7 Claims Audit Jobs

Role Overview We are seeking a Claims QC Manager to ensure accuracy, compliance, and fairness in health insurance claim processing. This role involves overseeing both rejection recommendations and approvals (including high-value cases), in alignment with IRDAI regulations , internal policies, and ethical standards. The QC Manager will drive process improvements, mitigate risks, and uphold operational excellence within the Claims QC function. Key Responsibilities 1. Rejection Review Validate all rejection recommendations for compliance with policy terms, regulatory guidelines, and documentation standards. Collaborate with Claims, Underwriting (UW), and FWA teams on disputed cases. Document an...

Claims Adjudicator US Healthcare (NSA Project) | 1+ Years | Mangalore | 3.5 LPA | Immediate Joiners Job Description Claims Adjudicator (US Healthcare NSA Project) We are seeking a detail-oriented and experienced Claims Adjudicator to join our No Surprises Act (NSA) project team . The ideal candidate will have a strong background in US healthcare claims adjudication with proven expertise in claims adjustments . Prior experience working on NSA-related initiatives will be a strong advantage. Key Responsibilities: Review, analyze, and adjudicate healthcare claims in line with US healthcare regulations and payer policies . Manage complex claim adjustments , ensuring accuracy and compliance with r...

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...

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

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...

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

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....