702 Claims Processing Jobs - Page 27

About Navi Navi is one of the fastest-growing financial services companies in India providing Personal & Home Loans, UPI, Insurance, Mutual Funds, and Gold. Navi's mission is to deliver digital-first financial products that are simple, accessible, and affordable. Drawing on our in-house AI/ML capabilities, technology, and product expertise, Navi is dedicated to building delightful customer experiences. Founders: Sachin Bansal & Ankit Agarwal Know what makes you a Navi_ite : 1. Perseverance, Passion and Commitment Passionate about Navis mission and vision Demonstrates dedication, perseverance, and high ownership Goes above and beyond by taking on additional responsibilities 2. Obsession with high-quality results Consistently creates value for the customers and stakeholders through high-quality outcomes Ensuring excellence in all aspects of work Efficiently manages time, prioritizes tasks, and achieves higher standards 3. Resilience and Adaptability Adapts quickly to new roles, responsibilities, and changing circumstances, showing resilience and agility Key Responsibilities: Review submitted health claims for accuracy, completeness, and compliance with insurance policies and applicable regulations Reviewing and evaluating medical claims to determine their eligibility for payment Investigating medical claims to identify fraud Making decisions about medical claims, such as whether to approve or deny a claim Negotiate with the treating doctor/ hospital in reducing the un-justified hospitalization cost Automate system and bring in improvements on claims processes Monitoring systems and processes to ensure sustained levels of performance Liaison with internal stakeholder to ensure the deadline of TAT’s and SLA’s & Work towards Designated Tasks Tracking of customer communication for effective grievance resolution within TAT & SLA’s Compliance- Through knowledge of products, regulations, guidelines is must to ensure process compliance all the time. Claim Analytics- Periodical claim analysis to identify frauds, monitor claim performance metrics. Informing the customer about the rejection of their claim through call Involves identifying discrepancies, fraud, or errors in claims to ensure compliance with health insurance policies and regulatory requirements What are some of the good to have skills for this role? Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Experience in handling audit Background in claims processing with clinical experience in a hospital setting Data analytics experience would be an added advantage Ability to handle independent assignments & having the acumen to take logical conclusions Should have a broad understanding of Claims Practice Sharp business acumen to understand health insurance claim servicing needs Excellent communication skills, including writing reports and presentations Ability to anticipate potential problems and take appropriate corrective action Knowledge of health regulations, IRDA circulars is a must. Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory.

Department - Claims Auto Role & responsibilities Closing Ratio/Minimize cost : Negotiate with dealers ; Avoid cost wastage in workshops; Regular training of claims policies ; Faster settlements Re-open ratio/Segmentation of vehicles: Separating the Claims according to Vehicles and minimizing the expenses Repair claims: Timely follow up with agent; visit the workshop within 48hrs of receiving the claim and follow up within 2days. Maintain the Hygiene/TAT(Total Around Time) : Proper evaluation on customer claims ; Claims should be closed within defined TAT (i.e.; Approval or rejection) Sort out claims related issues according to Regulations. Policy Compliance : Ensure that the claims process adheres to the insurance company's policies and guidelines. Customer Service : Communicate with policyholders, repair shops, and other relevant stakeholders to provide updates, explain assessment findings, and address any queries or concerns. Compliance with Regulations : Ensure compliance with local, state, and national regulations regarding motor vehicle assessments, repairs, and insurance claim processes. Negotiation Skills : Engage in negotiations with repair shops, policyholders, and other involved parties to reach mutually agreeable settlements. Fraud Detection : Detect and report any suspected cases of fraud or misrepresentation during the assessment process and work closely with the investigation team to gather evidence if necessary. Preferred candidate profile - Diploma in Automobile/Mechanical (10+2+3) or BE in Automobile/Mechanical - 2-4 years experince in any of the automobile workshop specially in body shop or in an insurance company in motor claims dept.

