418 Claims Management Jobs - Page 16

25+ years in healthcare payer leadership. Expertise in claims, value-based models, risk adjustment, and member engagement. Deep knowledge of CMS, HIPAA, ACA regulations. Experience with payer tech systems (claims, analytics, CRM).

An excellent opportunity for a seasoned operation professional to lead and manage high-performing teams in motor insurance claims. This role offers exposure to end-to-end claims operations, client interactions, and team leadership in a process excellence-driven environment. Your Future Employer - A leading global business process management company serving clients across industries like Insurance, Banking, Travel, Healthcare, and more. With a strong focus on innovation, analytics, and digital transformation, the organization enables businesses to achieve superior operational outcomes and efficiency. Responsibilities - Managing day-to-day operations and driving performance improvements across functions. Overseeing the motor bodily injury claims process with a focus on compliance and timely resolution. Leading and mentoring a team to foster engagement and accountability. Collaborating with legal and external stakeholders on complex claims. Monitoring KPIs, identifying process gaps, and driving continuous improvement initiatives. Ensuring compliance with industry regulations and internal controls. Driving automation initiatives and contributing to digital transformation efforts. Requirements - Graduate degree in Business Administration, Insurance, or a related field. Strong experience in operations management, especially in the insurance sector. Proven track record in managing motor insurance claims and leading large teams. Excellent communication, analytical, and stakeholder management skills. Familiarity with claims systems, risk assessment methodologies, and process optimization tools. What is in it for you - Opportunity to drive operational excellence and team performance. Exposure to global best practices in insurance operations. Be a key contributor to digital transformation and strategic projects. Reach us: If you think this role aligns with your career goals, please email your updated resume to vasu.joshi@crescendogroup.in for a confidential discussion. Disclaimer: Crescendo Global specializes in Senior to C-level niche recruitment. We are committed to enabling job seekers and employers with an engaging and professional recruitment experience. Crescendo Global does not discriminate on the basis of race, religion, gender, sexual orientation, age, disability, or any other protected status. Note: Due to the volume of applications we receive, we may only respond to shortlisted candidates. Thank you for your understanding. Scam Alert: Beware of fraudulent job offers in the name of Crescendo Global. We do not charge fees or request purchases. All valid opportunities are listed at www.crescendo-global.com. Profile Keywords - Deputy Manager Jobs, Operations Jobs, Insurance Claims Jobs, Motor Insurance, Claims Management, SLA Management, Team Leadership, Client Management, Operations Excellence, BPM Jobs, Insurance Operations, Claims Processing.

Job Summary The Contracts Manager is responsible for overseeing contract management, ensuring compliance with contractual terms, mitigating risks, and optimizing contractual outcomes for infrastructure projects This role requires strong expertise in contract negotiation, legal compliance, claims management, and stakeholder coordination, Key Responsibilities Contract Management & Administration Draft, review, negotiate, and finalize contracts, subcontracts, and agreements with clients, vendors, and subcontractors, Ensure compliance with contractual obligations, company policies, and legal requirements, Monitor contract performance, identifying and mitigating risks, Maintain proper documentation and records for all contract-related matters, Risk Assessment & Mitigation Identify potential risks in contracts and develop strategies to mitigate them, Ensure adherence to legal and regulatory frameworks governing infrastructure contracts, Manage claims, disputes, and contract-related litigations, Tendering & Procurement Support Assist in pre-bid discussions, contract negotiations, and bid submissions, Evaluate vendor and subcontractor agreements to ensure favorable terms, Support procurement teams in vendor selection and contract finalization, Stakeholder Coordination & Communication Liaise with legal teams, project managers, and procurement teams to ensure smooth contract execution, Serve as the primary point of contact for contract-related queries from internal and external stakeholders, Conduct contract briefings and training sessions for relevant teams, Claims & Dispute Resolution Handle contract claims, variations, and change orders, Assist in dispute resolution, mediation, and arbitration proceedings, Work closely with legal advisors to ensure smooth resolution of contractual disputes, Compliance & Reporting Ensure contracts comply with statutory, regulatory, and corporate governance requirements, Prepare periodic reports on contract status, risks, and financial implications, Implement best practices in contract management to enhance operational efficiency,

