3155 Claims Processing Jobs - Page 12

Description We are seeking a skilled Quality Analyst - AR Calling to join our team in the Revenue Cycle Management (RCM) sector. The ideal candidate will have a strong background in accounts receivable processes within the US healthcare system, ensuring accurate follow-up and resolution of outstanding claims. Responsibilities Review and analyze accounts receivable reports to identify outstanding claims. Conduct outbound calls to insurance companies to follow up on unpaid claims and resolve any discrepancies. Prepare and maintain documentation for all calls and communications with payers. Collaborate with the billing team to address and rectify any issues affecting collections. Monitor the st...

Roles & Responsibilities Oversee end-to-end billing operations for OPD, IPD, Emergency, Day Care, Diagnostics, and Surgical cases. Ensure accurate and timely billing as per tariff, package, and doctor orders. Monitor daily billing activities including advances, deposits, interim bills, and discharge finalization. Implement revenue leakage control by ensuring all services, consumables, and investigations are posted. Manage TPA / Insurance / Corporate billing including pre-auth, approvals, final bill submissions, and claim settlements. Coordinate with clinical and support departments (Nursing, Pharmacy, MRD, Front Office, Finance). Maintain compliance with hospital billing policies, audit requ...

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Conduct thorough analysis of clinical trial data to identify potential safety concerns. Develop and implement effective safety protocols to mitigate risks associated with medical devices. Collaborate with cross-functional teams Required Candidate profile Strong understanding of clinical trials, medical devices, and regulatory requirements. Excellent analytical and problem-solving skills. Ability to work effectively in a fast-paced environment.

Job Overview: We are looking for a Facets Full Stack Developer with extensive experience in healthcare and claims processes, particularly in Group Benefits and Eligibility. The ideal candidate should have over 9 years of experience in software development, with at least 4 years specializing in Facets software, .NET, and C#. This role involves designing and developing advanced applications, leveraging your expertise in healthcare processes, microservices, and modern development frameworks. Key Responsibilities : Application Development : - Design and develop web applications using C#.Net, Asp.Net, MVC, and Web API. - Create dynamic front-end interfaces using HTML, CSS, jQuery, and Bootstrap. ...

As a Senior Process Associate - Insurance at our company, your role involves handling end-to-end insurance operations, including client and underwriter communication, processing insurance policies, renewals, claims, compliance, and endorsements. You are expected to possess in-depth knowledge of various insurance classes and domains to ensure smooth operations and adherence to compliance standards. Key Responsibilities: - Engage in proactive communication with clients and underwriters to facilitate smooth deal closures. - Provide necessary clarifications on policies, coverage, and compliance requirements. - Address and resolve queries related to insurance covers and claims. - Handle new busin...

As a Cash Management Officer in this role, your responsibilities will include: - Arranging Cash to Master - Monitoring instances of negative balance of wages and escalating to line manager - Supporting the requirement to timely accrue cost commitments to avoid liability to the Company - Being responsible for the timely processing of seafarers wages and claims - Escalating seafarers grievances to line manager - Delivering performance as per job-specific KPIs To be successful in this role, you will need to meet the following requirements: - Minimum 5-7 years" experience in a similar position - Bachelor's Degree or Degree in Maritime / Logistic or related disciplines - Being an effective commun...

Job Title : Guidewire Forms Developer Experience : 5 to 9 Years Location : Pan India (Any UST Office Location) Employment Type : Full-Time Job Summary : We are looking for a skilled Guidewire Forms Developer with 5-9 years of experience to join our team at UST . The ideal candidate will have hands-on experience working with Guidewire PolicyCenter , BillingCenter , or ClaimCenter , and a strong background in Forms development using tools like SmartCOMM, DocuSign, or Thunderhead . This role involves working closely with business analysts, developers, and testers to deliver high-quality insurance forms tailored to client needs. Key Responsibilities : Design, develop, and implement forms for Gui...

Job Description Urgent Hiring for Deputy Manager Min 8+Years of Experience in Deputy Manager - Claims end to end. Min 2.0Years experience on Papers. Location: Pune/ Mumbai/ Bangalore Work Mode: Work from Office Shifts Timings: US Night Shifts Important Note: We are only looking for candidates with experience in the US/UK markets. Note: Strong knowledge of insurance claims (General Liabilities, Auto/Motor, Direct & Property & Casualty Deputy Manager - Claims End to End Requirements : Excellent communication skills with 8+ years of work experience. Must currently be working as a Deputy Manager (DM) on paper for at least 2 years. Team handling experience is mandatory. Candidates with experience...

Hello All, Greetings for the day! We have an job opportunity with our client Neovance (Earlier Called as Fortrea). Work Experience: 3-6 Years of Experience (2+ Years exp in US health experience or Recent experience in US Health care) Work Location: Bangalore (Preferred). Education: bachelors degree or a masters Degree with all Documents from a regular College/University. Project: 6 months (Extension based on Performance) Shift: 6:00 PM - 03:00 AM (2 Ways Cab facility) Work model: Work From Office. Interview Round: 3 Rounds (Mettle Assessment - Online Screening Round - Screening and In Person Interview at Client Place) Important Note: US or international Voice experience US Health Care and Cu...

Medical Officer - Claims Processing Job Title: Medical Officer Claims Processing Location: IBC Knowledge Park, Bangalore (Work from Office) Department: Central Claims Operations Control Room Job Type: Full-time Salary: 3,00,000 3,60,000 per annum About the Role We’re hiring Medical Officers (Claims Processing) for our Control Room team at IBC, Bangalore. The role involves end-to-end medical claim processing with focus on accuracy, coordination, and timely resolution. You’ll work closely with multiple departments to ensure smooth claim operations and compliance with TAT standards. Key Responsibilities Process medical claims accurately within defined timelines. Review and validate claim docume...

Role Overview This is a high-growth field sales opportunity where you'll play a key role in spreading awareness about NIAT in your region. You will interact directly with schools, colleges, and students , and be the face of NIAT in the field. Key Responsibilities Conduct field visits to 12th-grade schools and colleges to schedule and deliver engaging student demo sessions Build strong, trust-based relationships with 12th school/college principals and educational partners Carry out on-ground activities like stalls, events, and promotions to spread awareness. Manage outreach data and maintain daily reporting.

We are looking for an experienced Dental Claim Billing Expert who has in-depth knowledge of Open Dental Software and Medicaid billing (DentaQuest) . The ideal candidate should have hands-on experience in handling end-to-end dental billing processes, including claim submission, payment posting, denial management, and patient billing. Key Responsibilities: Manage and process dental insurance claims accurately and efficiently. Work on Open Dental Software for billing, claim tracking, and payments. Handle Medicaid billing (DentaQuest) with complete understanding of payer rules and claim procedures. Ensure timely submission and follow-up of claims to minimize denials or rejections. Post payments,...

Role & responsibilities Handle end-to-end payment processing including Authorization, Clearing, and Settlement for US clients. Perform transaction processing, reconciliation, and exception management within SLA. Manage chargebacks, disputes, and fraud investigation for card transactions. Provide operational support for payment gateways & merchant acquiring services. Ensure compliance with US banking regulations, PCI DSS, EMV, ISO8583 standards . Collaborate with internal teams (Risk, Technology, Client Services) for issue resolution. Monitor daily transaction flows, settlement reports, and reconciliations . Maintain accuracy, timeliness, and adherence to US time-zone processes . Preferred ca...

Lead, train and mentor staff members, ensuring high levels of engagements and productivity. Monitor and ensure excellent client service is always provided, addressing escalated client issues and resolving them in a timely manner. Bachelor Degree / Postgraduate Degree 3 - 7 Years Lead, Train, and Mentor Staff: Guide and support staff members to ensure high levels of engagement and productivity. Provide training and mentorship to help them develop their skills and perform effectively. Monitor Client Service: Ensure excellent client service is consistently provided. Address escalated client issues promptly and resolve them in a timely manner to maintain client satisfaction.

Job Description - ;We are seeking a skilled and motivated ;Data Engineer ;with hands-on experience in ;Google Cloud Platform (GCP) ;and ;Python, and a strong understanding of the ;Aetna Healthcare domain The ideal candidate will be responsible for designing, building, and maintaining scalable data pipelines and solutions that support healthcare analytics, compliance, and operational reporting Key Responsibilities: Design and develop robust, scalable, and efficient data pipelines using GCP services (BigQuery, Dataflow, Pub/Sub, Cloud Storage, etc Write clean, maintainable Python code for data ingestion, transformation, and automation Collaborate with Analysts and business stakeholders to unde...