AR Caller Physician Billing and Denial Management Job Description:- 1.Reviewing and analyzing claim form 1500 to ensure accurate billing information. 2.Utilizing coding tools like CCI and McKesson to validate and optimize medicalcodes. 3. Familiarity with payer websites to verify claim status, eligibility, and coverage details. 4.Expertise in various medical specialties such as cardiology, radiology,gastroenterology, pediatrics,emergency medicine, and surgery. 5.Proficiency in using CPT range and modifiers for precise coding and billing. 6.Working with Clearing House systems like Waystar and other e-commerce platforms for claim submissions. 7.Conducting voice-based communication with payers and medical staff to resolve billing discrepancies and facilitate claims processing. DesiredCandidate Profile: - 1 Should be a complete Graduate. 2.Comfortable to Sign a Retention Period. 3.Minimum of 2 years of experience in physician revenue cycle management and ARcalling. 4. Basic knowledge of claim form 1500 and other healthcare billing forms. 5.Proficiency in medical coding tools such as CCI and McKesson. 6.Familiarity with payer websites and their processes. 7.Expertise in specialties including cardiology, radiology, gastroenterology, pediatrics, orthopedics,emergency medicine, and surgery. 8.Understanding of Clearing House systems like Waystar and e-commerce platforms. 9.Excellent communication skills. 10.Comfortable to Work in Night Shifts. 11. Readyto join immediately or 15Days NP. Timings & Transport 1. Two Way Cab Facility will be provided with the shift 6:30pm to 3:30am 2.Complete Night Shifts (6:30 PM 3:30 AM) IST. 3. FIVE DAYS WORKING (MONDAY FRIDAY) & SATURDAY, SUNDAY WEEK OFF. 4. Need to be Comfortable with WFO-Work from office. Graduate and should have 1 yr of Experience in AR calling, should b ok with night shift should b in Hyderabad Perks and Benefits 1.Provides Night shift Allowance 2.Saturday and Sunday Fixed Week Offs. 3 24 days Leave in a Year. 4. 24days Leave in a Year. 5.Self-transportation bonus Please respond to my email immediately and let me know if you are Interested as we have limited Positions. Note:- for further details or query this is my mail id manali.modi@intignizsolutions.com and ph:-8186097101

Job Description: Our client, a leading AI platform specializing in medical billing operations, is seeking dedicated and detail-oriented Medical Billing and Insurance Claims Specialists to join our team. The ideal candidates will have at least 6 months to 1 year of experience in medical billing, insurance claims, or a related field and possess strong English proficiency . As part of our client-facing team, you will be providing vital support to client operations by ensuring accurate and compliant medical billing operations through outbound calling, data categorization, and transcript analysis. Key Responsibilities: Outbound Calling: Make outbound calls to insurance companies and payors to collect essential information, including claim statuses, denial reasons, and any additional relevant details. Conduct all calls in full compliance with company's guidelines and applicable healthcare regulations. Maintain professionalism and ensure clear communication during each call. Data Categorization and Labeling: Accurately record, categorize, and label calls or information gathered using the taxonomy and definitions provided by the client. Ensure all claim statuses and call outcomes are properly labeled for consistency in reporting and easy analysis. Deliver categorized data in periodic reports or through the portal developed by client, following the requested format and frequency. Call Transcript Analysis: Analyze recorded call transcripts to extract actionable insights, identifying trends, recurring denial reasons, and other patterns. Compile findings into periodic reports, providing valuable information to client to support process improvements and optimize workflows. Qualifications: Minimum of 6 months to 1 year of experience in medical billing, insurance claims, or a related field. Strong English proficiency , both verbal and written. Familiarity with healthcare regulations and industry guidelines. Excellent communication skills with the ability to make outbound calls to insurance companies and payors. Detail-oriented and able to maintain accurate records. Ability to work independently while adhering to internal guidelines and procedures. Proficiency in Microsoft Office Suite or similar software; experience with medical billing software is a plus. Additional Information: This is a full-time position, and the successful candidate will work closely with the clients team to support their AI-powered platform in improving medical billing operations. The role offers an opportunity for professional growth and development within a dynamic, technology-driven environment.

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English - 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 insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataYou will be responsible for developing and delivering business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Ability to manage multiple stakeholders,Ability to perform under pressure,Agility for quick learning,Collaboration and interpersonal skills,Commitment to qualityAbility to manage multiple stakeholders,Ability to perform under pressure,Agility for quick learning,Collaboration and interpersonal skills,Commitment to quality 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 Qualifications Any Graduation

Skill required: Claims Services - Payer Claims Processing Designation: Health Admin Services New Associate Qualifications: Any Graduation 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 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 a knowledge of the processes and systems to receive, edit, price, adjudicate, and process payments for claims. What are we looking for? Adaptable and flexible Ability to perform under pressure Ability to work well in a team Commitment to quality7-9 months experience in Claims processing Claims Processing Claims Administration 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 Qualifications Any Graduation