Back to Careers Page Senior Manager Insurance Full Time Gurugram Overview Key Terms & Benefits: The Senior Manager Insurance will oversee the management and placement of comprehensive insurance policies, ensuring coverage for the companys operations, assets, and projects, specifically within the renewable energy sector (solar, wind, and energy storage) The role requires expertise in multiple insurance lines, working with brokers and underwriters, managing claims, and optimizing risk coverage while ensuring compliance with industry standards and regulatory requirements, Insurance Program Management Develop and manage the companys insurance portfolio, including but not limited to General Liability, Property, Professional Liability (E&O), WorkersCompensation, Directors & Officers, Cyber Liability, Business Interruption, ContractorsAll Risk, Trade Credit, Marine & Cargo, Fidelity, and Group Personal Accident Insurance, Ensure adequate insurance coverage for solar power, energy storage, and wind energy projects, tailoring policies to the specific risks of these sectors, Risk Assessment & Mitigation Conduct risk assessments for all operations, projects, and assets, including renewable energy sites, to identify potential insurance requirements, Collaborate with project and Asset Management teams to ensure risks related to property, liability, environmental impact, and business interruption are effectively covered, Claims Management Oversee the full claims lifecycle, from incident reporting through to settlement, ensuring swift and fair resolution of claims, Coordinate with legal, finance, and project teams to handle claims efficiently, particularly for renewable energy projects Policy Placement & Negotiation Lead the placement of various insurance policies, negotiating with brokers and underwriters to secure optimal coverage terms, Ensure policies are tailored to the companys business needs, particularly for solar, wind, and energy storage projects, balancing risk exposure with cost-efficiency, Policy Renewal & Optimization Manage the timely renewal of all insurance policies, ensuring continuous coverage with optimized terms, Analyze the companys insurance needs and recommend adjustments to coverage to align with evolving project portfolios, particularly in renewable energy Compliance and Reporting Ensure compliance with local, national, and international insurance regulations, particularly in renewable energy project jurisdictions, Prepare regular reports on insurance status, claims management, and risk mitigation efforts, presenting them to senior management, Stakeholder Engagement Build and maintain relationships with insurance brokers, underwriters, and other third-party providers to ensure effective communication and service delivery, Provide guidance to internal teams on insurance policies and coverage needs, including risk management for renewable energy projects Budgeting and Cost Control Manage the insurance budget, ensuring premium costs are aligned with financial objectives without compromising coverage, Identify cost-saving opportunities through policy bundling or other strategic measures, Non-negotiable Technical Skills And Abilities Technical Competencies Proven track record in managing diverse insurance portfolios, including General Liability, Property, E&O, WorkersCompensation, D&O, Cyber, Business Interruption, ContractorsAll Risk, Trade Credit, Marine & Cargo, Fidelity, and Group Personal Accident Insurance, PERSONA/ BEHAVIORAL COMPETENCIES Soft Skills Strong negotiation skills to secure favorable insurance terms for renewable energy projects, Analytical and detail-oriented, with the ability to identify risks and recommend appropriate insurance coverage, Excellent communication skills, capable of liaising with both internal teams and external providers, Strong organizational skills to manage multiple policies and claims, Goal-oriented, with a proactive approach to risk management and insurance optimization, Interview Process Round 1: Screening by TA Round 2: Interview with Projects Head Education EDUCTION AND EXPERIENCE REQUIRED Bachelors degree in Finance, Risk Management, Insurance, or a related field Professional certifications (e-g , Chartered Insurance Professional, Associate in Risk Management) preferred, Experience 10 years of experience in insurance management, with specific expertise in placing policies for solar power, energy storage, and wind energy projects, THE SUNSURE ADVANTAGE At Sunsure Energy, We Believe In Nurturing Our Greatest Asset?our People Joining Our Team Means Becoming Part Of a Dynamic And Inclusive Culture Where Innovation Thrives, And Every Voice Matters The Sunsure Advantage Encompasses Empowerment and Growth: We are committed to your professional development through extensive onboarding programs, ongoing training via platforms like Harvard and Coursera, Recognition and Inclusion: We celebrate achievements and foster a sense of belonging with family-inclusive rewards and recognition programs, ensuring everyone feels valued, Well-Being Focus: Our holistic approach prioritizes the physical, mental, and emotional well-being of our employees, offering comprehensive benefits that support a healthy work-life balance, Feedback and Connection: Through initiatives like Miras check-ins and anonymous feedback surveys, we encourage open communication and continuous improvement, ensuring that your insights are heard and acted upon, Innovative Work Environment: Be part of a forward-thinking organization that values creativity and collaboration, driving sustainable energy solutions for a brighter future, If youre looking to make an impact while being supported by an organization that champions your growth and well-being, Sunsure Advantage is your path to success, About Us Sunsure stands as Indias leading Independent Power Producer, boasting exceptional capabilities in solar and wind technologies With expertise in utility scale and distributed RE projects, Sunsure caters to commercial and industrial (C&I) clients through open access and behind the meter solutions and leads the nations sustainable energy revolution as a premier renewable energy company Supported by a $400 million investment from Partners Group AG, Sunsures growth trajectory is bolstered by strategic partnerships and a commitment to shaping a greener India, Our mission and vision We are on a mission to deliver high performing renewable energy assets to meet the green power demand of Indias largest commercial and industrial corporates and in turn lead the charge for creating Indias clean energy powered future We aim to reach 5 GW of production capacity by 2028 using our expertise in solar, wind and battery storage technologies, and become Indias largest renewable independent power producer,

