Quality Specialist (US Healthcare) Golden Opportunities

4.0 - 8.0 years

0 Lacs

karnataka

On-site

Role Overview: You will be responsible for ensuring accuracy, compliance, and continuous improvement in healthcare claim processing in the role of a Quality Specialist, focusing on claims adjudication processes in the US Healthcare domain. Your role will involve identifying trends, errors, and areas for improvement, collaborating with teams to address quality gaps, preparing audit reports, maintaining documentation, supporting process improvement initiatives, and ensuring regulatory standards adherence. Key Responsibilities: - Identify trends, errors, and areas of improvement in claims adjudication processes - Collaborate with operations and training teams to address quality gaps and impleme...

Posted 1 day ago

Apply

US Healthcare Claims Adjudicator Immediate Joiners Mangalore White Horse Manpower Consultancy

1.0 - 6.0 years

2 - 3 Lacs

mangaluru

Work from Office

Review, analyze, adjudicate US healthcare claims in line with payer policies regulations Handle complex claims adjustments, ensuring compliance with guidelines Collaborate with cross-functional teams to ensure NSA compliance in claims processing Required Candidate profile Investigate and resolve discrepancies in claims data and documentation Support audit and quality assurance functions related to claims Stay updated with NSA regulations healthcare compliance standards Perks and benefits Perks and Benefits

Posted 4 days ago

Apply

Hiring For Manager & Sr. Manager- Medical Audit Virtuoso Staffing Solutions

6.0 - 11.0 years

10 - 12 Lacs

New Delhi, Gurugram, Delhi / NCR

Work from Office

Roles and Responsibilities Conduct medical audits for high-value claims, including inpatient and outpatient services. Review NCCI guidelines to ensure accurate coding and compliance with US healthcare regulations. Analyze CPT codes to identify discrepancies and optimize claim processing. Collaborate with internal stakeholders to resolve issues related to claims adjudication. Develop expertise in dollar value claims handling, focusing on accuracy and efficiency. Desired Candidate Profile 6-11 years of experience in Medical Audit or Claims Auditing/Audition role. Strong understanding of CPT, ICD-10-CM/PCS, HCPCS Level II codes; knowledge of anesthesia codes (G0152) preferred. Experience workin...

Posted 2 months ago

Apply

Senior Claims Manager - Mumbai Vandana Sharma

5.0 - 10.0 years

8 - 13 Lacs

Mumbai, Mumbai (All Areas)

Work from Office

Handle quality audits of Death/CI claims & Check ensure regulatory/customer/business/process norms are met Timely closure ATR audits Check, propose feasible changes/improvements avoid failure/leakages in claim process, reports, Required Candidate profile Role involves collating entire data present to Management, Managing dashboards & initiating various strategies to improve existing process enhance the functioning of the department

Posted 3 months ago

Apply

Manager - Health Insurance Claims Medi Assist

5.0 - 10.0 years

5 - 10 Lacs

noida

Work from Office

We are seeking a qualified and experienced Manager-Claims to join our dynamic team. The ideal candidate will be responsible for reviewing, analyzing, and auditing health insurance claims from a medical perspective to ensure accuracy, compliance, and appropriateness of billed services and also ensure that providers adhere to contract.This role requires a keen understanding of medical conditions, health insurance policies, and the ability to collaborate with both medical professionals and insurance teams. Key Responsibilities: Claims Review and Audit: Conduct comprehensive audits of health insurance claims to ensure they meet company guidelines, industry standards, and regulatory requirements....

Posted Date not available

Apply

Start Your Job Search Today

Browse through a variety of job opportunities tailored to your skills and preferences. Filter by location, experience, salary, and more to find your perfect fit.