validate claims documentation and eligibility. Handle complex or disputed claims and resolve issues efficiently. Coordinate with other departments for claim investigations. Train and guide claim processors to maintain accuracy and efficiency. Disclaimer : This job description has been sourced from a public domain and may have been modified by Naukri. com to improve clarity for our users. We encourage job seekers to verify all details directly with the employer via their official channels before applying.

SUMMARY Retail Staff Opportunity for Freshers ===================================== Summary ----------- We are seeking a dynamic and enthusiastic Retail Staff member to join our team in Rajasthan. As a key member of our retail team, you will be responsible for providing an exceptional customer experience, maintaining a well-organized store environment, and contributing to the overall success of our retail operations. Responsibilities - - - - - - - - - - - - - - - - - - - Folding and stacking merchandise at the basic table Timely displaying received stocks to ensure a visually appealing store environment Maintaining the upkeep of the store section, including ensuring a carton-free floor Ensur...

Roles and Responsibilities Manage insurance claims from receipt to settlement, ensuring timely and accurate processing. Conduct thorough analysis of claim documents, including medical records, police reports, and other relevant documentation. Identify potential fraud risks and take necessary actions to mitigate them. Collaborate with internal stakeholders, such as adjusters, attorneys, and medical providers to resolve claims disputes.

Roles and Responsibilities: 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 d...

Role & responsibilities Coordinate with patients, TPAs, and insurance companies for pre-authorization, approval, and final claim settlements. Prepare and submit claim documents and bills to TPAs/insurance companies in the prescribed format. Follow up regularly with TPAs for claim status, pending queries, and settlement updates. Verify patient insurance details, coverage, and eligibility before admission and discharge. Maintain accurate and up-to-date records of all claims submitted and settled. Handle rejections, discrepancies, and short settlements by coordinating with relevant departments and TPAs. Ensure compliance with hospital policies and TPA/insurance requirements. Generate periodic r...

Role & responsibilities Asst. Billing Manager works under supervision of Head of Accounts & Finance Guide and mentor team Maintains billing controls by preparing and recommending policies and procedures. Maintains financial security by following internal controls. Prepares refunds by verifying documentation, and requesting refunds. Maintains customer confidence and protects operations by keeping financial information confidential. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Accomplishes the result by performing the duty. Supervise, guide, train,...

Job Title: Team Leader-Claims Adjudication (US Healthcare)-Coimbatore Experience: 5-8 years Qualification: Bachelors degree Shift: Night shift Transportation: Pick up and drop would be provided Job Summary: Team Leader - Claims Adjudication will oversee a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, client-specific guidelines, and quality standards. The role ensures efficient workflow, team performance, process improvement, and client satisfaction. Key Responsibilities: Team Management & Leadership: Lead, mentor, and manage a team handling enrollment, Provider configuration- Coimbatore and...

Greetings!! Openings for " Immediate Openings-Claims Adjudication-Quality Analyst " -Coimbatore Required Skills: Subject matter expert in Claims process. Able to perform Quality Audits. Exceptional interpersonal, customer service, problem-solving, verbal and written communication, and conflict resolution skills. Proficiency with the necessary technology, including computers, software applications, phone systems, etc. Ability to improve and/or transform teams processes across functions within the organization. Ability to understand basic data and take appropriate action. Ability to drive individual and team efficiency and productivity through effective and efficient metric management. Ability...

- Bangalore Were hiring experienced professionals in US Healthcare! : •4+ yrs. US Healthcare claims experience for Non Voice (Claims adjudication/claim processing) • 4+ yrs. of experience in International contact Centre (Inbound Voice) Claims adjudication in US Healthcare or Internation contact center experience is mandatory. Should have good communication skills Speak , read and written . Open : • Operations -Team Leader / AM/DM/M/SM •Quality Specialist & TL Quality •Subject Matter Expert (SME) •Process Trainers. •WFM- RTA/ Cap Planning/ Forecasting & Scheduling (Specialist, AMs and DMS ) ? •Leading US Healthcare brand •Fast-track growth & leadership opportunities •Attractive benefits & rew...

Medcare Hospitals Medical Centres is looking for Associate - Insurance to join our dynamic team and embark on a rewarding career journey. 1. Customer service : Associates in Insurance serve as the primary point of contact for customers, providing them with information about policies, handling claims and addressing any concerns or issues they may have. 2. Risk assessment and analysis : They help assess risks associated with insuring different clients, analyze data and make recommendations to senior-level professionals. 3. Claims processing : Associates in Insurance handle claims processing, by gathering information, reviewing policies, assessing damage and negotiating settlements. 4. Complian...

The Opportunity: Avantor is seeking a Workday Analyst with expertise in Workday Benefits configuration to join our HR Technology team. This role is responsible for designing, implementing, and maintaining Workday Benefits functionality that supports Avantors global workforce. The analyst will collaborate with HR, Total Rewards, and external vendors to ensure benefits programs are accurately reflected, seamlessly administered, and compliant with regulatory requirements. This is a full-time position. If you are passionate about Workday Benefits and eager to grow into a broader Workday SME, Avantor is the place for you! The Team The HR Technology team partners with HR and business leaders acros...