Long Term Disability Claim Manager Role Overview: The LTD Claim Manager will manage an assigned caseload of Long-Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners in order to gather the information that is most relevant to each claim. It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate customer eligibility and interact with internal and external customers including, but not limited to, customers, employers, physicians, internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim. What You'll Do: Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach. Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information Execute on all client performance guarantees Respond to all communications within customer service protocols in a clear, concise and timely manner Make fair, accurate, timely, and quality claim decisions Adhere to standard timeframes for processing mail, tasks and outliers Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.) Clearly articulate claim decisions both verbally and in written communications Understand Corporate Compliance, Policies and Procedures and best practices Stay abreast of ongoing trainings associated with role and business unit objectives What You'll Bring: High School Diploma or GED required. Bachelor's degree strongly preferred. Long Term Disability Claims experience preferred. Experience in hospital administration, medical office management, financial services and/ or business operations is a (+) Comfortable talking with customers and having thorough phone conversations. Excellent organizational and time management skills. Strong critical thinker. Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously. Ability to focus and excel at quality production Proficiency with MS Office applications is required (Word, Outlook, Excel). Strong written and verbal skills demonstrated in previous work experience. Specific experience with collaborative negotiations. Proven skills in positive and effective interaction with customers. Experience in effectively meeting/exceeding personal professional expectations and team goals. Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset. Comfortable giving and receiving feedback. Flexible to change. Demonstrated analytical and math skills. Critical Competencies: Decision Quality Communicate Effectively Action Oriented Manages Ambiguity Customer Focus

