2028 Claims Processing Jobs - Page 12

Prepare and submit clean claims (electronic & paper) to insurance companies within specified timelines. Verify claim accuracy, coding, modifiers, and patient/payer details before submission. Ability to work in US Shift Timings (Night Shift).

Apex Insurance Broking is looking for Claims Manager - Corporate Claims to join our dynamic team and embark on a rewarding career journey Oversee the claims processing department and ensure timely settlements. Verify and validate claims documentation and eligibility. Handle complex or disputed claims and resolve issues efficiently. Coordinate with other departments for claim investigations. Train and guide claim processors to maintain accuracy and efficiency.

QA/Quality Lead-Insurance background Quality roles Graduate/PG Excellent communication Exp: 3.5 Years to 15+ years **Relevent exp into Insurance domain ,Claims and Quality mandatory** US Shift Both way cab Location-Noida Contact-9220771924 Akanksha Required Candidate profile - Graduation mandatory - Min exp 3.5 yrs to 15+yrs - Mandatory exp in Insurance background (voice/non voice/baackend) - **Specifically into Claims and Quality Expert**

Summary Retiral Specialists are responsible for managing the day-to-day Retiral Function with respect to Provident Fund/Superannuation Fund/Gratuity Fund/NPS. They should have a good knowledge on the latest updates with respect to retiral management and hands on exposure on day to day working on the operational part of Retiral work related to Remittance of Provident Fund/Settlement of Gratuity Fund/Settlement of Superannuation Fund/Assisting employees in any escalations/Bookkeeping with respect to Retiral Trusts Responsibilities Ensure statutory remittance happens on time monthly with respect to Provident Fund/Professional Tax/ESI/LWF/Superannuation Fund/NPS after checking the controls and validate the data. Ensuring Gratuity payments happens to employees leaving the organization within the statutory timeline. Monitoring of PF Claims/Gratuity Claims/SAF claims and updating the Tracker on a weekly basis and sharing the same with HRM. Maintaining Notice Tracker on PF/ESI/LWF/PT and follow up on Closure for any notice for this entity. Close Follow up on settlement of old claims with respect to PF/SAF/Gratuity Support on NPS Portability Assisting on NPS Migration Forms Tracking the Monthly PF Remittance file and updates all challans in SC Tool Interaction with Auditors on Statutory Remittances related to Payroll related Deductions Tracking & updating the changes in all statutory records with respect to change in composition of authorized personnel inside the organization To work on reengineer the best practices and should work towards improvement to the existing process. Updating KYC/Exit dates/Downloading of active master to find out the missing data, Guiding on E Nomination process and Creating of UAN and linking of Aadhar to UAN and verifying the same in system Must be able to connect with employees and guide them with the Process flow on any Provident Fund or Pension Fund rejection and should be able to navigate with steps to mitigate the Rejection Must work very closely with service provider for resolution of any query and able to turn around in a quick TAT on escalations that comes. Able to interact with Actuary and Finance Team on Actuary valuation exercise as per AS 15 and US GAP Accounting. Should be able to compile the data and share with Actuary and respond to all queries raised by Actuaries and Finance team in this regard. Support on Statutory Audit and Trust Audit Compliance.

Job Description Acts as an interface between the TPA, Insurance Company and the hospital. Responsible for investigation of suspicious claims. Effective usage of Fraud control measures. Act as a backend support to the TPA. Responsible for data mining and analytics related to Fraud and Investigation (IFD) Field visit for investigation purpose. Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive If interested kindly share your resume to recruitment1@mdindia.com

Hello, Greeting from Kotak Life Insurance! Job Location - Goregaon Job Role - Claims Contact Person - Sangita Mandal (8369252270) Email ID - kli.sangita-manadal@kotak.com KEY RESPOSIBILITIES: Claims & MIS 1. Timely and accurate reporting of Claims & maturity 2. Ensuring Regulatory Compliance 3. Overall Claims MIS, BAP & IRDA Reporting 4. Collaborate with various stakeholders like Finance, Legal, Actuary, Compliance team to ensure MIS are shared in time and discrepancies are resolved. 5. Ensuring Regulatory and other reporting are done from time to time. 6. Managing Ad hoc data requirements with accuracy

