1190 Claims Processing Jobs

GREETINGS FROM PERSONAL NETWORK !!!! TOP US MULTINTIONAL COMPANY @ Marthalli, BANGALORE IS LOOKINGOUT FOR Healthcare Professional FOT THEIR International Voice Health Care PROCESS. REQUIREMENTS :- POST :- CUSTOMER SUPPORT - HEALTHCARE PROCESS :- VOICE - INTERNATIONAL QUAL :- Graduates / BE / MCA EXP :- 1 to 4 Years SALARY :- 5 LAKH Location :- BANGALORE Shift :- US Shift / ROTATIONAL SHIFT CAB :- 2 WAY FOOD :- AVAILABLE Contact Tinna @ 76192 81864 RAJ @ 98451 62196 Anu @ 98450 43512 Best Wishes - Personal Network

Qualification: Any Graduation Years of Experience: Fresher Education: BA & B.com are priority but we can look for BBA, BMS, BBI, BMM as well Work Location: MDC-7 (Candidates should be located near the location and be comfortable with face-to-face interviews.) Job Summary: You will be a part of the Healthcare Claims team, which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation. In Payer Claims Processing, you will be responsible for delivering business solutions that support the healthcare claim function, leveraging knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims. Job Description: Utilize analytics, technology, domain, and healthcare industry expertise to enhance operational efficiency for healthcare clients. Deliver operational improvements for members Candidate Requirements: Immediate joiners with excellent communication skills. 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. 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 part of a team with a predetermined, narrow scope of work. Please note that this role may require you to work in rotational shifts.

Mandatory Points : 1. Good English Communication is required. 2. Should be Flexible with Night shits. 3. Looking for 2023 and 2024 Freshers. 3. Must have original Degree marksheets with PDC. US Consultant: is responsible for meeting individual key performance metrics related to business processes assigned while adhering to quality standards under the guidance/supervision of an identified mentor/lead. The employee is accountable for following process standard operating procedures. Also needs to identify various process related scenarios, perform proactive analysis around it and propose a solution or process improvement. Competencies: Ability to understand the basic nature of the domain and relating that to the entire value chain of mortgage and title insurance solutions, Time Share property, Claims Servicing & Claims Prevention etc. Should have basic knowledge of Australian Mortgage and Title Insurance Concepts Ability to Retrieve relevant information using appropriate Online Business-related Websites Ability to use these tools to perform required search and collate information. Ability to Process Simple, Medium and High complexity tasks o Follow the set guidelines/framework while structuring all work products o Maintain compliance to the Quality metrics o Ability to display the culture of FTR (First Time Right) While processing orders o Ability to quickly unlearn / learn various tools, processes and controls to deliver effectively Technical Skills: Educational Qualification and Experience: Minimum of 15 years of formal education Diploma/Graduate (Commerce/Art/Business Administration)

The purpose of the Claims Role is to effectively manage the claims process for clients, ensuring a smooth and fair settlement of claims. Your responsibilities will include reviewing and validating claims, liaising with insurers, advocating for clients" interests, and guiding them through the claims process to achieve a satisfactory outcome. You will be expected to accurately review and process claims in adherence to established protocols and guidelines. Furthermore, you will ensure that all necessary documentation is collected and maintained for each claim, including client statements, accident reports, and relevant records. As the main point of contact for clients during the claims process, you will provide timely updates and information, advocate for clients" interests and rights, and ensure a fair and just settlement of claims. Additionally, you will engage in substantiating the claim to the insurers to secure optimal claim settlements for clients, considering policy terms, legal requirements, and clients" expectations. In addressing client concerns, disputes, and inquiries related to claims, you will demonstrate professionalism and timely responses. Conflict resolution and maintaining positive client relationships throughout the claims process will be crucial aspects of the role. To excel in this role, you should possess a strong understanding of insurance policies, coverages, and claims processing. Familiarity with insurance regulations, industry standards, and claims-related legal aspects is necessary. Clear and effective communication skills, both written and verbal, will be essential to convey complex information to clients and internal stakeholders. Your interpersonal skills will be key in managing client interactions with empathy and professionalism. Your analytical skills will be utilized to assess claim details, policy information, and relevant documents to make informed decisions. Identifying potential challenges and developing effective solutions to ensure smooth claims processing will be part of your responsibilities. Effective negotiation skills will also be required to achieve optimal claim settlements for clients and persuasively present clients" cases and arguments to insurers. A bachelor's degree in business, insurance, finance, or a related field is preferred for this role. Prior 10 years of work experience in claims processing, claims handling, or related roles within the insurance industry is advantageous. Relevant certifications in claims management or insurance claims will be beneficial. Proficiency in using claims management systems, CRM software, and the Microsoft Office suite (Word, Excel, Outlook, etc.) is required for this position.,

