6255 Claims Jobs - Page 29

Execution Analyze the customer segmentation, sales trends in terms of demographics, geography, characteristics etc. to assess the potential for business Conduct trainings at the branch for all banking partners around regulatory guidelines and products. Plan for activation of branches through R&R activities to increase the penetration in active branches to realize full potential of the bank partner in the given geography Relationship Management Drive the campaign/contest for the Partner Bank to drive sales in profitable segments. Assist banking partners in pitching product to crucial customers & driving sales closure for the same. Identify cross sell opportunities for existing customers New A...

Claim registration On Daily Basis need to register the claims which has been assigned for processing , Scrutiny of the documents Reserve Setting :- Need to do the proper reserve setting on system based on the claim documents Technical processing claims which has been assigned for processing for health/ personal accident etc claims and deductions of Non-Medical charges, Standard deductions of co-payment as per the policy terms and conditions On Daily basis need to do technical Assessment of the claims post registration of the claim which include billing of the claim as per the respective heads, Data Entry as per the standard fields in system, Deductions of non-Medical Charges as per the stand...

Execution Support partners to register claims on behalf of customers, coordinate to ensure approvals within agreed timelines. Engage with cross functional teams to ensure seamless execution of work across channels and deliver desired productivity including everyday servicing and policy issuance etc. Gather relevant documents from customer post sales and submit the same to operations team; gather additional data/documents as required Resolve operational issues faced by the partners to ensure smooth experience while working with Bajaj General Insurance Limited Provide support for cancellation requests, policy endorsements; process & track such requests in coordination with internal ops team ; ...

Basic Function Claims Litigation Support Services to US P&C Insurance Carrier Managing litigation support services team providing following Claims Litigation Support Services Open/Close/Transfer cases Order Medical/Other records and follow-up Record Chronology and Summarization Litigation/Subpoena document review including redactions and privilege logs Interrogatories responses Legal correspondence for Attorney/Paralegal use during litigaiton Document management Claim File transfer Legal bill review Scheduling, Calendar management and Deposition scheduling/summarization Admin Responsibilities Scoping of projects to identify TAT and resources required Attending client calls and internal calls...

JD (Job Description) for Solutions Architect for Provider 360 C2 role About EXL Health Payments Analytics: At EXL Health Payments Analytics Center of Excellence, we are looking for passionate individuals with growth/startup mindset to experiment, fail fast, learn and contribute to our 5 fold growth story of $200M to $1B EXL is considered Special investigation Unit by 6 of top 10 US health insurance companies (~1/3rd US healthcare data is handled by us) helping with error/overpayment detection of the hospital/doctor claims. Unlike typical services and consulting companies we make our revenue from the savings we identify for the client(Commission/Outcome basis). We Productize algorithms and R&...

Job Title: Manager Agentic AI & Applied NLP Experience: 7 10 years Location: [Insert Location] | Type: Full-time Role Overview We are looking for a hands-on AI Manager with strong experience in NLP and GenAI to build intelligent, autonomous systems using LLM-powered agents. This role is ideal for someone with a builder mindset, who can lead the development of task-driven agentic workflows and coordinate across teams to deliver scalable AI solutions. Key Responsibilities Design and build multi-agent systems for real-world tasks such as document understanding, claims triage, compliance monitoring, and knowledge retrieval. Implement LLM-based agents that can plan, reason, interact with tools, a...

Reserving Data Analyst EXL (NASDAQ:EXLS) is a leading operations management and analytics company that helps businesses enhance growth and profitability in the face of relentless competition and continuous disruption. Using our proprietary, award-winning Business EXLerator Framework , which integrates analytics, automation, benchmarking, BPO, consulting, industry best practices and technology platforms, we look deeper to help companies improve global operations, enhance data-driven insights, increase customer satisfaction, and manage risk and compliance. EXL serves the insurance, healthcare, banking and financial services, utilities, travel, transportation and logistics industries. Headquart...

Summary ofroleThe roleinvolves building robust fraud detection frameworks, managing investigationsthrough empanelled risk agencies, engaging with law enforcement and businessteams, and driving awareness across teams Key Responsibilities Develop and implement fraud risk frameworks across customer and distributors life cycle Monitor transactions, claims and sales practices to identify red flags and fraud patternsLead and manage investigations of suspected fraud cases through empanelled risk agencies, ensuring timely closure with quality reporting Evaluate and monitor performance of risk agencies to ensure adherence to defined SLAs and investigation quality standards Drive vendor staff training...