Key Responsibilities: Adjudicate medical, dental, and vision claims using the Facets platform. Review and analyze claims for eligibility, provider contracts, coding accuracy, and payment rules. Ensure timely and accurate processing of claims per regulatory and organizational standards (e.g., CMS, HIPAA). Identify discrepancies or issues in claims data and take corrective actions. Apply plan benefit designs and provider fee schedules during claim review. Collaborate with cross-functional teams including customer service, provider relations, and medical management. Participate in audits and quality checks to ensure process accuracy. Maintain confidentiality and compliance with data protection ...

Job Title: Associate US Healthcare Voice Process Location: Airoli, Mumbai (Work from Office) Process: US Healthcare Voice (Inbound Calls) Work Mode: Work from Office Shift: Night Shift (5 Days Working) Training: 10 Days Virtual Work-from-Home Training Training Stipend: 5,000 (after completion of 10 days training) Salary: 22,000 In-Hand + 3,000 Night Shift Allowance (Total 25,000 per month) Transport: One-side cab facility provided (Free of cost) Job Responsibilities: Handle inbound and outbound calls for US Healthcare clients. Assist customers with queries related to healthcare plans, billing, and claims. Maintain high-quality customer service and accuracy on every call. Achieve daily produc...

Role & responsibilities Looking for Immediate Joiner (IC Role) Shift timings- 05:30 PM to 02:00 AM (Night Shift) Life Claims Adjudicator: The Individual Insurance Claims department plays a crucial role with our clients as we offer them financial help when they most need it. We are looking for a motivated individual who is eager to learn to hold the position of Claims Adjudicator. The position offers the possibility to progress internally through our career ladder. Life Claims Adjudicator Role summary: The Claims Adjudicator is responsible for the assessment of claims for individual insurance. Main Accountabilities: Assess the documentation received for a claim in order to reach a decision De...

Education Mandatory : Any Graduate (BSC/BCOM/BA) Desirable : Nil Experience Minimum 6 Months eligibility/enrolment experience (preferred) Technical Competencies : (Job related) Exceptional data entry skills with high attention to detail, strong organization skills and ability to multi-task Should have working knowledge of MS-Office: (Teams, Outlook, Excel, Word, OneNote) Soft Skills : (Job related) Effective verbal and written communication skills and excellent interpersonal skills Ability to work effectively with team members, employees/members, providers, and clients and vendors Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form F...

Role Objective: To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities: Process 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 PowerPointQualifications: Graduate 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 Set: Candidate should have good healthcare knowledge. Candidate should have ...

Job Title: Quality Team Lead (QTL) US Healthcare Claims Experience: 5+ years in Claims Adjudication, 3+ years in Quality Assurance Job Description: We are seeking a skilled Quality Team Lead (QTL) with strong expertise in US Healthcare claims adjudication and Quality Assurance practices . The role involves leading quality audits, ensuring compliance, identifying process gaps, and driving performance improvements through RCA, CAPA, and Six Sigma methodologies. The QTL will guide Quality Analysts, collaborate with operations, and ensure delivery of high-quality outcomes. Key Responsibilities: Lead and monitor quality audits in claims adjudication. Ensure compliance with HIPAA, CMS, and client ...

Key Responsibilities: 1. OPD & IPD Operations Management Supervise and streamline outpatient (OPD) and inpatient (IPD) services to ensure smooth patient flow and operational efficiency. Coordinate with clinical and non-clinical teams for timely and quality patient care. 2. Facility Management Oversee maintenance, cleanliness, safety, and functionality of all hospital facilities. Ensure availability of required medical and non-medical equipment. 3. Patient Satisfaction & Relations Monitor and improve patient satisfaction scores. Address and resolve patient complaints promptly and professionally. Implement patient feedback systems. 4. Hospital Operations & Administration Manage day-to-day hosp...

SUMMARY P&C Insurance Team Lead ========================== Summary ----------- We are seeking an experienced P&C Insurance Team Lead to manage a team and oversee all relevant technical/operational processing activities. The successful candidate will provide direct assistance to underwriting teams as needed, while also handling people management, performance appraisals, and client interaction. Responsibilities - - - - - - - - - - - - - - - - - - - Monitor the performance of a team of Claims adjusters and provide timely feedback Conduct employee performance reviews and assist with professional development Set objectives and manage the team's progression Coordinate with internal customers and m...

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

Hello Job Seekers, Greetings from ShiningstarsITPL !! We are hiring enthusiastic and detail-oriented professionals for our Claims Processing team in Bangalore. The role involves handling Property, Content Damage, Liability, and Injury claims with accuracy, compliance, and excellent customer service. Hiring for Claims Associate Location: Bangalore (Kundanhalli) Experience: Minimum 6 months (with all supporting documents) Qualification: Graduation Mandatory Salary: UPTO 4.2 LPA Shift: 9 Hours (5 Days Working) Cab Facility: Two-way cab available within 25 km radius Roles & Responsibilities Accurately capture and update claim files while maintaining compliance with company policies. Analyze fact...

Medical Officer (MBBS/BAMS/BHMS) at Good Health Insurance TPA. Responsible for cashless request processing, claim review, ICD coding, and policy adherence. Freshers can apply. Strong medical knowledge and computer skills required. 91212 46809