You will be working as an Insurance Coordinator at Cancer Institute Adyar in Chennai on a full-time on-site basis. Your primary responsibilities will include managing insurance claims, verifying patient coverage, coordinating with insurance companies, and ensuring precise billing and reimbursement procedures are followed. To excel in this role, you should have experience in insurance coordination and claims processing, a solid understanding of medical terminology and insurance procedures, meticulous attention to detail in billing, exceptional communication and interpersonal skills, the ability to thrive in a fast-paced environment, proficiency in MS Office applications, and ideally a certification in Medical Billing and Coding. A Bachelor's degree in Healthcare Administration or a related field will be advantageous. Join us at Cancer Institute Adyar, a renowned institution with a rich history of providing top-notch cancer care. Take on this vital role where you can contribute to our mission of being a beacon of hope for cancer patients through your expertise in insurance coordination and claims processing.,

As a Dental Claims Processor at MetLife, you will be responsible for scrutinizing dental claim documents and settlements, ensuring accurate processing of claims according to healthcare guidelines and HIPAA regulations. Your role will involve handling escalations, meeting quality and productivity targets, and complying with internal policies, external regulations, and information security standards. You will need to have a good understanding of claims adjudication fundamentals, ICT & CPT Codes, and be able to learn, adapt, and implement process guidelines effectively. To qualify for this position, you should hold a Bachelor's degree in any stream or a diploma with a minimum of 15 years of education. Additionally, you should have at least 2 years of work experience in US Health Claims processing, preferably in claims adjudication. Proficiency in computer navigation, keyboarding, data entry, MS Excel, and MS Word is required. Knowledge of insurance principles related to the US Insurance industry, US culture, and dental claims terminologies will be advantageous. As a successful candidate, you must possess strong organizational and communication skills, demonstrate the ability to work independently and in a team environment, be self-disciplined, results-oriented, and have the ability to multitask. Attention to detail, a positive attitude, and being a team player are essential soft skills for this role. Joining MetLife, a globally recognized financial services company, will provide you with the opportunity to contribute to creating a more confident future for colleagues, customers, communities, and the world at large. If you are motivated by purpose and empathy, and aspire to transform the next century in financial services, MetLife welcomes you to be #AllTogetherPossible. Join us in making a difference!,

As a Medical Billing Specialist specializing in Cardiology, you will be responsible for accurately billing various cardiology procedures such as cardiac catheterization, PTCA, PCI, angiography, and diagnostic tests like ECG and Holter monitoring. Your key responsibilities will include applying appropriate modifiers and coding, submitting claims to insurance companies, and rectifying any rejected claims or coding errors to ensure seamless processing. In addition, you will be expected to handle denial management and claims processing by generating appeals for denied claims, following up on authorizations and prior approvals when necessary. You will play a crucial role in revenue cycle management by running denial and accounts receivable reports to optimize billing processes. Acting as a liaison between insurers, medical offices, and patients, you will collaborate with provider offices to address accounts receivable issues and propose process improvements. Maintaining a high level of accuracy is essential, with a performance metric target of 97% in all tasks. Preferred skills for this role include proficiency in E-Clinical Works (ECW) software, experience in accounts receivable calling, a strong understanding of HIPAA laws and medical billing policies, and the ability to efficiently resolve inquiries from patients, insurance companies, and physicians. If you have a detail-oriented approach and a solid background in Cardiology Billing, we encourage you to apply for this full-time, permanent position based in Tambaram, Chennai. The benefits offered include commuter assistance, provided meals, health insurance, leave encashment, life insurance, and Provident Fund. The work schedule may involve day, evening, fixed, morning, night, or rotational shifts, with performance and yearly bonuses available. To be considered for this role, you should have 2 to 5 years of experience in Cardiology Billing, proficiency in charge entry, and be open to relocating to Chennai. Immediate availability to join the team in person is also required.,

Hiring for Healthcare authorization Need B.pharma & M.Pharma pass with 1yr exp in medical scribe, authorization, summarization Loc Gurgaon Salary upto 5.80LPA 5 Days working Rotational shift/OFF Snehal 9625998099 Lakshita 8595954721 Divya 9910810424 Required Candidate profile Candidates must have Good communication skills. Candidates must be comfortable working in any shifts.