Job Title: Assistant General Manager Role Purpose The Incumbent is a technical expert and is responsible of scrutinising the correspondence for contractual replies and technical issues and drafting the accurate responses for client replies and the documents required for ADR/legal matters. They handle coordination with external consultants for the preparation of correct documents. They vet the CoS, prior to submission. Key Responsibilities Contract Administration & Monitoring Preparation of CAD (Contract Appreciation Document), formats for CIS (Contract information system), risk register and monthly reports that can be used as reference by the Head - Contracts and the management team and follow ups with the site team for the completion of these reports. They will be coordinating with 4 to 6 project sites. ADR Management Scrutinize the correspondence received through DMS/Emails (for a group of projects) and segregate contractual technical issues requiring replies/other actions and apprise the Lead -Contracts. Assist in preparation of drafts for contractual matters, for submission of claims and other ADR related documents. Vet the CoS proposals, received from site, prior to submission. Stakeholder management Coordinate with the legal counsel for the technical aspects of ADR matters. Apprise the Lead in case of any variations required in the contract. People management – Facilitate development and growth of direct and indirect reportees while keeping track of overall function employee engagement. Ensure employee grievances are handled in the appropriate manner. Indicative Experience and Exposure Diploma or Graduate in (B.E./ B.Tech) Civil Engineering. Min 10 yrs. in Highways and Contract Management i.e. preparation of claims, handling of contractual correspondences, arbitration, etc.

Adhere billing process guidelines Review claims, Verify coverage Assist with inquiries Prepare claim forms & documents & timely claim processing Record Keeping & upload files on the portal Assist pre-authorizations Resolve billing issues/escalation Required Candidate profile Any graduation or BBA/BHA min. 1 year Billing Experience is preferred Please Email your resume at hr@jimsh.org

Check the medical admissibility of claim by confirming diagnosis and treatment details Verify the required documents for processing claims and raise an information request in case of an insufficiency Approve or deny claims as per T&C within TAT If candidates are interested please drop your update resume/CV on my WhatsApp no - 8951865563 Thanks & Regards Sarika Email - sarika.pallap@mediassist.in