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

We are looking for a highly skilled and experienced Administrator to join our team at the University of York Computer Science. The ideal candidate will have a strong background in computer science and administration, with excellent organizational and communication skills. Roles and Responsibility Manage and maintain computer systems, networks, and peripherals. Provide technical support and troubleshoot issues related to computer hardware and software. Develop and implement administrative policies and procedures. Coordinate with various departments to ensure smooth operations. Maintain accurate records and reports. Ensure compliance with university regulations and industry standards. Job Requ...

Job description Role & responsibilities 1. Review First Notice of Loss (FNOL) entries and confirm document completeness 2. Collect supporting documents (e.g., police reports, invoices, photos) from brokers and insureds as required 3. Maintain and update digital records of claim files in internal platforms (FIS, CMS, etc.) 4. Identify missing documents or data inconsistencies and flag them for the onshore team 5. Maintain up-to-date claim checklists and logs 6. Categorize claims based on pre-defined triage criteria (Low, Medium, High exposure) 7. Perform quality checks on document uploads, file naming conventions, and tagging 8. Communicate professionally with brokers and insureds via email o...

Role & responsibilities : Review and summarize patient medical records and clinical notes. Ensure accuracy and completeness of clinical documentation. Collaborate with billing and coding teams for data clarification. Maintain confidentiality and adhere to HIPAA compliance. Meet daily quality and productivity targets. Learn and work efficiently on EHR/EMR systems. Manage patient billing and claims submission processes accurately and timely. Monitor and follow up on unpaid claims, denials, and rejections. Coordinate with insurance companies for claim status and resolution. Verify patient insurance coverage and eligibility before service delivery. Maintain and update billing systems with accura...

Candidate Specification & Job Description: Excellent communication skills with 8+ years of work experience Individual contributor roles are acceptable Strong knowledge of insurance claims (General Liabilities, Auto/Motor & Direct) Candidates with experience in Subrogation total loss, admin team, Property & Casualty, or Health Insurance are not preferred Review and validate claims submissions for completeness and eligibility Capture claim details accurately in the system, ensuring proper documentation Coordinate with policyholders, agents, or brokers to obtain necessary supporting documents Evaluate claim merits based on policy terms and conditions Liaise with surveyors, investigators, hospit...

Position Purpose Manage the company's Accounts Payable approval workflow to ensure invoices are properly coded, routed to approvers, and timely paid Responsibilities Direct Responsibilities 1. Process expense claims or invoices as per given process & policies 2 Process invoices with high accuracy & TAT. 4 Should be able to identify process risk & provide desire solutions to mitigate the risk. 5 Able to manage clients query & provide them solutions to their issues 6. Have the ability to think creatively on process improvements. 7. Knowledge of India accounting & SAP will be advantage. Contributing Responsibilities Willingness to take initiatives and take ownership of work Have the ability to ...

Role: Hospital Desk Executive Hospital Desk Executive will be the Single point of contact at the Hospital for the Medi Assist Raksha Prime Service. Roles and Responsibilities Close Coordination with the Hospitals and the Medi Assist Internal Stake Holders for patients best discharge experience. Collaborate with the operations team to ensure timely and accurate data processing. Ensure maximum discharges are happening through the Raksha Prime Services. Use relevant tools and MIS tools to organize data for reporting purposes. Qualification : Bachelor's/Masters Degree in the field of Pharmaceutical/Hospital Management/Medical Sciences/Insurance (but not Mandatory) Experience: 2-3 Years Experienc...

Description We are seeking a detail-oriented Medical Coding IVR professional to join our team in India. The ideal candidate will have 1-4 years of experience in medical coding, with a strong understanding of coding guidelines and a commitment to accuracy in patient data. Responsibilities Review and analyze medical records and documentation to assign accurate codes for diagnoses and procedures. Ensure compliance with coding guidelines and regulations to maintain the integrity of patient data. Collaborate with healthcare providers to clarify diagnoses and procedures as needed. Participate in quality assurance audits and contribute to improving coding accuracy and efficiency. Stay updated on co...

Description We are seeking an experienced AR Caller to join our finance team in India. The ideal candidate will have a strong background in accounts receivable, excellent communication skills, and the ability to manage client relationships effectively. Responsibilities Conduct follow-up calls with clients to ensure timely payment of invoices. Review accounts receivable aging reports to identify overdue accounts. Communicate effectively with clients regarding payment terms and invoices. Resolve discrepancies and disputes related to payments and billing. Maintain accurate records of all communications and transactions with clients. Collaborate with the finance team to streamline the collection...