Arzion RCM is looking for Arzion Business Solutions - Trainee AR Caller in Chennai to join our dynamic team and embark on a rewarding career journeyAssisting experienced employees with their daily tasks and responsibilities.Observing and gaining hands-on experience in various aspects of the job.Receiving feedback and guidance from supervisors and mentors.Completing assigned projects and tasks under the supervision of experienced employees.Collaborating with team members and contributing to team projects.Demonstrating a strong work ethic, positive attitude, and a willingness to learn and grow.

- Offer comprehensive support through both phone and email communications. - Address complaints effectively, delivering suitable solutions and alternatives within established timeframes. - Conduct follow-ups to guarantee resolution. - Supply accurate and relevant information utilizing the appropriate tools. - Document and update notes for each call or email interaction. - Exceed expectations to prevent any inconvenience.

- Offer comprehensive support through both phone and email communications. - Address complaints effectively, delivering suitable solutions and alternatives within established timeframes. - Conduct follow-ups to guarantee resolution. - Supply accurate and relevant information utilizing the appropriate tools. - Document and update notes for each call or email interaction. - Exceed expectations to prevent any inconvenience.

Primary Responsibilities: To be an effective participant in Class room training and clear the training assessments with 85% quality Consistently meet the targets set for MOCK charts Eligible employee will get confirmed as Junior Coder within a max of 6 months from the Joining Punctuality, Attendance and General Adherence to company policies, procedures and practices Strives to provide ideas to constantly improve the process Ensure adherence to external and internal quality and security standards (HIPPA/ISO/ISMS) Be an effective team player Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so #NTRQ Eligibility To apply to an internal job, employees must meet the following criteria SG 22 can apply will move laterally Performance rating in the last common review cycle of “Meets Expectations” or higher Not be on any active CAP (Corrective Action Plan) or active disciplinary action Time in Role Guidelines Should have been in your current position for a minimum of 12 months, if you have not met the recommended minimum time in role, discuss your career interest with your manager and gain alignment prior to applying. And share the alignment email with respective recruiter while applying Required Qualifications: Any degree in Life Science or Bio-Science Any degree in Pharmacy or Pharmaceutical Sciences Any degree in Nursing or Allied Health Any degree in Medicine At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone – of every race, gender, sexuality, age, location and income – deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission. #NJP External Candidate Application Internal Employee Application

Urgent requirement for BHMS,BAMS -Nagpur Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Need to Do field Visit Required Candidate profile: BHMS,BAMS graduate. both male and female can apply Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Need to travel in Nagpur for filed investigation

100% adherence to Insite and Prato Insta process Update all the treatments in INSTA daily with 100% accuracy. Book GRN the very same day whenever material received with 100% accuracy. Book consumption in EuCliD daily with 100% accuracy. Cost optimization: Proper utilization of Consumable per treatment, Electricity, water, proper Management of patient and staff roster, repair and maintenance cost, local purchase, petty cash and etc. Generation of Management Information reports viz. (Consumable reports, Daily revenue reports, patient data Etc...). Responsible for updating of allied government schemes and claim process. Follow up patients scheduling and maintains report with patients, managers, and employees by arranging continuing contacts. Should maintain Patient details along with addresses and contact numbers. Responsible for rising indents in consultation with Sr. Technician. Responsible for sending his & the technician s attendance on daily basis. In coordination with operation timely submit invoices and follow-up for the payment. In coordination with clinical staff s ensure proper up time of network and complete admin related EuCliD activities. Adherence - Company Policies Ensure adherence to company s time & attendance policy Ensure adherence to company s code of conduct & Compliance Maintain the team camaraderie/harmony Drive effectively the positive environment for Unit 100% accuracy in reporting Material receivable and properly organizing materials in storeroom Dispensing daily consumable to clinical staff. Close monitoring on patient wise consumption Fresenius Medical Care is a global leader in providing high-quality healthcare solutions and services. We are committed to fostering an inclusive and diverse work environment where all employees are treated with respect and fairness, regardless of race, gender, caste, ethnicity, religion, disability, or any other characteristic. We believe in equal opportunities for all and celebrate diversity as a key driver of innovation and success. Our commitment to equality ensures that every individual has the opportunity to thrive

Role & responsibilities Claim Processing Preferred candidate profile BDS,BHMS & BAMS