About this role: Wells Fargo is seeking an Audit Manager - Executive Director (SSO). The Audit Manager Executive Director is individual contributor role that supervises, executes and oversees multiple concurrent projects or audit engagements as directed by senior management and also participates in audits generally as subject matter expert in a consulting capacity. Audit Managers demonstrate depth and breadth of knowledge that includes technology, operational, financial, and regulatory understanding across multiple businesses and may develop knowledge in a critical subject matter area. About Chief Operating Office (COO) Audit: The Chief Operating Office (COO) Audit team is responsible for delivering a more consistent approach to business operations across Wells Fargo, strengthening the company's risk and control infrastructure, and delivering effective and efficient enterprise services to employees and customers. COO Audit is responsible for coverage of the Chief Operating Office. Audit coverage is split across sub-teams aligned to the COO organization, which among other things is responsible for coverage for of various shared services operations groups like: Shared Services & Operations (SSO) - Shared Services Operations and Strategic Insight & Implementation business functions, including Payments Operations and Transformation, Business & Real Estate Services, Regulatory Utilities, Enterprise Business Process Management and Automation, Global Delivery Enablement, and Operations Change Initiatives. The SSO team is responsible for the oversight of Operations coverage across Audit, as well as Information Management and Transaction Processing & Execution/Payments Level 2 Risks. Consumer Operations - CLAT functions including Cards & Personal Lending, Home Lending Servicing, and Auto Operations, as well as CSBBAT functions, including Fraud & Claims Management, ATM Strategy and Vendor Solutions, Retail Core, and Customer Service Operations. Wholesale Operations - Wholesale Lending Operations, Corporate & Investment Banking Operations, and Wealth & Investment Management Operations functions. Operations Support and Oversight Functions - Operations support functions such as Financial Crimes, Technology, Finance, India & The Philippines, and Independent Risk Management (IRM) oversight. In this role, you will: Manage a team of audit staff to resolve highly complex and unique challenges requiring in depth evaluation across multiple areas or the enterprise, delivering solutions that are long term Manage defined audits within one or more segments of the Audit Plan Ensure audit engagements are risk based, and executed according to Wells Fargo Audit Services policies and guidance Assist in planning and organizing work in an annual cycle and project cycle Supervise and oversee assigned audits Provide timely feedback, coaching and monitoring of audit work and staff Develop and maintain solid business relationships within Wells Fargo Audit Services and with teams across Wells Fargo, and other stakeholders Required Qualifications: 7+ years of Audit, Risk experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualifications: Post-Graduation degree and/or certifications like CA, CIA, CFA, CPA, ACCA, and CISA will be a plus Lead audits independently Issue validation, regulatory validation, and remediation experience Combination of compliance and audit experience Experience with reporting, audit methodologies, skills gap assessments, project management, training, early talent, recruiting, audit tools and technology support Ability to travel approximately 10% of the time, if required. Deliver against plans with quality, including remediation and validation of issues. Drive further risk integration across lines of defense - Continue enhancement of capabilities across processes and technology to enable efficiency and effectiveness. Build a culture of improvement Champion the advancement and integration of innovation and use of cutting-edge technology to bolster assurance and streamline processes Be responsible for resource management at engagement level, assisting broader team in overall audit plan completion Manage defined audits within one or more segments of the Audit Plan at desired quality levels Accountable for supervision, oversight and timely completion of assigned audits Provides timely feedback, coaching and monitoring of audit work by staff assigned to audits Develops and maintains strong business relationships within Audit team, Control partners and with other teams across WFC and other stakeholders Assists in planning and organizing work in an annual cycle, risk assessments, not just project cycle Ensures audit engagements are risk-based, and executed according to Audit policies, methodology and guidance Assist Audit Management in hiring, coaching and providing feedback to engagement team members. Job Expectations: Strong years of relevant experience in Internal Audit preferably in banking sector, capability centers or Big 4s. Excellent understanding of the Front to Back banking processes, various touch points their inherent risks and controls Ability to effectively utilize the process and business knowledge to credibility challenge the business lines controls, and make recommendations to improve the same Experience of independently lead audit projects with accountability mindset Fluency in analytical procedures, exposure to analytical tools and techniques to identify thematic issues Ability and zeal to build domain knowledge and overall business acumen Sound understanding of audit methodologies, IIA standards, and tools that support audit processes, and / or orientation to risk and controls Excellent verbal, written, and interpersonal communication skills; Strong organizational, multitasking, and prioritizing skills Ability to positively impact a team environment and across all organizational levels, where flexibility, collaboration, and adaptability are important Ability to execute in a fast paced, demanding environment while balancing multiple priorities Agile mindset, problem solving attitude and good analytical skills with high attention to detail Experience leading and providing feedback to engagement staff on audit projects or engagements. As a senior leader in team, you are expected to achieve success by leading yourself, and the business. Specifically, you will: Inspire team with integrity and create an positive work environment where each team members feel included, valued, and supported to do work that energizes them Assist Audit Management for sourcing and hiring, providing ongoing coaching and feedback, recognizing and developing team members, identifying and managing risks, and providing risk insights.

Job Descriptions: Check the medical admissibility of claims by confirming the diagnosis and treatment details. Verify the required documents for processing claims and raise an information. Request a case of an insufficiency. Approve or Deny claims as per T&C witihin TAT. Required Qualification : B.Sc. Nursing, Msc Nursing, Interested candidates can share there profiles to sarika.pallap@mediassist.in or WhatsApp to 8951865563.

