4480 Claims Jobs - Page 40

Act as a Subject Matter Expert in Reviewing/Analyzing accounts or documents and determining appropriate and applicable treatment in line with set SOPs or other standard procedures established for varied tasks. 35% Individually capable to deliver consolidated reports and final work products of the appropriate documents or responses created as part of varied processes. Able to perform valid searches, consolidate findings and prepare end reports for stakeholders in a timely and accurate manner. 35% Able to act as a primary contact for certain processes, communicating closely with concerned paralegals and attorneys (stakeholders). Timely raising queries as well as calibrating the work-product to...

Basic Function Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems. Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision. Perform leave administration tasks as required, including recertification of health condition, intermittent claim track...

As a Data Scientist, youll partner with cross-functional teams to tackle business challenges head-on using data-driven solutions. Your mission will be to design, develop, and deploy advanced AI and machine learning models, leveraging diverse healthcare datasets to uncover actionable insights and optimize business processes. Accountabilities: - Collaborate with the Commercial Data Science team to identify and leverage internal and external data for business solutions. - Support the design, development, and deployment of AI and machine learning models tailored to business needs. - Assist with large-scale projects using both online/offline, structured/unstructured, and set-top box data to build...

Qualification : BA/B Com/BBA/BBM/M Com/MA Shift : US Shift Work from Office model Job Location : Pune (Hinjewadi) Open Demand for PE Level : 15 Open Demand for SPE/SME : 15 TL : 2 Share available candidate details with Resume from the below list. Questions for SPE /SME Level : Property and casualty insurance Premium Audit experience is compulsory Claims Underwriting Endorsement Deductible Insurance life cycle of claim What is collision Comprehensive coverage What is deductive What is liabilities What do you understand by Property and casualty Insurance What is Endowment FNOL Endorsement Subrogation litigation RB Traction What is liabilities generally, example What is PIP What is P&C in gener...

Financial Outcomes Primary Sales - Develop the channel partner network and implement the distribution objectives to drive reach & penetration across the territory Secondary sales (Retail Distribution) - Increase number of retail outlets, maintain high service level, drive visibility of all categories of products and ensure commercial hygiene (usage of technology while placing retail orders) in the territory Customer Service Provide ground-level inputs for promotions, local activations & demand forecasting exercise Ensuring timely submission of stockiest claim along with supporting documents adhering to the company s guidelines Internal Processes Regular analysis of primary & secondary sales ...

Ensure compliance with all applicable federal laws and regulations related to coding and documentation for Risk Adjustment Programs. Conduct remote medical record reviews to identify and capture relevant diagnosis codes that fall under Hierarchical Condition Categories (HCC) . Perform two-way reviews by auditing claims data and removing unsupported ICD-10-CM codes. Validate that all diagnosis codes are fully supported by medical documentation and compliant with ICD-10-CM Official Guidelines and client-specific coding instructions. Maintain coding quality, accuracy, and productivity metrics as defined by the organization. Employment Qualifications Education & Certification (Required): High sc...

About The Role TBD Qualification TBD

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years Language - Ability: English(Domestic) - Intermediate What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insuranc...

Business Analyst and Data analyst resources with the strong WINS and Worker Compensation Policies knowledge. Please do an exhaustive search on below requirements and let us know if you find matching candidates. Technical Skills: Experience with the Policy Admin files of the WINS system. Experience with the AS400 commands Strong SQL knowledge for querying the data base Microsoft Word, Excel, PowerPoint, Visio Understanding COBOL is a plus Methodology: Waterfall Knowledge of how a WC policy is rated, algorithms used for std earned prem calculations Understand how the data is mapped from hard copy policies to the wcpols files for regulatory reporting Ability to understand data flow, process map...

AM/DM - Claims - Commercial Lines - Non-Motor - 2-6 Years - Bangalore Location - Bangalore & Mumbai An exciting opportunity for professionals with 26 years of experience in Non-Motor Claims (Property, Fire, Engineering, Miscellaneous, Workmen Compensation). This role demands strong analytical, communication, and customer service skills to handle claims effectively, detect fraud, and ensure timely resolution. Your Future Employer - A leading and one of Indias fastest-growing digital-first general insurance companies , revolutionizing the insurance industry through technology, customer-first service, and innovative products. Responsibilities - Handle and process Non-Motor claims (Property, Fir...

Roles * Excellent communication skills required. No Cab, Travel own. Night shift. Walkin Interview - 11th September 2025 Time: 9am to 5pm Venue: Osprosys Software Pvt Ltd Ramagondanahalli, Whitefield, Bangalore Ph: 9845701484. anitha@osprosys.com.

Role & Responsibilities: Configure and customize Guidewire ClaimsCenter including UI and system integrations. Gather, analyze, and validate requirements for Personal and Commercial Lines of Insurance. Perform impact analysis for change requests and ensure proper documentation. Collaborate with QA to define test scenarios, acceptance criteria, and ensure quality delivery. Review insurance data models for compliance with industry standards (Canonical, Accord). Preferred Candidate Profile: 5+ years of experience in Guidewire development with expertise in Claims Configuration & Integration . Strong knowledge of Personal Lines (Auto, Property, Umbrella) and Commercial Lines (GL, Workers Comp, Com...

To efficiently and compassionately process death claims by verifying documentation, ensuring compliance with policies and regulations, and providing timely support to beneficiaries during a sensitive time Claims processed within defined turnaround time (TAT) Zero non-compliance issues in adherence of regulatory compliance Identification and escalation of suspicious claims Timely and accurate collaboration with the legal team on disputed or complex cases Effective coordination with underwriting, finance, and customer service teams High accuracy in verifying and recording claim details with minimal rework Timely and accurate claim settlements to avoid interest penalties Detection and preventio...

NTT DATA- Hiring for Asst. Manager (BPO Supervisor) - Healthcare & Insurance in Gurgaon- Permanent Role Interested candidates may share your CV on whatsapp @ 8881551615 Job Title Asst. Manager ( BPO Supervisor ) (45 Hours Per week) Job Type - Full-time - Both side Cabs Work Timings: Scheduled shifts: Monday - Friday, 9:00 p.m. - 7:00 a.m. IST Domain - Healthcare & Insurance Location - NTT Data, Gurgaon Role: Purpose of the Post: The Asst. Manager role is to collaborate with the Director Operation / Manager to lead a core team of staff to process Disability management claims to achieve the defined productivity and quality as per the Service level Agreement by facilitating training, coaching a...

Genpact is a global professional services and solutions firm committed to delivering outcomes that shape the future. With a workforce of over 125,000 individuals spanning across 30+ countries, we are fueled by our innate curiosity, entrepreneurial agility, and passion for creating lasting value for our clients. Our purpose revolves around the relentless pursuit of a world that works better for people, enabling us to serve and transform leading enterprises globally, including the Fortune Global 500, through our profound business and industry expertise, digital operations services, and proficiency in data, technology, and AI. We are currently seeking applications for the position of Domain Tra...

Key Responsibilities: Review and process insurance claims submitted by policyholders, providers, or third parties. Verify the accuracy and completeness of submitted claims and supporting documents. Investigate and validate claims using internal systems and guidelines. Coordinate with internal departments (e.g., underwriting, customer service) for clarification or additional information. Maintain accurate and organized records of all claims and transactions. Communicate claim decisions to stakeholders clearly and professionally. Escalate complex or disputed claims to senior team members or supervisors. Meet individual and team KPIs such as turnaround time, accuracy rate, and productivity. Ens...

Greetings From Scorelabs Inc ! Validate medical necessity and check eligibility Ensure accurate claim coding for inpatient, outpatient, and day-care procedures. Should Have Exp In 1-4 years of in claims Required Candidate profile Handle claim resubmissions, rejections, and audits from insurance providers. Collaborate with physicians, billing teams, and insurance officers for clarification or denials. Hr Mounika - 8688334476

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...

Conduct Market research to study latest industry developments Ideate and brainstorm with supervisor and Marketing teams to develop new products/ changes in existing products to achieve a competitive advantage Collaborate with Actuarial, Legal & Finance teams to decide on the pricing and market placement aspects Present the product ideas to Product Management committee and Senior Leadership for approval Design product filing documents including all terms and conditions and work on modifications to the product wordings as per the feedback provided by the regulatory authority. Build marketing and other support collaterals to take the product to market Collaborate with Marketing and other teams ...

1.Handling Coinsurance Private Sector Reconciliation, Receivables and Payables Management in SUNGL, ETASS . 2 Handling Commission Payment advice to commission team, 3.GST Reconciliation for Admin/ TDS. 4.Team Management. 5 Co-ordination with UW and Claim, Business team wrt Premium/ Claims and Commission. 6. Handling Internal Audit, Process Audit and Statutory Audits 7. Ensuring maintenance of Compliance records. 8. Relationship Management with Insurance Companies. 9. Maintenance of Insurance and Revenue stamps records and passing the entries in the SUNGL after consulting the operations team/ Compliance team.

Overview The Accounts Receivable (“AR”) Specialists are primarily responsible for analyzing collections, resolving non-payables, and handling bill inquiries for more complex issues. AR Specialists are responsible for insurance payer follow-up ensuring claims are paid according to client contracts. Complies with all applicable laws regarding billing standards. Responsibilities Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients. Process assigned AR work lists provided by the manager in a timely manner. Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution. Identified and resolved denied, non-paid, a...

Tailor a project-specific integrated Master Programme in Coordination with all relevant Parties, and submit to the line manager for review and approval. Propose, record and plan actions with the Design Manager and Project Lead to pursue areas of concern, anticipate consequences & delays, recovery of such delays and continuous updates. Develop a pretender risk register in consultation with the Project Lead and relevant departments, and continue to consult and update as required throughout all project phases for use as a tool by PMT in responding to potential and actual project risks. Ensure integration between Project Master Programme and Lead Consultant Programme. In order to ensure accuracy...

Learn the Settlements process thoroughly and deliver results. Follow everything that is mentioned in the SOP from a process standpoint. Address any issues, concerns timely and ensure the daily activities are not compromised. Maintain record of every transaction / trade processed to evaluate process guidelines in the case of Audit and / or Claims No financial or nonfinancial errors to be committed Timely escalation and address queries / issues with the right audience to interact with internal clients (like traders / middle offices) and external counterparties. Should take initiatives within and outside the team to enhance individual / process development. Also get cross trained and learn anot...

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 ResponsibilitiesDevelop 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 ...

Maintaining relations with the suppliers. Placing orders for necessary raw materials and purchased parts according to the requirements of the production. Receiving and handling the confirmations. Checking the purchase orders and modifying them according to the changes in the production plan with the help of the Shortage List and the Open Purchase Order List. Tracking shipments, urging them if needed. Regular, weekly check of the stocks, avoiding overstock. Minimizing the risk of obsolescence with the help of the weekly check of the obsolete report. Correspondence with the freight forwarders, warehouses, and in case organizing the transportation. Dealing with claims, settling debit and credit...