NP - Immediate to 30 days At least 4+ years of experience in working on Guidewire ClaimCenter Configuration & Integration. Guidewire ClaimCenter configuration as well as integration developer. Must be Guidewire certified in any of the Xcenters, preferably ClaimCenter Possess good knowledge in FNOL, exposure, incidents, recoveries, payments, check/bulk invoice, assignments, activities. Possess good knowledge in Message queue, events, Batch, Web services, API. GW Cloud knowledge Experience in Agile SCRUM or SAFe methodology P & C Insurance domain knowledge Convert User Stories to code to configure the application or integrate it with other applications. Design and execute unit tests and implement the same with a continuous integration tool/environment. Location - Bengaluru,Kochi,Hyderabad,Chennai

Claim registration On Daily Basis need to register the claims which has been assigned for processing , Scrutiny of the documents Reserve Setting :- Need to do the proper reserve setting on system based on the claim documents Technical processing claims which has been assigned for processing for health/ personal accident etc claims and deductions of Non-Medical charges, Standard deductions of co-payment as per the policy terms and conditions On Daily basis need to do technical Assessment of the claims post registration of the claim which include billing of the claim as per the respective heads, Data Entry as per the standard fields in system, Deductions of non-Medical Charges as per the standard IRDAI list, Co-Payment deductions as per the policy terms and condition/ Benefit charts etc. Co-ordination with Branch Offices/Clients/Hospitals for requirements Need to have follow up with branches office/clients/hospitals for additional documents whenever require NEFT Updation Updation of customer/insured NEFT details on system while processing the claims Travelling/Relocation Candidate should be open for travelling whenever require for official work and also ready to relocate based on the organization or business requirement.

About the Role We are seeking an experienced AR Caller with strong expertise in denial management to join our growing team. This is an excellent opportunity to advance your career in the US healthcare industry while working in a supportive environment. Job Title: AR Caller Denial Management Location: Hyderabad and Chennai Experience: 4 Years Shift: US Shift (Night Shift) Roles & Responsibilities Review work orders and follow up with insurance carriers for claim status. Check the status of outstanding claims and obtain payment details. Analyse claim rejections and take appropriate corrective actions. Ensure all deliverables meet defined quality standards. Who Can Apply? Experience: 1 - 4 years in AR Calling (US Healthcare). Strong knowledge of denial management & physician billing (CMS 1500). Excellent communication skills. Immediate joiners are preferred. Willingness to work night shifts (US shift). Perks & Benefits 5-day working (Weekends Off). Pickup & Drop cab facility (within boundary limits). Growth opportunities in the US healthcare domain. Apply Now Share your updated resume! (Karthick: 8056060950) Email: karthick@aramhiring.com Join us and take your career to the next level! Role & responsibilities Preferred candidate profile

01) Analyze claims which are unpaid and takes end to end action based on the denial received. 02) Call insurance and check for the reason why the claim was denied/rejected and make changes necessarily. 03) Generates reports to distinguish the collectable and non-collectables. 04) Checks status for the claims which have been recently submitted. 05) Documents notes based on the conversation with the insurance rep and updated provider office if any new issues are found. 06) Need to appeal the claim in portal (or) through call so the claim could get paid. 07) Need to have strong knowledge how an RCM works. Required Key Skills / Desired Experience: 01) Educational Qualification: Any Graduate Degree is mandatory. 02) Work Experience: Minimum 1 to 2 years experience in AR Calling. 03) Prior experience in with experience in AR Calling including handling denials would be highly desirable. 04) Notice Period: Candidates who can join immediately or in 10 or 15 days would be considered favorably. 05) Salary Range: Rs. 2.64 to 4.80 Lacs Per Annum / Rs. 22,000 to 40,000 Per Month. 06) Communication and Languages: Excellent communication and interpersonal skills to interact with US customers. 07) Should be willing to work in night shift as per the company requirements. 08) Able to multitask, prioritize, and manage time efficiently in a fast-paced BPO environment. 09) Ability to flourish with minimal guidance, be proactive, and handle uncertainty. 10) Strong problem-solving and analytical skills to address complex customer issues.

Position : AM/Executive Claims Experience: Min 6 – 8 years Industry preferred: FMCG Location: Paradise, Hyderabad Job Summary: We are seeking a detail-oriented Claims Processor to review and process sales claims, tour claims, and travel claims. The successful candidate will ensure accurate and timely processing of claims, adhering to company policies and procedures. Key Responsibilities: - Review and process claims (sales, tour, travel) for accuracy and completeness - Verify claim documentation and supporting materials - Apply company policies and procedures to claims processing - Communicate with claimants, agents, or internal teams to resolve issues or request additional information - Maintain accurate records and databases - Meet productivity and quality standards Requirements: - Strong attention to detail and analytical skills - Excellent communication and interpersonal skills - Ability to work in a fast-paced environment - Proficiency in MS Office and claims processing systems (if applicable) Preferred Qualifications: - Bcom Computers - Experience in claims processing or customer service - Knowledge of insurance, travel, or sales industry Interested candidates can apply on talent@bambinoagro.com

Job Title: AM/Executive Sales Admin Experience: Min 6 plus years Industry preferred: FMCG Location: Secunderabad/ Hyderabad Job Summary: We are seeking a detail-oriented Claims Processor to review and process sales claims, tour claims, and travel claims & Tracking of GPRS location & Settlement of Travelling Expenses for Sales Team, Also candidate will ensure accurate and timely processing of claims, adhering to company policies and procedures. Key Responsibilities: - Review and process of claims related to Sales Department (sales, tour, travel) for accuracy and completeness - Verify claim documentation and supporting materials. - Apply company policies and procedures to claims processing - Tracking of GPRS location & Settlement of travelling expenses for Sales team - Maintain accurate records and databases - Meet productivity and quality standards Requirements: - Strong attention to detail and analytical skills - Excellent communication and interpersonal skills - Ability to work in a fast-paced environment - Proficiency in MS Office and claims processing systems (if applicable) Preferred Qualifications: - Bcom - Experience in claims processing - Knowledge of travel, or sales industry Interested candidates can apply on talent@bambinoagro.com

QA/Quality Lead-Insurance background Quality roles Experience: 3.5 Years to 15+ years ( Relevant Experience Only) US Shift Location Noida only graduation can be considered. Amit Gandhi 9910877518 amit.imaginators@gmail.com

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-5 years WORK FROM OFFICE ONLY. Job description : 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. 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 nonavailability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. We are looking for fresher or exp candidates BAMS, BHMS mail id - livya.jennifer@mediassist.in Thanks & Regards Whatsapp : 9008118597

Bpo Hiring For Health Care Domain Voice Process 6.5 LPA Location Gurugram Only Graduates. No B.E./Btech/UG''s Minimum 1 Year of Voice Experience With International BpO MUST Pls Cal Dipankar @ 9650094552 Email CV @ jobsatsmartsource@gmail.com

About The Role Skill required: Membership - Life Sciences Regulatory Operations Designation: Health Operations New Associate Qualifications: BCom/B.B.M Years of Experience: 0 to 1 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Management team which is responsible for the administration of hospitals, outpatient clinics, hospices, and other healthcare facilities. This includes day to day operations, department activities, medical and health services, budgeting and rating, research and education, policies and procedures, quality assurance, patient services, and public relationsCoordinate the essential documentation and resources required for the filing of global applications. Understand, manage & process electronic submissions that include original application filings, Life Cycle Management submissions such as CMC, Ad-promos, amendments, annual reports, SPL submissions, etc. What are we looking for? Looking for a resource with Medicare Enrollment processing experience or a fresher. Ready to work in US shift time. Ready to work under stringent case timelines 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 BCom,B.B.M

We are Hiring Claims Adjuster/Adjudicator US Insurance domain Location-Viman Nagar(Pune) Experience-3+Years of experience Candidates can apply Salary-Max 8LPA(Decent hike on last CTC) Shifts-(US)Shifts Notice Period -Up to 60Days Contact -7757051088

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 candidate profile Credit Cards, Debit Cards, Prepaid Cards Payment Processing (Authorization, Clearing, Settlement, Reconciliation) Chargebacks & Disputes Management Merchant Acquiring & Payment Gateway Operations Switching & Routing Systems (BASE24 / TSYS / Connex / VisionPLUS / FIS) Nice to Have Knowledge of SWIFT, ACH, Wire Transfers, RTGS, NEFT Exposure to PCI DSS, Tokenization, ISO20022 Experience in US Banking & Financial Services domain Shift US Shift (Night Shift) Candidate must be comfortable working in US hours.

Job Title : GB P&B Job Location : Thane Experience : 0 to 3 Years Shift Timing : 6:30 AM to 3.30PM & 1.30PM to 10.30PM Candidate who are immediate Joiners and are recent 2025 Pass out are preferred for the role Job Summary: P&B team plays an integral part in the end to end servicing of an account. We act as the documentation and billing team for our brokers, enabling them with information to service an account in a timely manner. Placing and Billing relates to - creation of documents before and after placing the business, generating invoices on behalf of the broker and providing the final policy document. Principal Duties/Responsibilities KPI Management Deliver as per the KPI's defined for the role. To always maintain set SLA Accuracy/quality, TAT standards prescribed by the Business Unit. Manage work load/ volumes and delivery expectations as per business requirement Develop a sound understanding of the business process. Update work tracker and time tracking tools accurately and on real time basis Complete ad-hoc tasks as directed by Team Leader. Ensure adherence to compliance and operate within the guidelines of internal and external regulators. Ensure that all statutory and company procedures are followed while processing work to protect clients, colleagues and the business interests of the company. Operations Management/Operational Effectiveness Participate and contribute in team huddles. Proactively support key initiatives that have been delivered to implement change. To ensure any feedback (including breach/errors) found in the process is informed to the team Manager instantly. Relationship management Ensure ongoing, effective relationships with stakeholders (Internal/external) Qualifications: Minimum bachelors degree required. Preferred Commerce or Insurance background Functional Competencies: (Skill levels are for managerial reference only) Analytical : Analytical skills refer to the ability to research, collect, interpret, analyze and problem solve information (includes numerical and graphical). Attention to Detail : Attention to detail is the ability to achieve thoroughness, accuracy and completeness when accomplishing a task. Communications Skills : Communication skills refer to the ability to comprehend, articulate and respond effectively to information in a logical manner through verbal and written mediums. MS Office : Having the requisite knowledge level and understanding of MS Office

ob Opportunity Join our team as a Senior Associate - Online Quoting Specialist for US insurance services . - Salary: Up to 7LPA - Location: Kodigehalli - Process: Non-voice, with cab service both ways In this role, you will: - Provide accurate and timely insurance quotes to GGB US Select CSMs through online platforms - Understand client needs and ensure a seamless customer experience - Utilize quoting tools to enhance efficiency Requirements: - Experience in Insurance Submissions, quoting, or customer service is beneficial - Proficiency in online quoting tools and CRM software - Strong communication and interpersonal skills - Detail-oriented with excellent organizational abilities - Ability to work independently and in a team - Knowledge of insurance products and industry regulations - Strong analytical and problem-solving skills - Customer-focused mindset for high-quality service delivery contact :- shiva- 8884496984 Rinky- 7996180830 sujay- 9513900442

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * 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 Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS mail id - sarika.pallap@mediassist.in Thanks & Regards Whatsapp : 8792840500

Role & responsibilities 1. Document Indexing Printing documents into Image Right folders and labeling the pages 2. Medicare Compliance Verifying Medicare status of claimants and reporting of claims 3. Deductible Reimbursement Invoicing Track and manage collection of delinquent deductible payments from members. Qualifications/Requirements: Excellent written and verbal communication skills. Self motivation, ability to work independently, and ability to problem solve is essential. Good interpersonal and analytical skills. Excellent organizational and time management skills and attention to detail. Excellent data entry and keying skills are required. Excellent computer and technology skills. Preferred candidate profile Bachelors or Associates degree in Accounting preferred, or equivalent of 2 - 4 years accounting experience. Should have minimum 2 years of relevant experience - Claims processing Should have Excellent Communication Proficient with Microsoft Office products. Intermediate to Advanced MS Excel knowledge and proficiency required. Note Shift timing - 6:30 pm to 3:30 am IST Only one way cab - Drop will be provided The candidate should be based in Chennai If you are Interested, please share your updated resume via WhatsApp - Lilavathi HR 9840347647

Review incoming health insurance applications for completeness and accuracy. Extract and validate medical information from application forms and supporting documents. Perform initial risk assessment based on predefined underwriting guidelines. Coordinate with internal teams to obtain missing or additional medical information. Ensure compliance with Hong Kongs Insurance Authority (IA) regulations and data privacy laws. Input and update underwriting decisions in the policy administration system. Refer complex or borderline cases to senior underwriters or medical officers. Maintain accurate documentation of underwriting decisions and rationale. Support the issuance of policy documents post-underwriting approval. Respond to internal queries related to underwriting status and documentation. Participate in training sessions to stay updated on underwriting protocols. Ensure timely processing of applications to meet service level agreements (SLAs). Service and resolve inquiries from customers, members, beneficiaries, and others regarding Health Care products and benefits across multiple product lines Ability to communicate effectively across multiple channels, including phone, e-mail, chat, and text Ability to succinctly collect information from a customer to set up a new claim Ability to gather information from multiple source systems to understand and articulate the claim and what information may be needed, next steps in processing, etc. Role & responsibilities Preferred candidate profile Bachelor’s degree in Life Sciences, Nursing, Healthcare Administration, or related field. Basic understanding of medical terminology and health insurance products. Proficiency in Microsoft Office and insurance processing systems.

Max Life Insurance Company Limited is looking for Relationship Associate - Bancassurance to join our dynamic team and embark on a rewarding career journey Customer Relationship Management Relationship Associates in Bancassurance establish and maintain strong relationships with bank customers They engage with customers to understand their insurance needs, provide information about available insurance products, and offer personalized solutions based on individual requirements Insurance Product Knowledge They develop a comprehensive understanding of the insurance products offered by the bank This includes life insurance, health insurance, general insurance, and other relevant insurance solutions They stay updated on product features, benefits, terms, and conditions to effectively communicate the offerings to customers Sales and Cross-Selling Relationship Associates actively promote and sell insurance products to bank customers They identify cross-selling opportunities by analyzing customer profiles and financial needs They explain the features and benefits of insurance products, address customer queries, and guide customers through the insurance purchasing process Needs Analysis and Solution Design They conduct needs analysis for customers to determine their insurance requirements They assess the customer's risk profile, financial goals, and coverage needs Based on the analysis, they design suitable insurance solutions that align with the customer's preferences and financial capabilities Documentation and Application Processing Relationship Associates assist customers with the completion of insurance application forms and related documentation They ensure accuracy and completeness of information provided by customers and facilitate the smooth processing of insurance applications Customer Service and Support They provide ongoing customer service and support to address inquiries, claims processing, and policy servicing requirements They act as a point of contact for customers throughout the insurance policy lifecycle, resolving any issues or concerns that may arise

Hiring for Manager - Medical Billing / RCM Project Manger - US Healthcare || 17 Lpa || Vizag & Shilong Designation : Senior Manager or RCM Project Manger Skills :- Need overall 10-12 yrs in the role of a Medical Billing Or Claims and must have End to End RCM Experience . Need 1 yr ON Paper Experience as RCM Manager or Claims Manager or RCM Project Manager Loc :- Vizag & Shilong Qualification :- Degree Mandate Notice Period :- Immediate to 60 Days Package :- 17 LPA Interview Mode :- Virtual Interview Rounds :- 3 Rounds Intrested Candidates can drop their CV to HR Bhavana - 8374730176 or can drop their cv to mail id Bhavana.D@axisservice.co.in