Exclusive Walk in Drive - US Healthcare RCM Trainer - 24 May 2025 Date : 24th May 2025 Venue : HCL Tech , 138, 602/3, Medavakkam High Road, Elcot Sez, Sholinganallur, Chennai, Tamil Nadu 600119 POC : Shinaz JOB SUMMARY We are seeking a knowledgeable and experienced US Healthcare RCM Trainer to join our team. The ideal candidate will be responsible for training employees on various aspects of revenue cycle management, including insurance processing, registration, eligibility, claims management, billing, collections, and denials. The trainer will develop and deliver training programs to ensure that employees are well-versed in RCM processes and best practices. Role & responsibilities Train new agents on client-specific processes and ensure they are process-ready with the necessary skills. Evaluate, Review and identify training needs to equip staff with essential knowledge. Assist in developing training standards and assess performance. Update and keep training materials current. Collaborate with stakeholders on training methods and scoring. Implement feedback from training managers and leads for improvements. Responsible for maintaining high throughput from training to production SKILLS AND COMPETENCIES Effective public speaking and presentation skills Skilled in engaging and motivating trainees Comprehensive understanding of US healthcare and RCM Advanced interpersonal, presentation, and written communication skills FORMAL EDUCATION AND EXPERIENCE Graduation in any stream 1-2 years of full-time trainer in US healthcare and provider RCM

Managing CGHS, ECHS, CAPF and ESIC and All Government Portals: Medical file Audit Claim Processing Uploading Query Management Required Candidate profile Mandatory practical experience of government empanelment such as CGHS ECHS ESIC CAPF etc. and medical file audit and processing for Railways, CGHS, ECHS and other govt empanelment's.

Responsible for P&L of the branch Achievement of Branch targets for retention, cross selling and new business Retention of the Companys clients in assigned region Leveraging on the existing clients of the Company for cross selling Identification and conversion of leads for new business generation (corporate business) in assigned region Handling day-to day underwriting and servicing requirements of clients on a timely basis to ensure complete customer satisfaction Effectively managing the team that reports to him Ensuring that all underwriting requirements of clients are met as per Company defined TATs Effectively coordinating between client / centralised claims team to ensure timely resolution of claims Ensuring that all operational requirements / processes are met as per Company defined TATs. Minimum: 5 years with insurance broking firm / insurer . Excellent knowledge of general insurance products to enable effective marketing / servicing of the same Good knowledge of general insurance underwriting / claims management If he has a book of business that can be brought over to the Company, it is a big plus as it will reduce the pressure on new business generation In depth knowledge of the general insurance market in assigned region - corporates and their contacts, renewal dates, databases etc Good relationships with most insurers in assigned region Prior experience with insurance broking firm / insurer Able to deal with / handle the requirements of large corporates Proactive in handling customer needs Multi-tasking & prioritizing Strong interpersonal skills Excellent communication skills Networking & Collaborative Abreast with technology.

Preferred candidate profile Candidate should be from Property and Casualty Claims Process Immediate Joiners Only Good English Communications

We Have Urgent Requirement of TPA Manager

In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6+ months of Call Center experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

Job Summary The Insurance Verification Manager will be responsible for overseeing the insurance verification process, ensuring timely and accurate verification of patient insurance eligibility and benefits. This role involves managing a team, optimizing workflows, and leveraging advanced features to enhance operational efficiency and patient experience. Key Responsibilities: Supervise and mentor the insurance verification team, setting performance goals and conducting regular evaluations. Provide training and support to team members on insurance verification tools and best practices. Ensure timely verification of patient insurance eligibility, benefits, coverage levels, exclusions, and limitations. Monitor and manage the verification process, addressing any discrepancies or issues promptly. Utilize efficient scheduling and patient list management techniques to prioritize verification tasks. Implement and maintain insurance templates to streamline data entry and reduce errors. Coordinate with other departments to ensure seamless integration of insurance verification with scheduling, billing, and patient care. Communicate with insurance providers to resolve verification issues and stay updated on policy changes. Generate and analyze reports on verification metrics, claim statuses, and aging balances. Ensure compliance with HIPAA and other regulatory requirements in all insurance verification activities. Qualification Bachelors degree in Healthcare Administration, Business Administration, or a related field. Minimum of 5 years of experience in insurance verification or healthcare revenue cycle management, with at least 2 years in a managerial or supervisory role. In-depth knowledge of insurance policies, eligibility criteria, coverage details, and claims processes. Proficiency in using insurance verification software, practice management systems, or related healthcare management tools. Strong understanding of HIPAA regulations and other healthcare compliance requirements. Excellent leadership and team management skills. Strong analytical and problem-solving skills, with the ability to make data-driven decisions. Effective communication and interpersonal skills, with the ability to coordinate with cross-functional teams. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and experience with data analysis tools. Professional certifications in healthcare management or medical billing and coding (e.g., CPC, AAPC, CHAM) are a plus. Willing to work in night shifts