Dear Aspirants, Warm Greetings!! We are hiring for the following details, Position: - AR Analyst - AR Caller (Credentialing only) - Charge Entry & QC - Payment Salary: Based on Performance & Experienced Exp : Min 1 year Required Joining: Immediate Joiner / Maximum 10 days NB: Freshers do not apply Work from office only (Direct Walk-ins Only) Monday to Friday ( 10 am to 6 Pm ) Everyday contact person VIBHA HR ( 9043585877 ) Interview time (10 Am to 6 Pm) Bring 2 updated resumes Refer( HR Name VIBHA HR) Mail Id : vibha@novigoservices.com Call / WhatsApp ( 9043585877 ) Refer HR VIBHA Location : Chennai , Ekkattuthangal Warm Regards, HR Recruiter VIBHA Novigo Integrated Services Pvt Ltd,Sai Sadhan, 1st Floor, TS # 125, North Phase,SIDCOIndustrial Estate, Ekkattuthangal, Chennai 32 Contact details:- HR VIBHA vibha@novigoservices.com Call / Whatsapp ( 9043585877 )

Skill required: Supply Chain - Warranty Management Designation: Business Advisory Associate Qualifications: BE/BTech/Diploma in Automobile Years of Experience: 1 to 3 years What would you do? provide required warranty cost saving to our client by adjusting the claims submitted by dealer. Investigate warranty claims and take appropriate decision. Be a process SME and take initiative to improve team performance. Diagos complex automotive claims. Verifcation and Analisys of automotive warranty repair claims based on external support resources (Parts catalog, dealer assist & standard labor time). Implement practices to improve operational efficiency. What are we looking for? BE Automobile Graduate/Diploma with or without Automotive experienceBE Mechanical Graduate/Diploma with Automotive experienceExperience in WarrantyExperience with Auto componentsInterpersonal skills to deal with dealers, warranty engineers, etcData processing accuracy, detail oriented, and ability to evaluate/research a warranty claimExpert level capability in use of desktop software (MS Office Suite, with focus on Excel)Organized, timely, pro-active and highly productiveStrong written communication in EnglishAttention to detail and ability to multi-taskExperience in Warranty /Auto Dealership Automotive Warranty Automotive Warranty Claims Processing Automotive Warranty Claims Administration Automotive After Sales Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts

Skill required: Delivery - Warranty Management Designation: I&F Decision Sci Practitioner Analyst Qualifications: Any Graduation Years of Experience: 3 to 5 years What would you do? Data & AIIn Warranty Management, you will be working on defining warranty offerings; run outsourced after-sales warranty support and entitlement programs; evaluate customer feedback and planned versus actual costs of warranty coverage; use warranty data analytics to reduce cost and improve product quality; increase recoveries from suppliers and design and deploy warranty solutions. The team also works on the verification and analysis of warranty claims based on available and external resources - a portal with supporting information. What are we looking for? Warranty/ Analytics/ Automobile Data Analysis Business Intelligence Reporting Scripting Adaptable and flexible Ability to work well in a team Commitment to quality Agility for quick learning Written and verbal communicationPython, SQL, ML Roles and Responsibilities: In this role you are required to do analysis and solving of lower-complexity problems Your day-to-day interaction is with peers within Accenture before updating supervisors In this role you may have limited exposure with clients and/or Accenture management You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments The decisions you make impact your own work and may impact the work of others You will be an individual contributor as a part of a team, with a focused scope of work Qualifications Any Graduation

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years 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 insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataYou will be responsible for developing and delivering business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for? Ability to establish strong client relationship Ability to handle disputes Ability to manage multiple stakeholders Ability to meet deadlines Ability to perform under pressure 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 Qualifications Any Graduation