Book your interview slot WhatsApp your profile @ 9623462146 / 7391077622 or Dipika@infiniteshr.com ******Hiring for P & C Insurance Team Manager / Sr TM , Salary upto 14.00L*** ****Hiring Team Manager Insurance process**** Salary upto 10 LPA Exp: 6 to 15 Yrs Salary : Upto 14 Lacs Regards Dipika Sharma 9623462146 7391077622 8888850831

Job Title: Motor Insurance Claims Handler (Bodily Injury Focus) Location: Bangalore Employment Type: Full-Time Department: Claims / Insurance Operations Reports To: Claims Team Lead / Claims Manager Job Summary: We are seeking a skilled and detail-oriented Motor Insurance Claims Handler with experience in bodily injury claims . The successful candidate will be responsible for managing and processing motor insurance claims efficiently and fairly, with a specific focus on bodily injury liability, third-party damages, and personal injury claims. This role requires strong analytical skills, empathy, and knowledge of motor insurance policies, local legislation, and medical terminology. Key Responsibilities: Handle and manage a portfolio of motor insurance claims, including bodily injury and third-party liability cases. Assess the validity of claims through careful investigation and policy review. Liaise with policyholders, third parties, medical providers, legal professionals, and law enforcement. Obtain and analyze medical reports, police reports, and other relevant documentation. Negotiate settlements in accordance with legal guidelines, policy terms, and internal procedures. Maintain accurate records of claim decisions and supporting documentation in the claims management system. Collaborate with legal and fraud teams where litigation or fraudulent activity is suspected. Keep up to date with changes in legislation and case law relevant to motor and injury claims. Ensure claims are processed within regulatory and internal timeframes. Deliver high-quality customer service during the claims lifecycle. Required Qualifications & Experience: Proven experience (1+ years) handling motor claims , specifically bodily injury or third-party personal injury . Familiarity with local insurance regulations and liability assessment. Experience working with medical terminology and understanding of injury classification. Knowledge of claims management systems and insurance software. Excellent verbal and written communication skills. Strong negotiation, analytical, and decision-making skills. Ability to manage multiple claims with attention to detail and urgency. Preferred Qualifications: Degree in Law, Insurance, Risk Management, or a related field. Insurance certifications. Experience with litigation claims or working with external legal counsel. Soft Skills: Empathy and tact when dealing with injured parties or sensitive situations. Integrity and professionalism. Resilience and ability to work under pressure. Collaborative mindset and team orientation. Contact Point : Deepanshu - 9900024811 / 9686682465 / 7259027282 / 7259027295 / 7760984460

Job Title: Inbound Contact Representative Industry: Healthcare (Voice Process) Experience: Minimum 3 years in Customer Service Preferred: Associate's or Bachelor's degree. Experience in an inbound call center . Healthcare domain experience (voice process only) is a strong plus. Role & responsibilities Handle incoming calls , emails, or written inquiries from customers. Provide support for benefit queries , issue resolution, and customer education. Document customer interactions and take appropriate actions. Escalate unresolved complaints as needed. Perform routine to moderately complex admin and customer support tasks . Make decisions within defined guidelines, using some independent discretion. Work with minimal supervision while meeting quality and timing standards.

As a Third Party Administrator at HOSPITAL STAFF RECRUITMENT SERVICES, you will play a crucial role in managing various administrative tasks associated with health insurance claims while delivering exceptional customer service to patients. Your responsibilities will include processing health insurance claims accurately and efficiently, verifying patient information and eligibility, and engaging with insurance companies, healthcare providers, and patients to ensure smooth claim processing and resolution. You will be expected to maintain meticulous records, adhere to company policies and industry regulations, and collaborate with the team to achieve productivity and quality standards. Additionally, your role will involve addressing customer inquiries and concerns, identifying areas for process enhancement, and contributing to the overall efficiency of claims processing. The ideal candidate for this full-time position in Borivali, Maharashtra, India, will possess 1 to 3 years of experience as a Third Party Administrator in the healthcare industry, a strong understanding of TPA processes, familiarity with Mediclaim and cashless health insurance procedures, and excellent communication and organizational skills. If you are detail-oriented, customer-focused, and thrive in a fast-paced environment, we welcome you to join our team at HOSPITAL STAFF RECRUITMENT SERVICES and make a meaningful impact in the healthcare sector.,