Job Title: MBBS Medical expert- Claim & Insurance (Claim Adjudication & Medical Auditor) Location: Delhi/NCR Key Responsibilities Review and adjudicate medical claims for accuracy, completeness, and compliance with established guidelines and protocols. Evaluate clinical documentation and medical necessity to ensure appropriate utilization and minimize fraudulent claims. Support the development and implementation of medical audit frameworks and tools. Collaborate with internal teams, insurers, and government stakeholders for scheme design and policy formulation. Analyze claim trends, identify irregularities, and propose corrective and preventive actions. Provide expert insights and recommendations on complex medical claims and health benefits adjudication. Contribute to the design and delivery of training programs related to claims processing, auditing, and compliance. Assist in drafting SOPs, process manuals, and operational guidelines for public health insurance schemes. Participate in healthcare policy evaluation, scheme monitoring, and audit assignments for state and national-level projects. Required Qualifications & Skills Essential: MBBS from a recognized university. Minimum 3 years and 7 years of post-qualification experience in the healthcare or health insurance sector. Health insurance or underwriting. Healthcare practice or claim processing/medical insurance services. Healthcare schemes or claims management/medical auditing. Strong analytical skills with an investigative approach to claim validation. Knowledge of ICD codes, medical billing, and healthcare regulations. Desirable: MD from a recognized university or institute. Proven experience in health insurance, medical underwriting, claims adjudication, or medical audit. Familiarity with government-sponsored health schemes (e.g., PM-JAY, state insurance programs). Strong analytical mindset with attention to detail and a structured investigative approach. Proficiency in using health claims management systems and audit tools. Excellent written and verbal communication skills. KPMG India has a policy of providing equal opportunity for all applicants and employees regardless of their color, caste, religion, age, sex or gender, national origin, citizenship, sexual orientation, gender identity or expression, disability, or other legally protected status. As an equal opportunity employer, KPMG is committed to fostering a culture where everyone feels welcomed and is treated fairly. If you have any reasonable accessibility or accommodation requirement that will make you more comfortable during the assessment and recruitment process, please let us know and our Talent Acquisition colleague will connect with you

Timely settlement of assigned claims Effectively coordinating between client / branch office / insurer / surveyor to ensure timely resolution of non-EB claims within Company defined TATs Handling day-to day servicing requirements of claims on a timely basis to ensure complete customer satisfaction Effectively managing the team of Executives who may report to him / her Ensuring that all required MIS reports are updated and submitted on a timely basis Ensuring compliance with IRDA requirements in respect of claims management Maintaining excellent relationships with insurers / surveyors to ensure support for claims settlement Ensuring that all operational requirements / processes are met as per Company defined TAT

Role & responsibilities Oversee and manage the end-to-end claims process, ensuring timely processing and adherence to internal policies Analyze claims data to identify trends, assess process gaps, and evaluate financial impact Prepare and present reports including claim status, pending settlements, and loss projections to senior management Collaborate with internal teams and external partners to resolve operational challenges and enhance efficiency Act as the primary point of contact for claim-related insights, fostering clear communication among stakeholders Identify and implement best practices to improve claim management accuracy and efficiency