Project Role : Business Architect Project Role Description : Define opportunities to create tangible business value for the client by leading current state assessments and identifying high level customer requirements, defining the business solutions and structures needed to realize these opportunities, and developing business case to achieve the vision. Must have skills : GuideWire ClaimCenter Good to have skills : NA Minimum 5 year(s) of experience is required Educational Qualification : Any Degree Minimum 15 years full time Summary : As a Business Architect, you will be responsible for leading current state assessments and identifying high-level customer requirements, defining the business solutions and structures needed to realize these opportunities, and developing a business case to achieve the vision. Your typical day will involve working with GuideWire ClaimCenter and collaborating with cross-functional teams to create tangible business value for the client. Roles & Responsibilities: - Lead current state assessments and identify high-level customer requirements. - Define the business solutions and structures needed to realize opportunities. - Develop a business case to achieve the vision. - Collaborate with cross-functional teams to create tangible business value for the client. - Utilize expertise in GuideWire ClaimCenter to deliver impactful solutions. - Work directly with the client gathering requirements to align technology with business strategy and goals - GuideWire ClaimCenter ie FNOL, claim closure, exposures, reserves - Good experience in Property and Casualty - Working knowledge of SOAP / REST web service - Should be able to create/ consume the web services in Java - Understanding of XML, XSD - Knowledge of messaging, plugins Professional & Technical Skills: - Must To Have Skills:Expertise in GuideWire ClaimCenter. - Good To Have Skills:Experience in Business Architecture. - Strong understanding of business solutions and structures. - Experience in developing business cases. - Collaboration and communication skills to work with cross-functional teams. - Good to have Guidewire Developer in Integration/ Configuration, GOSU scripting and Java Enterprise Edition - Good to have Experts internally and externally for their deep functional or industry expertise, domain knowledge, or offering expertise - Basic SQL and Database knowledge Additional Information: - The candidate should have a minimum of 5 years of experience in GuideWire ClaimCenter. - The ideal candidate will possess a strong educational background in Business Architecture or a related field, along with a proven track record of delivering impactful solutions. - This position is based at our Bengaluru office.nan

Skill required: Reinsurance - Collections Processing Designation: Claims Management Senior Analyst Qualifications: Any Graduation Years of Experience: 5 to 8 years 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 insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Canceling and rewriting insurance policies and endorsementsThe Collections Operations team focuses on managing collections and disputes such as debt collection, reporting on aged debt, bad debt provisioning, trade promotions, and outperform cash reconciliations. The team is responsible for follow up for missing remittances, prepare refund package with accuracy and supply to clients, record all collections activities in a consistent manner as per client process (tool), delivery of process requirements to achieve key performance targets, and ensure compliance to internal controls, standards, and regulations. What are we looking for? Ability to perform under pressure Problem-solving skills Written and verbal communication Commitment to quality Agility for quick learningKnowledge of German Language would be an added advantage. Roles and Responsibilities: In this role you are required to do analysis and solving of increasingly complex problems Your day to day interactions are with peers within Accenture You are likely to have some interaction with clients and/or Accenture management You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments Decisions that are made by you impact your own work and may impact the work of others In this role you would be an individual contributor and/or oversee a small work effort and/or team Please note that this role may require you to work in rotational shifts Roles & Responsibilities Analyze and process various treaty and facultative premiums statements in the system Ensure cash call refunds are booked on time Maintain adequate trackers for all aspects of SOAs are maintained Analyze and process various types of claims in the system Analyze, Process and track large losses Ensure payment transactions are revied and cash is allocated in timely manner Ensure adequate follow ups are done to ensure to keep unallocated cash to the minimal Ensure outstanding balances are tracked, followed up and reported periodically to the stakeholders. Liaise and work with various stake holders to ensure all queries are addressed on time Initiate process improvements through automation and assist in implementing the same. Actively participate in knowledge sharing and training Taking ownership and be accountable for activities performed Actively get involved in cross departmental activities and show eagerness to learn all activities. Qualifications Any Graduation

1.Reviewing and analyzing claim form 1500 to ensure accurate billing information. 2.Utilizing coding tools like CCI and McKesson to validate and optimize medicalcodes. 3. Familiarity with payer websites to verify claim status, eligibility, and coverage details. 4.Expertise in various medical specialties such as cardiology, radiology,gastroenterology, pediatrics,emergency medicine, and surgery. 5.Proficiency in using CPT range and modifiers for precise coding and billing. 6.Working with Clearing House systems like Waystar and other e-commerce platforms for claim submissions. 7.Conducting voice-based communication with payers and medical staff to resolve billing discrepancies and facilitate claims processing. DesiredCandidate Profile: - 1 Should be a complete Graduate. 2.Comfortable to Sign a Retention Period. 3.Minimum of 2 years of experience in physician revenue cycle management and ARcalling. 4. Basic knowledge of claim form 1500 and other healthcare billing forms. 5.Proficiency in medical coding tools such as CCI and McKesson. 6.Familiarity with payer websites and their processes. 7.Expertise in specialties including cardiology, radiology, gastroenterology, pediatrics, orthopedics,emergency medicine, and surgery. 8.Understanding of Clearing House systems like Waystar and e-commerce platforms. 9.Excellent communication skills. 10.Comfortable to Work in Night Shifts. 11. Readyto join immediately or 15Days NP. 12.Graduate and should have 1 yr of Experience in AR calling, should b ok with night shift should b in Hyderabad Timings & Transport 1. Two Way Cab Facility will be provided with the shift 6:30pm to 3:30am 2.Complete Night Shifts (6:30 PM 3:30 AM) IST. 3. FIVE DAYS WORKING (MONDAY FRIDAY) & SATURDAY, SUNDAY WEEK OFF. 4. Need to be Comfortable with WFO-Work from office. Note:- for further details or query this is my mail id manali.modi@intignizsolutions.com and ph:-8186097101

Will be responsible for driving sales by engaging prospective students, guiding them through the enrollment process, and building long-term relationships Respond to inquiries from prospective students via calls, emails, and in-person visits. Counsel and guide students and parents regarding courses, eligibility, admission procedures, and career paths. Handle the end-to-end admissions process from application to enrollment. Maintain and update student records in the admissions system.

We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: bachelors degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: bachelors degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: bachelors degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

Urgent requirement for BHMS/BAMS/BDS/MBBS-Pune (Vadgaonsheri) Freshers/candidate with clinical or TPA experience Interested candidates can call on 7391042258 (Sneha- HR department) or share their updated resumes to recruitment@mdindia.com Roles and responsibilities: 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/ MBBS graduate. Good Medical & basic computer knowledge Should have completed internship (Provisional /Permanent Registration number is mandatory) Freshers can also apply. Work from office . Interview Timings-11am To 5pm(Monday To Saturday) Venue Details: MDIndia Health Insurance TPA Pvt. Ltd. S. No. 46/1, E-space, A-2 Building, 4th floor, Pune Nagar Road, Vadgaonsheri, Pune 411014

Skill required: Provider Network - Life Sciences Regulatory Operations Designation: Health Operations New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? Timely and Accurate Enrollment:Ensure that all members and groups are enrolled within the agreed-upon timelines by capturing required information and verifying eligibility, generating Invoice and reconciling payments. You will facilitate a smooth enrollment and billing process while maintaining attention to detail to meet deadlines ID Card Issuance:After completing enrollments, promptly issue ID cards to members, ensuring all details are accurate. This will help members gain seamless access to healthcare services Processing Changes and Terminations:Accurately process changes, additions, deletions, and terminations for members to ensure their records are always up-to-date. Ensure that all updates are reflected correctly in the system and communicated to relevant parties Enrollment & Billing Materials Distribution:Ensure that members and groups receive the necessary enrollment and Billing materials, such as benefits guides and plan details. You will provide clear and accessible information to help members understand and navigate their healthcare benefits Compliance and Accuracy:Adhere to all organizational policies, compliance standards, and SLAs while processing enrollments. You will focus on data accuracy to minimize errors and maintain reliable records for all members and groups What are we looking for? Minimum 0-1 Year Experience in Enrollment and Billing:Basic understanding of enrollment and Billing process, eligibility verification, and billing practices in the healthcare domain Attention to Detail and Accuracy:Ability to accurately process enrollments, changes, terminations, and ensure all data is up-to-date and error-free Efficiency and Timeliness:Ability to process enrollments and changes promptly while adhering to established SLAs and ensuring smooth operations Strong Communication and Compliance:Ensure clear communication of enrollment materials and compliance with organizational policies and regulations NA Roles and Responsibilities: Timely Enrollment and Data Accuracy:Ensure the accurate and timely enrollment of members and groups, generating Invoice and reconciling payments. Verifying eligibility and billing data by capturing all required information to meet organizational timelines ID Card Issuance and Verification:Issue ID cards promptly post-enrollment, ensuring all member details are correct and meet organizational standards for seamless healthcare service access Processing Changes and Terminations:Accurately process member and billing changes, additions, deletions, and terminations, ensuring timely updates and communication across relevant systems and departments Compliance, Enrollment Materials, and Quality Assurance:Distribute necessary enrollment materials to members and groups, adhere to compliance requirements, and maintain high accuracy in data entry to ensure reliable and up-to-date records Qualification Any Graduation