Role Overview: ;Experienced and strategically minded Solutions CoE Manager to lead legal solutioning and project transitions within Legal Support Services practice. The ideal candidate will possess deep expertise in U.S. claims litigation processes, legal operations, client engagement and will play a critical role in pre-sales support, due diligence and capability buildout. ; ;Key Responsibilities: ;Lead the solutioning and transition of legal support engagements from discovery to steady stateParticipate in client due diligence sessions and document as-is and to-be workflowsDesign and deliver pre-process and process-specific training for new engagementsWork directly with client stakeholders ...

Work Type Back Office ProcessSearch for claims related documents in different systems, create a case, attach the documents to the cases createdDetermine if case can be resolved or must be forwarded to a Subject Matter Expert (SME)Once the case is received from SME, action cases as guided by the SMEGenerate letter and send it to the customer Essential Functions Navigate through multiple system / applications for data gatheringProficiency with computer skills (navigating multiple systems and keyboarding)Understand the goals and standards to ensure that quality and productivity standards are metAccurate and timely updating of the database Meet the agreed upon KPIs as per the operational definit...

Job Description Position Title, Responsibility Level Advisor Motor Claims Function Operations, Executive Reports to Assistant Manager Operations Permanent/ Temporary Permanent Span of Control NA Location Noida - SEZ Basic Function This is a complexity level 3 Voice process The role primarily involves dealing with end to end claims - responsibilities include receiving/making inbound/outbound calls, settling liability, taking action on incoming correspondence/payments and following up on claims for progression until closure Essential Functions Ensure that the process transactions are processed as per standard procedures Ensure that the assigned targets in accordance with SLA are met Ensure tha...

Job Description Position Title Advisor Damage Fulfilment Function, Responsibility Level Operations, Executive Reports to Assistant Manager Operations Location Noida / Pune SEZ Span of Control NA Permanent/ Temporary Permanent Basic Function This Damage Fulfilment role primarily involves dealing with different activities within motor claims The responsibilities include handling inbound calls, making outbound calls, managing customers hires, arranging inspection, disposing Salvage, taking action on incoming post/Documents/Spreadsheets, following up on claims for progression and making payments All transactions are to be completed based on the guidelines set for the process Essential Functions ...

Job Description Position Title, Responsibility Level Advisor Motor ClaimsFunction Operations, ExecutiveReports to Assistant Manager OperationsPermanent/ Temporary PermanentSpan of Control NALocation Noida - SEZ Basic Function This is a complexity level 3 Voice process The role primarily involves dealing with end to end claims - responsibilities include receiving/making inbound/outbound calls, settling liability, taking action on incoming correspondence/payments and following up on claims for progression until closure Essential Functions Ensure that the process transactions are processed as per standard procedures Ensure that the assigned targets in accordance with SLA are met Ensure that the...

Preferred knowledge of the UK London market Insurance and Claims domainGathering and updating the data into the client systemsEvaluate incoming applications, interpret necessary information for completing assigned tasksIndexing and filing of documents electronically on Provided SystemsContact relevant parties to obtain missing information (as necessary)

Desirable SkillsAbility to read and comprehend English language in clear and precise mannerReasoning SkillsProblem SolvingEye for detailTechnical SkillsGood computer navigation skillsTyping speed of 25 Words per Minute with 95% Accuracy Basic knowledge of Microsoft Office, Outlook and ExcelProcess Specific SkillsCandidate should preferably have knowledge of US Life and Annuity InsuranceKnowledge of processing claims transactionsAbility to navigate multiple systems and applications Ability to produce high quality outcomes in a highly productive environmentSoft skillsAbility to work independentlyAbility to understand and question established process guidelines for possible process improvements...

JOB DESCRIPTION Position Title, Responsibility Level: Senior Executive Function: Operations Reports to - Assistant Manager Operations Permanent/ Temporary: Permanent Span of Control Nil Location: Gurgaon- C-61 Fraud Investigation Specialist We are seeking a talented and self-motivated Fraud Investigator to join our Fraud Operations team. Candidate will be responsible for all aspects of Fraud investigations as it relates to Application Fraud, Transactional Reviews, Debit/Credit Card Fraud, Check Deposits, ACH/Check returns, as well as the review of any/all related suspicious activity across all products (checking/savings, credit cards, loans and Investment accounts); advising and assisting Ma...

Summary: Support Agent is responsible for transaction processing based on SOPs. Key Responsibilities: Process voluntary deactivation and withdrawal requests from employees. Conduct background check reviews, adjudication, and manage suspension administration. Handle E-Verify/I-9 processing for new hires, ensuring compliance with legal standards. Administer employee terminations and related processes. Coordinate drug testing and workers compensation claims, ensuring timely communication with affected employees. Administer benefits programs, ensuring accurate enrollment and updates. Manage sexual harassment training administration and ensure compliance. Oversee attendance policy adherence, incl...

Job Description Repricing Analyst Job Name: Repricing Analyst Position Title: Senior Executive Band: A2 Domain : Healthcare Reporting to: Assistant Manager Location/Site: EXL India, Chennai Overview: The main objective of this position is to validate, calculate, and accurately report any overpaid amounts in the system. As a Repricing Analyst, you will be analyzing claims to determine the precise overpaid amount and recording the outcomes in the client/internal system. Your contribution to these tasks will help us maintain the accuracy and integrity of our clients financial records. Qualifications: Any Graduate/ Postgraduate Working Hours: 40 hours /week, Full Time Employee Telecommuter/Inter...

Overview: Certified CPC/CCS coder with minimum 3 years of post-certification experience, experience and skillset, to review the medical records and determine the coding corrections. E&M Coders. ;Qualifications:CPC/CCS Certified Coder with minimum 3 years of experience after certification.Credential should not have Apprentice (CPC-"A").Should have experience in E&M Outpatient, Inpatient and ED Coding along with minor surgery procedures. ;E&M Inpatient coding experience is mandatory.Experience in Multispecialty will be an added advantage. ;Experience:Coding experience: Minimum 3 years (Post Certification)Auditing experience (Optional) ;Communication: ;Strong written (documentation) and oral co...

The Claims assistant will be responsible for managing a high volume of claims, ensuring timely resolution, accurate documentation, and strong customer/carrier satisfaction. This role involves reviewing claim submissions, validating documentation, escalating complex cases, and maintaining clear communication with stakeholders. The advisor will also support reporting, data tracking, and claims prevention by identifying trends and recommending process improvements. Bachelor s Degree or equivalent work experience. Prior Logistics or Transportation experience preferred Prior experience managing claims Review, process, and resolve claims efficiently and accurately. Maintain complete and accurate c...

Processing invoices and recording payment for goods and services and related expenses in the General Ledger Setting up vendor accounts and reconciling statements Work with client contacts/vendors for timely resolution of pricing and quantity discrepancies on invoices and invoice exceptions ;Respond to AP inquiries and requests (from either vendors and/or business associates) Periodically perform reconciliation of vendor accounts and request for missing invoices and also vendor statements Responsible to adhering to applicable policy, procedures, standards and internal controls ;Competencies Required: Excellent communication skills both verbal and written Should be able to deal with a large am...

Senior Executive:Must have strong experience in CPT/ ICD 10-CM Coding, Modifiers, Anatomy and Physiology, Sound surgery and E&M knowledgeMust possess good communication skill with neutral accentInitiate telephone calls to provider office to communicate the outcome of the denial reviewWilling to work in Eastern shift.Must be spontaneous and have high energy levelMinimum work experience in voice process will be an added advantageManage claims with timely follow upMust be good with MS Office, especially Excel and PPTUnderstand the client requirements and specifications of the projectEnsure that the deliverable to the client and adhere to the quality standardsMandatory CPC or CCS certification. ...

Accounting to book Accruals (Journal entries for premiums, commission, reserves etc)Monthly & Quarterly reconciliation of GL and SL balances and research for variances, as neededAccounting skills to understand the accounting treatment for corrections/errors/reclass etc ;Receivables Management - Preparation of invoices/billing statements, Tracking of outstanding receivables and Transfer of non-recoverable amount (>90 days) to non-admitted account. Preparing wires/settlements.Research and resolve queries pertaining to any adhoc tasks/audits/reports etcCoordinate with multiple stakeholders like Brokers, TPAs, Underwriters, Claims, Actuaries, Treasury etc on a regular ;Assist project team in the...

Subrogation Support - Non voice Skills and abilities: Interpersonal skills like listening, questioning, intonating Self-driven, result oriented, team player Should possess right attitude, patience and a habit of working hard Hands on experience in MS Office Suite (Word, Excel) Solid analytical skills Curiosity and interest in analyzing, understanding process in depth Maintaining accurate file documentation Responding timely to all electronic, written and verbal communications Using available resources to investigate on paid claims Reviewing and evaluating accident or incident reports, individual claims, medical or other documents relating to funds paid Maintaining a high level of productivit...

Processing invoices and recording payment for goods and services and related expenses in the General Ledger Verifying and processing of expense claims Setting up vendor accounts and reconciling statements Work with client contacts/vendors for timely resolution of pricing and quantity discrepancies on invoices and invoice exceptions Respond to AP inquiries and requests (from either vendors and/or business associates) Periodically perform reconciliation of vendor accounts and request for missing invoices and also vendor statements Update Vendor master information / changes as and when requested by vendors / business associates Responsible to adhering to applicable policy, procedures, standards...