As an Order Processing Engineer within the Water and Industrial Business Unit at Sulzer, you will play a crucial role in processing product and spare parts orders while ensuring customer satisfaction through effective communication and timely delivery. Your responsibilities will include liaising with factory logistic personnel, maintaining customer and product records, reviewing order flows, and handling claims processes. Additionally, you will be involved in SAP training, coordination with factories, handling bank guarantees and letter of credits, and monitoring delivery times. To excel in this position, you should possess a Bachelor's or Master's degree in Engineering, Commerce, or a related field along with over 5 years of relevant experience. Attention to detail, strong communication skills, self-motivation, and proactive attitude are essential qualities for success. Being a team player with a good telephone manner, basic PC skills (Excel & Word), and knowledge of data input to mainframe computer systems, particularly SAP, will be advantageous. Furthermore, you will be responsible for maintaining Health, Safety, Quality, and Environmental standards, ensuring compliance with corporate directives and local legislation. Sulzer values diversity and offers an inclusive work environment, striving to be a top employer in various countries by 2025. If you are seeking a challenging role where you can leverage your expertise to contribute to innovative solutions for a sustainable society, we encourage you to join our dynamic team at Sulzer's Water and Industrial Business Unit in Pune, India.,

Guidewire Developer exp. with (Policy / Billing / Claims / Integration / Configuration / Insurance Now / Portal / Rating) Integration & configuration is must work Location – Hyderabad, Mumbai, Pune, Bangalore, Chennai, Kolkata location Property & Required Candidate profile GW Claim Center,policy Center (DEV),GW Integration/ Edge API/Config GW Rating;GW PC Configuration;GW ClaimCenter/ PolicyCenter/ Integration/Configuration• At least 1Product exp. Claim/Policy/Billing)

Generate New U.S. clients for offshore RCM services (Billing, Coding, AR) Pitch, close deals, and manage client onboarding Coordinate with India delivery team. Handle client communication, contracts and CRM Report meetings and calls in U.S. time zone Office cab/shuttle Health insurance Provident fund Annual bonus Food allowance

Hiring for US Healthcare Voice Process (Customer Service) Location: Sector 30, Gurgaon Shift Timings: Rotational (including night shifts) Week Offs: Rotational Transport: Both-side cab facility provided Transport allownce upto 6,000 Compensation: Upto 3.43 LPA Education: Undergraduates and graduates eligible Experience Required: Minimum 6 months in a US healthcare voice process ----- Candidate Requirements: Prior experience in a US healthcare voice-based process is mandatory (NO Freshers) Excellent spoken English and communication skills Willingness to work in rotational shifts and week offs Immediate joiners preferred

FHRM is looking for Credentialing Specialist to join our dynamic team and embark on a rewarding career journey Credential Verification: Credentialing Specialists collect and verify all relevant documents and information from healthcare providers, including medical licenses, certifications, education, training, work history, and references. Provider Enrollment: They facilitate the enrollment of healthcare providers in insurance networks and government healthcare programs by ensuring that all necessary paperwork and credentials are in order. Compliance: Credentialing Specialists ensure that healthcare providers comply with legal and regulatory requirements, as well as with the organization's policies and standards. Application Processing: They process applications for medical staff privileges or employment, which typically involves gathering and assessing information about the provider's background and qualifications. Verification of References: Credentialing Specialists contact references and previous employers to verify the provider's work history and obtain feedback on their performance and professionalism. License and Certification Monitoring: They continuously monitor the status of licenses and certifications to ensure that they are up to date. This includes tracking expiration dates and initiating renewals when necessary. Peer Review: In some cases, they assist in coordinating the peer review process, where healthcare providers are evaluated by their peers to ensure that they meet the organization's clinical and ethical standards. Database Management: They maintain accurate records and databases of healthcare providers' credentials and documentation, making this information accessible to the organization's leadership and relevant departments. Communication: Credentialing Specialists liaise with healthcare providers, administrative staff, and regulatory authorities to ensure all requirements are met. Reappointment: They manage the recredentialing or reappointment process, ensuring that healthcare providers remain in compliance with all requirements for continued practice. Quality Improvement: They participate in quality improvement initiatives related to the credentialing process, making recommendations for process enhancements. Compliance with Accreditation Standards: They ensure that the credentialing process aligns with the accreditation standards of relevant accrediting bodies. Freshers may apply (with US dialing experience)

POSITION: MEDICAL OFFICER PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Bangalore Educational Qualification Shift BHMS, , BAMS, Pharm D Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and 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. • • • Responsibilities 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 deny the claims as per the terms and conditions within the TAT. • Handle escalations and responding to mails accordingly. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies