1040 Claims Management Jobs - Page 10

As a Business Solution Specialist at Prudential Health India (PHI), you will be part of a mission to make Indians healthier and bridge the health protection gap. You will be working in a greenfield health insurance deployment in India, focused on creating customer-centric Claims Management functions powered by Data & Technology. Your responsibilities will include: - Collaborating and co-creating with cross-functional workstreams for new products, processes, testing, and implementation. - Implementing, launching, and managing a customer-centric Claims Management function/workflow with a focus on automation, scalability, and productivity. - Developing a deep understanding of business processes...

Job Title: Senior Credentialing Specialist Experience: 5 to 8 Years US Shift: 4:30 Pm to 1:30 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 d...

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Health Claims to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development ...

The candidate will have to ensure the following tasks: Insurance Policy Management Claims Management Liaison with Insurers & Brokers Compliance & Regulatory Requirements Budgeting & Reporting Employee Insurance Programs

Our client is a product-tech company, launched in 2016, solving real-world problems for customers, starting with insurance. And as a customer-first organization serving the digitally-savvy,our Client value proposition of Welcome Change focuses on offerings that make insurance simple and hassle-free! With features such as zero commission, zero paperwork, instant renewal, same-day claim settlements, and app-based updates on claims,our Client is a 'Welcome Change' from traditional insurers. Having said that, we are not just another conventional insurance firm, or the people consulted solely for "claims! Anchored in a tech-centric philosophy, our Client approach fuels innovation, empowering us t...

Retail Claims - Automation & ProjectsKey Responsibilities1 Automate Claims Processes- Design anddevelop automated workflows and business rules to streamline claims processing Integrate with Existing Systems- Integrateautomated claims processing solutions with existing systems and technologies Testing and UAT - Test and validateautomated claims processing solutions to ensure accuracy and efficiency Daily production issue - Troubleshootissues and resolve problems related any day-to-day production issues across allclaim systems for death and health claims5 Collaborate with IT stakeholders, claim team and other requiredstakeholders to understand requirements and implement solutions6 Strong techn...

Entero Healthcare Solutions About us : Did you know that India has 8 Lakh+ chemists, more than 60k+ distributors and still more than 30% of prescriptions go unfulfilled or partially fulfilled in our country every day. We at Entero has been trying to change that by building a robust tech driven supply chain which helps chemists in stocking better and improving the prescription fill rates. We have scaled up from zero to 5000 Cr annual revenue (Actual Revenues, Not GMV) in last 5 years, we are a trusted supply chain partner to more than 84k+ chemists and 3500+ hospitals across 540+ districts as on today. We are also healthcare supply chain partner for more than 1900 healthcare companies both MN...

We are seeking an experienced RCM Manager to oversee and enhance our revenue cycle operations. The ideal candidate will have a strong background in revenue cycle management and a passion for improving financial performance within the healthcare sector. Responsibilities Manage the revenue cycle process including billing, collections, and accounts receivable. Develop and implement strategies to optimize revenue cycle performance. Ensure compliance with regulatory requirements and best practices. Analyze revenue cycle metrics and report on performance to senior management. Collaborate with clinical and administrative staff to streamline processes and improve efficiency. Train and mentor team me...

We are seeking an experienced RCM Manager to oversee and enhance our revenue cycle operations. The ideal candidate will have a strong background in revenue cycle management and a passion for improving financial performance within the healthcare sector. Responsibilities Manage the revenue cycle process including billing, collections, and accounts receivable. Develop and implement strategies to optimize revenue cycle performance. Ensure compliance with regulatory requirements and best practices. Analyze revenue cycle metrics and report on performance to senior management. Collaborate with clinical and administrative staff to streamline processes and improve efficiency. Train and mentor team me...

As a Staff Developer at EY, you will be responsible for coordinating Majesco toolkit related development activities end-to-end. This includes tasks such as developing enhancements/Story cards, unit testing, and debugging complex issues. You will also be working on development activities across client interfaces such as Java, etc, and Configuration flows. Additionally, you will collaborate with Analysts/Customers to design, develop, program, and/or configuration changes and maintain complex integration software. It is important to understand and adapt to interface requirements and configuration needs, create/change Data-object modeling, customer interface, integrations, etc, based on requirem...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years 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 insurance environment and offers a flexible operating mod...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years 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 insurance environment and offers a flexible operating mod...