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years Language - Ability: English(International) - 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 insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Property and Casualty Insurance Ability to establish strong client relationship Ability to meet deadlines Ability to perform under pressure Ability to work well in a team Prioritization of workload Claims Processing Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems Your day to day interaction is with peers within Accenture before updating supervisors In this role you may have limited exposure with clients and/or Accenture management You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments The decisions you make impact your own work and may impact the work of others You will be an individual contributor as a part of a team, with a focused scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Skill required: Delivery - Financial Management Designation: I&F Decision Sci Practitioner Sr Analyst Qualifications: Bachelor's in actuarial science/Master's in actuarial science Years of Experience: 5 to 8 years What would you do? Data & AIDesign and implement the org structure, responsibilities, procedures and supporting technology to ensure finance and accounting operations run effectively and efficiently. Ability to perform day-to-day management of financial accounts, provide financial assistance for decision making in timely manner, apply accounting principles, prepare accurate and timely financial management reports and statements and ensure accurate recording and analysis of revenues and expenses. What are we looking for? Insurance Claims Financial Reporting Ability to work well in a team Adaptable and flexible Agility for quick learning Commitment to quality Ability to manage multiple stakeholders Roles and Responsibilities: In this role you are required to do analysis and solving of increasingly complex problems Your day-to-day interactions are with peers within Accenture You are likely to have some interaction with clients and/or Accenture management You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments Decisions that are made by you impact your own work and may impact the work of others In this role you would be an individual contributor and/or oversee a small work effort and/or team Qualification Bachelor’s in actuarial science,Master’s in actuarial science

About Navi Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a Navi ite : 1. Perseverance, Passion and Commitment Passionate about Navis mission and vision Demonstrates dedication, perseverance, and high ownership Goes above and beyond by taking on additional responsibilities 2. Obsession with high-quality results Consistently creates value for the customers and stakeholders through high-quality outcomes Ensuring excellence in all aspects of work Efficiently manages time, prioritizes tasks, and achieves higher standards 3. Resilience and Adaptability Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility Key Responsibilities: Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations. Identify any inconsistencies, overbilling, or discrepancies between services provided and the claims submitted Detect potential fraudulent claims by analyzing patterns and identifying suspicious activities or behaviors Providing detailed reports on audit findings, Decision accuracy, including identifying overpayments, underpayments, or fraudulent activities Recommend actions based on findings, such as denying, reducing, or adjusting claims Communicate audit results and findings to management and external stakeholders Suggest process improvements to enhance the efficiency and accuracy of the claims audit process. Stay updated with industry trends, regulations, and changes in healthcare policies that may impact claims auditing Provide guidance and training to claims team members or other related stakeholders Investigating medical claims to identify fraud Automate system and bring in improvements on claims processes Team Management- Build and manage the team of doctors supporting the function The role involves identifying discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements What are some of the good to have skills for this role? Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Experience in handling audit Background in claims processing with clinical experience in a hospital setting Data analytics experience would be an added advantage Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Knowledge of health insurance policies and regulations, IRDAI circulars is must Strong analytical and problem-solving skills. Excellent attention to detail and ability to spot discrepancies Ability to anticipate potential problems and take appropriate corrective action Effective communication skills for working with different stakeholders Time management skills to meet deadlines. Should have a broad understanding of Claims Practice Sharp business acumen to understand health insurance claim servicing needs Excellent communication skills, including writing reports and presentations

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Senior Analyst Qualifications: Any Graduation Years of Experience: 5 to 8 years Language - Ability: English(International) - 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 insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Property and Casualty Insurance Ability to establish strong client relationship Ability to manage multiple stakeholders Ability to perform under pressure Process-orientation Written and verbal communication Payment Processing Operations Roles and Responsibilities: In this role you are required to do analysis and solving of increasingly complex problems Your day to day interactions are with peers within Accenture You are likely to have some interaction with clients and/or Accenture management You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments Decisions that are made by you impact your own work and may impact the work of others In this role you would be an individual contributor and/or oversee a small work effort and/or team Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(International) - 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 insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Property and Casualty Insurance Ability to establish strong client relationship Ability to meet deadlines Ability to perform under pressure Ability to work well in a team Prioritization of workload Claims Processing Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation