52 Claims Operations Jobs

Job Description : Claims operations On monthly basis, monitor key performance parameters such as - Claims settlement TAT Claim Settlement Ratio Efficiency ratio, etc. Track deviations against set targets and identify reasons for deviations Closely monitor and control the high ageing open claims, including co-insurance claims Review the reserve revisions for Non Motor claims in the zone Enter into a discussion and negotiation with the surveyor and the client in order to obtain his consent and release payment accordingly To keep liaison with other departments Co-ordinate with Surveyor/Investigator Recommend head office to empanel service provider, after taking market feedback. Appoint appropri...

Responsibilities Manage and oversee all insurance-related operations within the hospital. Coordinate with insurance companies to ensure timely processing and settlement of claims. Facilitate communication between patients, healthcare providers, and insurance firms. Ensure compliance with all relevant insurance policies and regulations. Analyze and report on insurance claims and related financial metrics. Provide guidance and support to junior associates in handling complex insurance cases. Skills Strong Analytical Skills Exceptional Communication Abilities Proficiency in Insurance Software Attention to Detail Problem-Solving Skills. Required Qualifications Bachelor's degree in Business Admin...

Role Overview: You will be leading the Claims Operations team for US Healthcare, managing end-to-end claims processing operations, ensuring service excellence, compliance with client SLAs and regulatory standards, and leading high-performing teams in a fast-paced BPO environment. Key Responsibilities: - Manage day-to-day operations of the claims processing department, including adjudication, adjustments, rework, and quality control. - Act as the primary point of contact for client operations teams. - Conduct regular client calls, business reviews, and performance reporting. Qualification Required: - Candidates with good experience in Claims and managing a large scale business team. Company D...

JOB DESCRIPTION PURPOSE OF ROLE Providing operational leadership to the Central Operations function ensuring quality, productivity, utilization of manpower and adherence to SLA. Designation AVP- Central Operations Function Central Operations - Supervisor Location Bangalore Educational Qualification MBA / Any IT Professional / BAMS / BHMS / MBBS Industry Type TPA / Insurance / Healthcare Roles and Responsibilities Claims Processing Metrics Claims Settlement Cycle Time: Average days from claim receipt to payment, targeting quick resolution to enhance member satisfaction Claims Denial Rate: Percentage of claims rejected, indicating adjudication accuracy and policy compliance. Claims Processed P...

As an Assistant Vice President in Specialty Insurance within a high-impact leadership position, you will be responsible for overseeing Finance & Accounting (F&A), Underwriting Support (UWS), and Claims operations for a global Specialty P&C Re/Insurance service provider. With a strong international presence across various regions, you will manage a team of approximately 270 professionals across different domains such as RI UWS, Insurance UWS, Delegated Authority, Claims, R2R, I2C, P2P, FP&A, Tax, and Statutory Reporting. Key Responsibilities: - Provide strategic leadership across Insurance & Reinsurance UWS and F&A domains, especially in London Market operations. - Drive transformation initia...

As an Assistant Vice President in Specialty Insurance (London Market), you will be responsible for overseeing Finance & Accounting, Underwriting Support, and Claims operations for a global Specialty Property & Casualty Re/Insurance provider. You will manage a large team of professionals across various functions and locations, ensuring smooth operations and client satisfaction. Key Responsibilities: - Provide leadership in Insurance and Reinsurance operations, focusing on London Market processes. - Drive business transformation, automation, and analytics initiatives to deliver value. - Maintain strong relationships with senior client stakeholders and ensure service delivery meets SLAs/KPIs. -...

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, a...

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, a...

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, a...

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, a...

Role Overview: You will be joining AssetPlus as the Manager of Claim Relationship Management, where you will play a crucial role in transforming and setting new benchmarks in the claim process. Your primary focus will be on advocating for partners and customers to ensure seamless, empathetic, and efficient claim journeys. Your work will directly contribute to building trust and driving growth for the company. Key Responsibilities: - Own the end-to-end claims experience, serving as the primary advocate and single point of contact for partners and customers throughout the entire claims lifecycle. - Arbitrate and resolve complex, high-stakes claims escalations, mediating between customers, part...

Manager - Claim Relationship Management Location: Chennai, India About AssetPlus AssetPlus is one of India's fastest-growing assisted wealth-tech platforms, empowering over 15,000 Mutual Fund Distributors (MFDs) to serve more than 1.5 Lakh retail investors. As we scale our insurance vertical, operational excellence is at the heart of what makes the business work. We believe that the insurance purchase journey must be fast, accurate, and partner-first. Whether it's a lead requesting quotes or a customer awaiting policy issuance, we aim to eliminate friction, improve speed, and maximize trust and that's exactly what this role will drive. The Role - When a customer faces a claim, it's their mom...

About the Role We are hiring an accomplished AVP Claims Operations (US Healthcare) to lead and transform large-scale claims operations, elevate service delivery, and drive innovation across a major healthcare BPM setup. The role oversees multi-location delivery teams, partners with global stakeholders, leads automation and analytics-driven transformation, and manages a portfolio of USD 1020M. This is a high-impact leadership role reporting into the senior operations leadership team. Key Responsibilities Strategic & Operational Leadership Lead end-to-end US Healthcare Claims Operations to industry-leading standards. Manage large-scale back-office claims functions including PI, SIU, Rework, En...

Lead the delivery of customer service management solutions within the workers compensation domain, ensuring high-quality service and client satisfaction Oversee policy administration processes, optimizing workflows to enhance efficiency and accuracy Provide strategic direction for new business initiatives, aligning them with organizational goals and market demands Manage claims processes, ensuring timely and accurate resolution to support client needs and regulatory compliance Collaborate with cross-functional and cross-Geo teams to integrate customer service management with policy administration and claims operations Develop and implement best practices for workers compensation policy admin...

About the Role We are looking for experienced and detail-oriented professionals to join our Claims Case Management Team . The role involves reviewing and analyzing health insurance claims, ensuring accuracy, compliance, and cost-effectiveness while maintaining a strong customer-centric approach . You will collaborate closely with hospitals, TPAs, and internal teams to identify irregularities, prevent financial losses, and uphold the integrity of the claims process . Key Responsibilities 1. Claim Review & Analysis Assess claims for admissibility, medical necessity, and identify irregularities or overbilling. Conduct root-cause analysis using claims data, treatment records, and clinical guidel...

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. 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 expe...

Experience : 8+ Years (12 Years as ASSISTANT Manager on paper) Key Requirements: Hands-on experience in End-to-End Claims (Mandatory) Strong exposure to General Liability, Auto, Motor, or Direct Insurance (US / UK markets only) Experience across multiple lines of business & ability to handle complex scenarios Excellent communication skills verbal & written Proven team management experience with knowledge of performance metrics. Do Not Consider :Candidates from Total Loss / Admin / Subrogation / Property & Casualty Insurance.

Job Description: About Us At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities and shareholders every day. One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We're devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being. Bank of...

You will be leading the Claims Operations team for US Healthcare in a fast-paced BPO environment. Your role will involve managing end-to-end claims processing operations, ensuring service excellence, maintaining compliance with client SLAs and regulatory standards, and fostering high performance within the team. Your responsibilities will include: - Managing day-to-day operations of the claims processing department, including adjudication, adjustments, rework, and quality control. - Acting as the primary point of contact for client operations teams. - Conducting regular client calls, business reviews, and performance reporting. Qualifications required for this role: - Candidates with signifi...

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...

As an Assistant Vice President in Specialty Insurance, your role will involve overseeing Finance & Accounting (F&A), Underwriting Support (UWS), and Claims operations for a global Specialty P&C Re/Insurance service provider. You will be leading a team of approximately 270 professionals across various functions such as RI UWS, Insurance UWS, Claims, R2R, I2C, P2P, FP&A, Tax, and Statutory Reporting. Key Responsibilities: - Provide strategic leadership across Insurance & Reinsurance UWS and F&A domains, specifically focusing on London Market operations. - Drive transformation initiatives to ensure smooth operations and deliver value to clients. - Implement tech-enabled and data-driven operatio...

Role Overview: You are invited to apply for the role of Assistant Vice President Specialty Insurance (London Market). As a niche leadership position, you will be responsible for overseeing end-to-end Finance & Accounting (F&A), Underwriting Support (UWS), and Claims operations for a global Specialty Property & Casualty Re/Insurance provider with a presence across the UK (including London Market), Europe, Bermuda, the US, and Latin America. Your role will involve managing a large span of approximately 250 professionals across various functions including RI UWS, Insurance UWS, Delegated Authority, Claims, R2R, I2C, P2P, FP&A, Tax, and Statutory Reporting for both Assumed and Ceded operations. ...

About this role: Wells Fargo is seeking a Fraud & Claims Operations Associate Manager. In this role, you will: Supervise a team of specialists within a fraud and claims program for proactive fraud identification, prevention, and detection, as well as ensuring the recovery, execution, and handling of claims Identify opportunities for process improvement and risk control development in fraud and claims management to maximize efficiency and enhance customer service Make supervisory decisions and resolve issues related to work distribution under direction of fraud and claims management Leverage interpretation of internal processes and procedures to establish performance standards, evaluate perfo...

Assistant Manager / Deputy Manager - Claims -2+ Years - Pune Are you a highly motivated claims professional looking to make an impact in the insurance industry? We are seeking an experienced Assistant Manager / Deputy Manager - Claims with over 2 years of expertise in managing and processing claims. This is your chance to work in a role where you can bring value, drive process improvements, and enhance customer satisfaction. If you are ready to embark on an exciting journey of professional growth, this is the perfect opportunity for you! Location:- Pune Your Future Employer A leading organization in the insurance domain, known for its dynamic work environment and commitment to professional e...

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 experience in Claims - managing a larg...