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 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 insurance environment and offers a flexible operating model t...

TATA AIG General Insurance Company Limited is looking for Senior Manager - Commercial Claims to join our dynamic team and embark on a rewarding career journey Analysis for the current business practice. Find out the different operational strategies. Work on developing the current operational strategy applied to the company with the most recent technology. Coordinate with the operations manager to take the required steps after brainstorming and research. Optimize the operations in the company. Put the suitable operational strategy to fit with the companys culture. Implement the operational strategy in the different departments of the company. Supervise the strategy, and make sure that all the...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years 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 insurance environment and offers a flexible operating mod...

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...

Job description WHO YOU ARE: As the Director of Life Insurance and Annuity Claims, you will be responsible for overseeing and managing the entire claims process related to life insurance and annuity products. This leadership role requires a combination of strategic thinking, operational expertise, and a deep understanding of the insurance industry. The successful candidate will lead a team of claims professionals, ensuring the timely and accurate processing of claims while maintaining a high level of customer satisfaction. WHAT YOULL DO: Develop and implement the overall strategy for the life insurance and annuity claims department in alignment with the company's goals and objectives. Stay i...

As the first point of contact for assigned clients, your role will involve addressing employee and HR queries, attending emergency cashless calls, and supporting clients with Wellness activities. You will also be responsible for maintaining the EB portal Odin assure for assigned clients, managing claims by attending queries and collecting and scrutinizing reimbursement claim submission documents. Additionally, you will support employees with information and processes for planned hospitalizations, monitor cash deposit statements, and deliver customized MIS to clients. Key Responsibilities: - Act as the first point of contact for assigned clients - Address employee and HR queries - Attend emer...

Role & responsibilities We are seeking an experienced and dynamic professional to lead our Claims Operations team for US Healthcare. Will be responsible for managing end-to-end claims processing operations, driving service excellence, ensuring compliance with client SLAs and regulatory standards, and leading high-performing teams in a fast-paced BPO environment. Manage day-to-day operations of the claims processing department, including adjudication, adjustments, rework, and quality control. Serve as the primary point of contact for client operations teams. Conduct regular client calls, business reviews, and performance reporting. Must Have Skillset Looking for candidates with good experienc...

Job Description: Under direct supervision, the Associate is responsible for the timely and accurate posting and imaging of new claims. This includes accessing various systems, both internal and external, for eligibility. Other assignments can include managing incoming email inboxes, bulk uploading of claims and managing automated claims kick outs. The essential functions and responsibilities of this job position include, but are not limited to the following: Timely and accurately posts new claims in the Administrative System within established turnaround time Codes incomplete claims as appropriate Research claims eligibility to ensure the claim belongs to DRMS prior to posting. Reaches out t...

Position : Assistant/Manager Contracts Location : Head Office, Ahmedabad Industry : Infrastructure (Building, Roads, Highways, Projects) Experience : Minimum 10 -15 years in Contracts Department Email for Applications : jdoshi@sccinfrastructure.com Key Responsibilities Draft, review, and negotiate contracts, subcontracts, and agreements with clients, vendors, and subcontractors Ensure compliance with legal and regulatory requirements in all contract documentation Manage claims, disputes, and contractual obligations throughout project lifecycle Coordinate with project teams to monitor contract performance and mitigate risks Maintain contract records and documentation for audits and internal r...

Claims Associate Medical Company : GoDigit General Insurance Department : Health Claims – Medical Position Overview Looking to leverage your medical expertise in a dynamic insurance environment? As a Claims Associate – Medical, you will play a key role in ensuring the accuracy, quality, and integrity of health claims decisions by applying clinical knowledge, regulatory awareness, and strong attention to detail. This role demands a balance of technical understanding and operational execution. Key Responsibilities Claims Processing: Review, analyze, and process health claims accurately and within turnaround time (TAT) as per internal SOPs and regulatory norms. Medical Review: Assess the clinic...

Role & responsibilities Comprehensive understanding of property and liability insurance, policy structures, and claims processes, Ability to manage complex cross-functional coordination, Commitment to developing robust self-management practices, thorough process documentation, and early risk escalation to supervisors. Preferred Candidate Profile: Prior experience collaborating with brokers, insurers, and internal risk or compliance teams is preferred

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...