3145 Claims Processing Jobs

Nandadeep Eye Hospital is looking for TPA Co Ordinator Professionals to join our dynamic team and embark on a rewarding career journey Collaborate with cross-functional teams to achieve strategic outcomes Apply subject expertise to support operations, planning, and decision-making Utilize tools, analytics, or platforms relevant to the job domain Ensure compliance with policies while improving efficiency and outcomes Disclaimer: This job description has been sourced from a public domain and may have been modified by Naukri.com to improve clarity for our users. We encourage job seekers to verify all details directly with the employer via their official channels before

Job description: Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements. Verify that all necessary clinical documentation is included to support claim submissions and medical necessity. Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims. Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines. Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information. Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record...

Claims Processing and Administration Input and maintain accurate claims records for designated accounts, within appropriate AGC&S Claims administration systems Proactively review late/non-payment of premium and support credit control process with Underwriting / Accounts Investigation and Reserving of Claims Investigate domestic and international claims that involve some complex issues and/or litigation - requires qualified legal analysis (in cooperation with legal) Evaluate and address coverage issues and determine appropriate reserving levels Select and direct independent external service providers (egLoss Adjusters) and establish and maintain professional relationship with litigation servi...

AR Callers Experienced candidates. Reviewing and analyzing claim form 1500 to ensure accurate billing information. Utilizing coding tools like CCI and McKesson to validate and optimize medical codes. Familiarity with payer websites to verify claim status, eligibility, and coverage details. Expertise in various medical specialties such as cardiology, radiology, gastroenterology, pediatrics, orthopedics, emergency medicine, and surgery. Proficiency in using CPT range and modifiers for precise coding and billing. Working with Clearing House systems like Waystar and other e-commerce platforms for claim submissions. Conducting voice-based communication with payers and medical staff to resolve bil...

Medical Billing Associate Job Location: Mohali Salary Range: 20,000-22,000 Eligibiity : 12th+6 months Experience with letter Graduatate Fresher can also apply 5 Days working with Night Shift Cab facility Available Can share your Profile@ 7696111291

Hirings For AR Callers: AR Callers for Experienced candidates: Reviewing and analyzing claim form 1500 to ensure accurate billing information. Utilizing coding tools like CCI and McKesson to validate and optimize medical codes. Familiarity with payer websites to verify claim status, eligibility, and coverage details. Expertise in various medical specialties such as cardiology, radiology, gastroenterology, pediatrics, orthopedics, emergency medicine, and surgery. Proficiency in using CPT range and modifiers for precise coding and billing. Working with Clearing House systems like Waystar and other e-commerce platforms for claim submissions. Conducting voice-based communication with payers and ...

Skill required: Property & Casualty- Underwriting - Insurance Underwriting Designation: Underwriting New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We e...

Role & responsibilities Claims Processing - Health claims Preferred candidate profile BDS,BHMS & BAMS

POSITION: MEDICAL OFFICER/CONSULTANT MOS APPROVER Designation: Medical Officer/Consultant Function: Claims MOS Approver Reporting to: Assistant Manager Claims Location: Noida Educational Qualification: MBBS(Indian registration Required) Shift: Rotational Shift (for female employee shift ends at 8:30 PM) Week offs: 6 rotational week offs Provided per month Management Level: Junior Management Level Industry Type: Hospital/TPA/Healthcare/Insurance Roles and Responsibilities Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy Interpret the ICD coding, evaluate co-pay details, ...

Roles and Responsibilities Manage claims processing, adjudication, and settlement for corporate clients. Ensure accurate documentation of all processes related to insurance claims. Coordinate with healthcare providers for smooth claim settlements. Process bills, refunds, and other financial transactions efficiently. Handle enrollment procedures for new clients and maintain existing ones.

Key Responsibilities: Manage and monitor all TPA & insurance-related activities in the hospital. Coordinate with insurance companies and TPAs for pre-authorization, claim submissions, and approvals. Review and verify patient documents for cashless and reimbursement claims. Ensure timely billing, claim processing, and settlement. Maintain accurate records of all TPA transactions and claim status. Train and guide the TPA team on claim procedures and documentation. Liaise with internal departments (billing, accounts, front office) for smooth cashless patient admission & discharge process. Handle claim rejections and resubmissions effectively. Prepare TPA-related MIS reports and present to manag...

Manages processes as per global Disputes SOP. Helps team buildefficiency by sharing knowledge, best practices and eliminating wastesteps in the process. You'll be responsible for: Achieving/exceeding targets of service delivery. Conducting ""on the job"" training wherever relevant. Learning and executing BCP tasks. Ensuring no fines or penalties are imposed. Preventing claims. Providing suggestions to improve efficiencies. Contributing with ideas/suggestions for overall improvement of the operations business unit.

Job Summary Join our team as a PE-Ins Claims specialist Data resource where you will play a crucial role in managing insurance claims processes. With a focus on customer service and IT domain expertise you will ensure efficient claims handling and contribute to enhancing customer satisfaction. This hybrid role offers rotational shifts providing flexibility and exposure to diverse work environments. Responsibilities Manage and process insurance claims efficiently to ensure timely resolution and customer satisfaction. Collaborate with cross-functional teams to gather necessary information and documentation for claims processing. Analyze claims data to identify trends and areas for improvement ...

Job Summary The SPE-Ins Claims role requires a professional with 2 to 5 years of experience in customer service within the insurance domain. The candidate will work in a hybrid model with rotational shifts focusing on claims processing and customer interactions. Expertise in property and casualty insurance is preferred ensuring efficient service delivery and client satisfaction. Responsibilities Manage and process insurance claims efficiently to ensure timely resolution and customer satisfaction. Collaborate with cross-functional teams to gather necessary information for claim assessments. Analyze claim data to identify trends and improve service delivery. Provide exceptional customer servic...

Job Summary Join our dynamic team as a Specialist in Insurance Claims where you will leverage your expertise in customer service and domain knowledge to enhance our claims processing. With a hybrid work model and rotational shifts you will play a crucial role in ensuring efficient and effective claims management contributing to our mission of providing exceptional service in the Property & Casualty Insurance sector. Responsibilities Manage and process insurance claims efficiently to ensure timely resolution and customer satisfaction. Collaborate with cross-functional teams to gather necessary information for accurate claims assessment. Utilize domain knowledge to identify potential issues an...

Job Summary The SPE-Ins Claims role is designed for professionals with 2 to 5 years of experience in customer service and domain expertise. This position requires handling claims efficiently within the Property & Casualty Insurance domain. The role operates in a hybrid work model with rotational shifts ensuring flexibility and adaptability to meet client needs. Responsibilities Manage claims processes efficiently to ensure timely resolution and customer satisfaction. Collaborate with team members to streamline operations and improve service delivery. Analyze claim data to identify trends and areas for improvement in the claims process. Utilize domain knowledge in Property & Casualty Insuranc...

Hiring For Claims Analyst Good communication with experience in managing customer claims in the retail industry Degree in Commerce, Accounting with good analytical skills and high level of accuracy and attention to detail Analyze customer claims and deductions by reviewing supporting documentation such as purchase orders, invoices, and proof of delivery to determine their validity. Should be able to analyse, validate customer claims and deductions Work closely with various internal teams, including sales, accounting, and customer service, to gather information and achieve resolution Research and resolve various types of deductions, including those for shortages, pricing, and other terms of s...

As a L&A Business Consultant at EY, you will be part of the Consulting team, engaging in a wide range of topics to support clients in various domains, including but not limited to: - Proficient in Individual and Group Life Insurance concepts, different types of Annuity products, etc. - Proficient in different insurance plans such as Qualified/Non-Qualified Plans, IRA, Roth IRA, CRA, SEP - Solid knowledge of Policy Life cycle, Illustrations/Quote/Rating, New Business & Underwriting, Policy Servicing and Administration, Claims Processing, and Disbursement - Demonstrated ability in Insurance Company Operations like Nonforfeiture option/Face amount increase, decrease/CVAT or GPT calculations/Dol...

As an Infoscion, your primary role will involve interfacing with clients for quality assurance issue resolution and ensuring high customer satisfaction. You will be responsible for understanding requirements, creating and reviewing designs, validating architecture, and delivering high levels of service offerings in the technology domain. Your tasks will include participating in project estimation, providing inputs for solution delivery, conducting technical risk planning, performing code reviews, and unit test plan reviews. Additionally, you will lead and guide your teams in developing optimized high-quality code deliverables, continual knowledge management, and adherence to organizational g...

Role Overview: As a Configuration Lead, you will support and lead client product implementations in the healthcare administration domain. Your role will involve mentoring the configuration team, ensuring process adherence, and acting as a bridge between technical and business teams to deliver successful client outcomes. Key Responsibilities: - Lead the end-to-end configuration and implementation of healthcare administration products. - Drive product implementation plans to ensure delivery within defined timelines, budgets, and SLAs. - Guide and mentor Configuration Analysts and Engineers, ensuring adherence to best practices. - Design and configure Core Admin systems for Claims and Clinical ...

Role & responsibilities 6 to 10 Years in US Healthcare Claims adjudication US shifts Job Loc : Kochi

Role & responsibilities Fresher - 2022 - 2025 Passouts with all Documents Willing to work for Non Voice Process - US Healthcare Claims Willing for Night shifts Job Loc : Kochi

Candidate must have relevant experience of 8+ years of experience with IT/ITES Companies. Should have good knowledge about AMCs of engineering equipment like air-conditioner, UPS batteries, access control system, firefighting system etc., Preventive Maintenance of equipment, housekeeping management, cafeteria management, security management, key management, front office management, contracting with various service provider, Fleet Management. Must have experience on annual budgeting exercise for Facilities operations, Ready to help his DR for AMC Negotiations, Vendor selections and finalization with the help of Procurement Team. Ready to help Procurement team for executing successful RFP proc...

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

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We e...