6244 Claims Jobs - Page 3

Job Description: Applying medical knowledge in evaluating the medical claim files to ascertain the medical admissibility. Must understand the policy wordings including Terms & conditions to adjudicate the Admissibility/Rejection. Processing of claims as per regulatory guidelines. Adhering to the TATs in processing. Quality review of processed files. Grievance redressal, handling escalations and identifying the fraudulent claims. Required understanding and evaluation criteria : Preferably from Insurance and TPA experience Clinical Acumen/knowledge in terms of hospital and medical procedures Understanding of Treatment Protocol Ready to work from Office, No Work from Home, open on rotational sh...

Job Title: Senior Credentialing Specialist Experience: 5 to 8 Years US Shift: 5 Pm to 2 Am Mode of Work: Work From Office Work Location: Chennai - Valasaravakkam Transportation: Cab Provided (Only for Female Employees) Interested candidates send your cv to shane@parkmedicalbilling.com Job Summary: We are seeking an experienced Credentialing Specialist with a strong background in Accounts Receivable (AR) calling . Credentialing Duties: Prepare, submit, and track applications for provider credentialing and re-credentialing with insurance payers and healthcare organizations. Maintain up-to-date provider files, licenses, certifications, and other required documents. Monitor credentialing deadlin...

Role: QA Lead Key Responsibilities: Develop, execute, and maintain end-to-end test scenarios spanning multiple healthcare domains (Member, Enrollment, Claims, Prior Auth, Encounters, Care Management). Collaborate with Business Analysts, Product Owners, and Stakeholders to understand requirements and translate them into comprehensive test strategies. Conduct functional, Automation , integration, regression, and UAT support testing across cross-functional modules. Validate data flow across systems (EDI, downstream platforms, provider/member portals, etc.) and ensure alignment with business rules. Identify data requirements and create test data (including mock EDI files like 834, 837, 278, etc)...

Role: Quantity Surveyor (QS) - High Rise Projects Location: Cyprus, Limassol (Relocation from India) Company: Leading Real Estate Developer & Construction Firm Employment Type: Full-time / Permanent About the Role We are seeking a qualified Quantity Surveyor with a strong background in high-rise residential or commercial projects to join our expanding team in Cyprus . The ideal candidate will be responsible for managing all aspects of project cost control, from estimation and tendering through to final accounts, ensuring value, quality, and cost efficiency throughout each stage of development. This is an excellent opportunity for a motivated professional from India looking to advance their i...

Role & responsibilities Mosaic Wellness is building digital first, health brands for elective health concerns. Man Matters, is a digital elective health platform for men, helping 2.5M+ men every year diagnose and solve for their hair loss, beard growth, fitness and nutrition concerns by offering personalized treatment plans and access to expert doctors and health coaches. Be Body Wise, is an online womens elective health platform, serving 4M+ women every year by providing personalized solutions and doctor consults across concerns for hair health, body care, Sleep and nutrition. Little Joys, is an online health platform for kids, helping 2M+ parents every year solve for their child’s physical...

Desktop Investigation Trigger identification through data at intimation/Referral stage Social media searches Cold calling using digital platforms Identify key business people, link analysis Claim Investigation Allocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC clearance & validate the submissions against shared triggers Success in claim investigation based upon strong medical & legal evidences Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law Report submission and coordination with claims team. Evidence Ma...

SUMMARY About the Role: We are looking for dedicated and proactive professionals to join our Revenue Cycle Management (RCM) team as Process Executives and Senior Process Executives . The role involves managing the accounts receivable process, following up with insurance companies, and ensuring timely resolution of medical claims. This position offers an excellent opportunity to build a rewarding career in the healthcare BPO industry with structured growth pathways. Designation & Experience: Process Executive: 0 1 year of experience Eligibility Criteria: Qualification: Non-Technical Graduates (B.Tech graduates are also eligible) Experience: Freshers and experienced candidates in Revenue Cycle...

Gen Re delivers reinsurance solutions to the Life/Health and Property/Casualty insurance industries. Represented in all major reinsurance markets through a network of , we have earned superior financial strength ratings from each of the major rating agencies. We value diversity, equality and inclusion and promote a culture that supports professional and personal growth Your Role Our Global Finance team is seeking to appoint a highly skilled and motivated (Senior) Accountant to work in our Mumbai office. In this role, you will be handling financial and regulatory reporting, audits for owned areas, managing client accounting for our Life/Health business and collaborating with Global Finance te...

Job Description Position Title, Responsibility LevelManager/Senior ManagerFunctionSolvency II ReportingReports to AVP/SAVP- OperationsPermanent/ TemporaryPermanentSpan of Control15+ membersLocation Noida C59 Hands on production experience of all mandated QRT s templates as per the timetable released by PRA (for Quarterly and Annual templates) Partnering in setting the team s strategic direction and assisting in the overall running of the team s operationsUnderstanding of bridging items between local/ US GAAPs and Solvency II requiring eg DAC, Receivables, and technical provisions Review of critical journal entries, GAAP supplemental before submission to onshore teamSlice and dice premiums, c...

Nandadeep Eye Hospital is looking for TPA Co Ordinator Professionals to join our dynamic team and embark on a rewarding career journey Collaborate with cross-functional teams to achieve strategic outcomes Apply subject expertise to support operations, planning, and decision-making Utilize tools, analytics, or platforms relevant to the job domain Ensure compliance with policies while improving efficiency and outcomes 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

Provide general administrative support including handling emails, filing, and organizing claim-related materials Maintain accurate and up-to-date information in the claims database Assist with bill processing, documentation production, and data entry Use the Claims System for inquiries and to generate correspondence Resolve routine administrative inquiries and ensure timely responses Proofread and edit materials to uphold accuracy, thoroughness, and professionalism Maintain confidentiality and comply with HIPAA regulations in managing sensitive information Support the team in delivering exceptional service to our customers, reflecting MetLife s value of putting customers first

1. Warehouse Data Entry Enter inbound (GRN) and outbound (Dispatch/OBD) details into WMS/SAP/ERP accurately and on time. Maintain daily records of pick slips, packing slips, invoices, delivery challans, and gate passes. Record stock transfers, material returns, shortages, and damages in the system. Ensure real-time updating of stock to avoid mismatches between system vs. physical stock. Good knowledge about Man management & resource management . Develop ground level team skill . 2. Documentation & Record Control Prepare and maintain logbooks, registers, and reports for warehouse operations. File and archive supporting documents (GRN, delivery notes, transport documents, claim reports). Assis...

Responsible for implementing financial planning and analysis, end-to-end finance operations, adherence to and compliance with internal financial rules, controls, and regulations as well as regulatory and statutory requirements Participate in the preparation of monthly management reporting, review and analysis of financial results with commentary Demonstrated track record of adding value to a Finance function Experience working in an accounting or reporting function withinin banking, insurance or similar industry Ability to manage internal expectations to ensure matters are appropriately prioritised and dealt with in accordance with an agreed timeline and scope Ability to interpret and analys...

Month-End Close and Accruals Execute monthly accrual bookings for premiums, commissions, and claims. Review and validate month-end reports; perform trend analysis and flag anomalies. Manage booking of reinsurance-re lated accounting entries and coordinate with the finance team for ledger closures. 2. Reinsurance Statement Preparation & Settlements Prepare and reconcile monthly/quarte rly/annual reinsurance statements. Manage settlement of reinsurance balances including wire transfers, clearing entries, and follow-ups. Ensure accuracy of treaty data for multiple countries and formats. 3. Stakeholder & Query Management Resolve queries received from reinsurers, controllers, and internal stakeho...

Medical Claims Review Senior Analyst/Medical Advisor The Medical Advisor is a member of the medical team which develops and manages health and wellness programs for Cigna customers. Together with a team of nurses and physicians she/he will ensure attainment of quality, production, timeliness, cost containment goals, and excellent customer satisfaction for both internal and external customers. Ability to review, investigate, and respond to external and internal inquires/complaints. Provides guidance and acts as a mentor or coach for the nurses and other non-clinical staff. He/she works with a multicultural population and is constantly aware of the cultural differences among that population an...

We are seeking a detail-oriented and analytical professional to manage MIS and regulatory reporting related to legal claims. The role involves compiling, analyzing, and presenting data to support legal and compliance functions, ensuring timely and accurate submissions to internal stakeholders and regulatory bodies. Key Responsibilities Prepare and maintain MIS reports related to legal claims, litigation status, and financial impact. Ensure timely and accurate regulatory reporting as per statutory requirements (e.g., RBI, SEBI, IRDAI, etc.). Coordinate with legal, finance, and compliance teams to gather relevant data and documentation. Track and monitor legal claims, settlements, and provisio...

Who we are: We Are Modernizing Medicine ( WAMM )! We re a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling , we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMeds global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and ...

The work is project based and will give you the opportunity to work with the latest technologies. Your main task will be to test, start-up and fine-tune our solutions, both our branded processing units and complete process lines, at our production site and at end-customer s factories all over the world. We can offer you a very interesting position and an opportunity to grow and become professional in one of our core technologies for food processing. You will focus on Commissioning, start-up and troubleshooting of branded processing units and process lines at our customer s sites. Delivery tests to be performed in our engineering workshops. Technical training and support to Tetra Pak s Market...

Quantify PPH burden and drivers across the insured population, implement a reproducible prospective data pipeline for routine monitoring, and track PHC performance under the new capitation model through validated KPIs and dashboards that support payment reconciliation, provider feedback, and policy decisions. Scope of Work Design and implement a monitoring framework to track PHC performance under the new capitation payment model, integrated with the PPH/ACSC study and prospective claims pipeline. Monitor financial flows (capitation payments, adjustments, bonuses/penalties), service utilization, quality, and outcomes (including PPHs) at facility and provider levels. Retrospective analysis of ...

Develop and maintain VBA code to connect Excel with external data sources such as SQL databases Automate workflows by integrating Excel with other Office applications (eg, Outlook) Cleanse, validate, and transform large datasets using advanced Excel formulas and VBA scripting Consolidate and integrate data from multiple sources, ensuring accuracy, completeness, and readiness for analysis Design and build custom Excel user forms and interactive interfaces using VBA Troubleshoot, debug, and optimize existing VBA macros and Excel models Collaborate with business stakeholders to gather requirements and translate them into effective data solutions Monitor key performance indicators (KPIs) and gen...

The work is project based and will give you the opportunity to work with the latest technologies. Your main task will be to test, start-up and fine-tune our solutions, both our branded processing units and complete process lines, at our production site and at end-customer s factories all over the world. We can offer you a very interesting position and an opportunity to grow and become professional in one of our core technologies for food processing. You will focus on Commissioning, start-up and troubleshooting of branded processing units and process lines at our customer s sites. Delivery tests to be performed in our engineering workshops. Technical training and support to Tetra Pak s Market...

Required Lead Assistant Manager B1 and Manager C1 Experience Req: o B1: 3+ years o C1: 8+ years • CTC Range: o B1: INR 8 LPA Fixed o C1: INR 15 LPA Fixed • Qualification: B. Pharma/BDS/BPT • Notice Period: Immediate to 30 days (max DOJ of 1st Dec 2025) • Shift: US Shift • Work Mode: Work from Office • Key Requirements: o Exp in medical record review o Very good comm skill o Must have team handling exp • B1- 20 FTE • C1- 20 FTE o Exp in cancer claims is good to have o BPO/KPO/corporate exp is must have Short Description: The Process Lead (Supervisor) will oversee daily operations while serving as a key liaison between the team, leadership, and external stakeholders. Description: The Process L...

Desktop Investigation Trigger identification through data at intimation/Referral stage Social media searches Cold calling using digital platforms Identify key business people, link analysis Claim Investigation Allocation of assigned claims to respective vendors with case relevant triggers Follow up for IR and TAT management Level 1 QC clearance & validate the submissions against shared triggers Success in claim investigation based upon strong medical & legal evidences Preparing reports based on findings and observations and guide / Gathering and Analyzing the facts and developing & creating evidence which stands in court of law Report submission and coordination with claims team. Evidence Ma...

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...

We are looking for the right people people who want to innovate, achieve, grow and lead. We attract and retain the best talent by investing in our employees and empowering them to develop themselves and their careers. Experience the challenges, rewards and opportunity of working for one of the world s largest providers of products and services to the global energy industry. Job Duties Position: Temporary/Contractual Role (1 Year) Overview: We are seeking a detail-oriented professional with strong expertise in SAP documentation and global trade compliance. This role involves managing import, export, and re-export processes while ensuring adherence to regulatory standards and timely execution ...