3155 Claims Processing Jobs - Page 14

Job Description Position Title Associate / Sr. Associate (A1/A2) Function Operations Reports to Assistant Manager/Lead Assistant Manager Process Name RD/Content/ALE Complexity Level TBD Location Pune Permanent/ Temporary Permanent Basic Function As an associate / Sr. Associate in Claims Processing, your role is vital in ensuring accurate bill review and data entry items attached on email received in system. Their roles involves in decision making to match the correct bill, review the claim and data entry. This position requires a Lean approach, technical proficiency, and a proactive attitude toward innovation. You will manage intricate claims services functions, handle correspondence, and sp...

International insurance claims processing for Member claims. Job Description Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles. Responsibilities: - Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. Monitor and highlight high-c...

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 claims Collaborate with IT stakeholders, claim team and other requiredstakeholders to understand requirements and implement solutions Strong technical skills while alsounderstanding the business requireme...

Drive overall performance and manage FNOL team and process deliverables. Responsible for supervisory support through transaction monitoring and delivering results as per Service Level Agreement targets / timelines Bachelor or Associate Degree in any stream 5-8years experience in any BPO Voice process preferably with Leadership background Caters to new claim filing related to damage/s to our customers dwelling, contents, vehicle, and liability. Responds to basic claim status inquiries such as claim payment details, claim process and guidelines and Turnaround time. Transfers calls to adjuster/different departments as applicable.

Insurance supports the Insurance Manager in overseeing the company s insurance operations, ensuring proper risk management, policy administration, and claims processing. The role involves coordinating with insurance providers, managing compliance with regulatory requirements, and contributing to the development of insurance strategies to minimize risk exposure. Bachelor Degree in relevant field with 4 - 6 years of relevant experience Assist in managing the day-to-day insurance operations, including policy issuance, renewals, and claims processing. Liaise with insurance companies, brokers, and other stakeholders to negotiate terms and ensure best coverage at competitive rates. Review and anal...

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health insurance context primarily managesclaims processingclient servicing, and coordination with insurers and hospitals, while an AyushmanMitra is a frontline rolein theAyushman Bharat scheme, responsibleforidentifying andverifying beneficiaries,

Role: Back End Operations -US Health Insurance Work Location: 2-15+ years' work experience in back-office US Health Insurance/Retirement pension domain /BFSI can apply Location: Wipro Elcot SEZ, Survey No. 602/03, Elcot Sez, Shollinganallur, Chennai, Tamil Nadu Shift Timing- 5.30pm to 3am Cab Facility- One way drop Work from Office: From Day 2 Onwards (Work from office ) Permanent work profile with Wipro Education - B.com, BA, BBA, Any B.sc (graduates only)/ NO BE/B TECH will be eligible for this hiring Job Summary Strong understanding of client plan provisions/product & processing guidelines and SLA metrics Able to manually perform Benefit processes and complex tasks/calculations that requi...

Excellent communication skills with 8+ years of work exp Should be working as an AM / DM on paper for min 2 years. Team handling exp is mandatory. Strong knowledge of insurance claims (General Liabilities, Auto/Motor, Direct & Property & Casualty) Required Candidate profile Should be flexible with US Shifts Prefer Immediate joiners or max 1 month of notice period

Role & responsibilities Conduct timely follow-up on outstanding payments with customers, corporates, insurance companies, and third-party administrators (TPAs). Manage part-payment and short-payment reconciliations, ensuring accurate tracking and proper accounting entries. Prepare and maintain outstanding reports (daily, weekly, and monthly) for management review. Monitor aging analysis and escalate long-pending dues for resolution. Coordinate with billing, finance, and customer service teams to ensure smooth payment flow and dispute resolution. Maintain accurate documentation and communication records related to payment follow-ups. Assist in month-end closing activities, ensuring proper pos...

Designation: Senior Medical Officer Function: Claims PA/RI Approver Reporting to: Assistant Manager/Manager Location: Andheri East, Mumbai Educational Qualification: BAMS, BHMS, BPT, MBBS, BSc. Nursing Additional Qualification: None Specialization: General Medicine Related courses attended: None Management Level: Junior Management Level Industry Type: Hospital/TPA/Healthcare/Insurance Roles and Responsibilities : Check the medical admissibility of a High Value claim, scrutinize and process it as per terms & conditions of insurance policy. Handle escalations, customer queries and responding to mails accordingly Effectively manage the team so that the targets are met while reducing the no. of ...

Role & Responsibilities Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counseling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Outstanding follow-up with TPA. To obtain and review referrals and authorizations for treatments. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies...

Role & responsibilities Prepare, verify, and submit TPA and insurance bills accurately and on time. Coordinate with TPA coordinators and insurance representatives for claim approvals and settlements. Handle pre-authorization requests and maintain all relevant documentation. Track claim status and follow up for pending or rejected claims. Reconcile TPA accounts and maintain updated records of claims, payments, and rejections. Assist in preparing MIS reports related to TPA billing and collections. Ensure compliance with hospital billing policies and TPA/insurance guidelines. Coordinate with the finance and accounts teams for payment postings and reconciliations. Address patient and TPA queries...

Roles and Responsibilities Handle health claims from receipt to settlement, ensuring timely processing and quality service delivery. Conduct thorough audits on insurance claims, identifying areas for improvement and implementing corrective actions. Prepare accurate and detailed audit reports, highlighting key findings and recommendations. Manage email communication with clients, agents, and internal stakeholders regarding claim status updates and queries. Utilize MS Office skills to maintain efficient records management systems. Salary- 25k/month + other benefits Work Location-Gurgaon work from Office only Timings: 9:30am to 5:30pm (Monday-Saturday) Contact No-9971006988 through whats app ch...

Hiring for KPO insurance company for Deputy Manager Min 8 years exp with 2 years as a DM Strong knowledge of insurance claims (General Liabilities, Auto/Motor, Direct & Property & Casualty) Team Handeling exp is MANDATE Pckg- 16 LPA CALL 8237076800

Role & Responsibilities: Claims Specialists are responsible for accurately reviewing and processing claims for Flexible Spending Accounts and Health Reimbursement Arrangements in accordance with IRS regulations and specific employer plan rules. Claims Specialists spend their entire day working through the automatically fed claims queues within OnBase in the designated order to ensure turnaround times are met for our clients. Preferred Candidate Profile A candidate with claims adjudication experience is preferred. Freshers are also encouraged to apply. (Should have provisional / Consolidated certificate) The candidate should be flexible with working in 24-hour rotational shifts. "Sutherland n...

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 ...

Overview Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accurate trade accruals, contract approvals and verification. Manage exception through verbal and written interactions with Sales and Sales Finance. Responsibilities Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment wi...

Overview Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment with accurate trade accruals, contract approvals and verification. Manage exception through verbal and written interactions with Sales and Sales Finance. Responsibilities Managing Deduction claims and Invoice claims processing in SAP TPM Assist with promotional event enrolments / claim approvals. Ensure all customer contract legends are current to provide Trade Promotion Analyst guidance. Maintain a strong control environment wi...

WE ARE CONDUCTING MEGA JOB FAIR FOR TOP 10 COMPANIES WITH IMMEDIATE JOINING, CANDIDATES WITH BELOW SKILL SET CAN APPLY FOR THE ROLE. Mandatory Skill sets & Non-Negotiable (Need to have) Working knowledge of Insurance Domain (P&C or Life) Must possess strong English comprehension skills to effectively engage in client-led training sessions and understand process documentation. A minimum typing speed of 25 words per minute is required to ensure timely and efficient responses during live chat interactions. Clear, confident, and spontaneous communication both written and spoken is essential to manage real-time customer queries and deliver high-quality support. Basic computer literacy is expected...

***People only with US Healthcare Medical Billing Experience alone apply, others avoid*** Candidates experienced in Charge Entry alone is needed. Immediate joiners preferred. Greetings from ACP Billing Services! We are hiring for the following roles - Work from Office Charge Entry - Medical - Near Madhavaram Location preferred. Experience & Requirements: Minimum 2+ years of experience in US Medical Billing. Candidates who worked in charge entry process for at least 2 years completely are eligible. Good verbal and written communication skills. Charge Posting candidates with good typing skills will have an added advantage. Competitive remuneration as per industry standards. Spot offers for sel...

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...

Key Responsibility: Meet Quality and productivity standards. • Contact insurance companies for further explanation of denials & underpayments • Should have experience working with Multiple Denials. • Take appropriate action on claims to guarantee resolution. • Ensure accurate & timely follow up where required. • Should be thorough with all AR Cycles and AR Scenarios. • Should have worked on appeals, AR Follow up, refiling and denial management. Role / Responsibilities: Understand the client requirements and specifications of the project. Ensure that the deliverable to the client adheres to the quality standards. Must be spontaneous and have high energy level. A brief understanding on the ent...

Job Title: Manual QA Tester EDI & US Healthcare Claims - Immediate Joiner Role Summary: Responsible for testing healthcare EDI transactions, ensuring accuracy and compliance with HIPAA standards, and validating claim processing workflows across payer and provider systems. Key Responsibilities: Perform manual testing of healthcare EDI transactions including 837 (claims), 835 (remittance), 270/271 (eligibility), 276/277 (claim status), 999/TA1 (acknowledgments). Validate EDI file structure, syntax, and compliance with HIPAA 5010 standards. Verify data mapping between EDI files and internal application or database tables. Conduct end-to-end testing of claim life cycle — from submission to adjud...

Urgent requirement for BHMS/BAMS/BDS -Chennai(Annasalai) 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. Required Candidate profile: BAMS / BHMS / BDS graduate. Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can als...