Job Description Position Details: Efficiently oversee CLD Claims for external clients, ensuring files are downloaded through automation, verifying successful uploads, and promptly communicating the status of each request. Thoroughly examine diverse Excel and text files to address any error handling requirements in CLD uploads. Possess a proficient understanding of multiple portals, adeptly navigating their functionalities, and assisting colleagues in retrieving essential data. Effectively communicate any concerns within the business process, ensuring seamless execution from initiation to completion. Collaborate with cross-functional teams to streamline CLD claims processes and implement improvements for enhanced efficiency. Stay updated on best practices related to CLD claims management, actively seeking opportunities to enhance internal processes. Contribute to a positive work environment, fostering teamwork, and actively participating in team meetings and initiatives. Resolve the errors based on a defined set of rules and perform corrections where required. Meeting contractual deadlines. Managing workload to accommodate more challenging timelines. Ensuring customer compliance with contract terms. Also, there could be inconsistencies in information from different sources. Working with unconventional customer data formats. Working with a whole new contracting system that was recently launched in the market. Relies on instructions and pre-established guidelines to perform the functions of the job. Monitors and reviews data from the system. Reconcile, track, and troubleshoot requested vs actual data received/validated. Analyze errors and troubleshoot solutions. Job Profile: Resolve the errors based on a defined set of rules and perform corrections where required. Meeting contractual deadlines. Managing workload to accommodate more challenging timelines. Ensuring customer compliance with contract terms. Also, there could be inconsistencies in information from different sources. Working with unconventional customer data formats. Working with a whole new contracting system that was recently launched in the market. Relies on instructions and pre-established guidelines to perform the functions of the job. Monitors and reviews data from the system. Reconcile, track, and troubleshoot requested vs actual data received/validated. Analyze errors and troubleshoot solutions. Qualifications Any graduate (with preference for backgrounds in business, finance, accounting, or information management preferred) Exceptional attention to detail and strong organizational skills. Excellent communi

Authorization & Referral Associate Summary GM Analytics Solutions is looking for a driven, dedicated and experienced Authorization & Referral Associate, who is experienced in the medical billing domain,. Authorization Analyst is articulate professionals who can communicate with insurance companies and other payers in regards to unpaid claims and assist with actions and information needed to properly review, dispute, or appeal denial until a determination is made to conclude the appeal. Who should be proficient in US healthcare, and is comfortable working in Night shift (US time). Job Description Minimum 1-3 years experience is required in Authorization & Referral process for US Healthcare & should have knowledge in Commercial & Workers Compensation Insurance. Who can receive medication referrals and collects insurance information via multiple methods, runs test claims, and Completes administrative duties. Work in teams that process Authorization & Referral transaction which strive to achieve team goal. Can review clinical documents for prior authorization/pre-determination submission purposes. Who can contact referral source, patient, and/or doctors office to obtain additional information that is required to Complete verification of benefits or prior approvals. Can perform outbound calls to patients or doctor offices to notify of any delays due to more information needed to Process or due to prior authorization. Provides exceptional customer service to external and internal customers, resolving any customer requests in A timely and accurate manner. Ensures the appropriate notification of patients in regard to their financial responsibility, benefit coverage, And payer authorization for services to be provided. Maintains prior authorizations and verifies insurance coverage for ongoing services. Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per The direction of the leadership. Collect, analyze, and record all required demographic, insurance/financial, and clinical data necessary to verify Patient information. Refer patients to Financial Counselors as needed to finalize payment for services. Document financial and pre-certification information according to a defined process on time. Request and coordinate financial verification and pre-certification as required to proceed with patient care; Document financial and pre-certification information according to defined process. Good Knowledge and understanding of Human Anatomy. Proficiency in Microsoft office tools Willingness to work the night shift Education/ Experience Requirements: Should be a Graduate from any stream. Should possess excellent communication & written skills. Quick and eager to learn and mold accordingly to the process needs. Should have knowledge in Medical Terminology, knowledge of the different types of health insurance plans; i.e. HMO s, PPOs, etc. Ability to effectively handle multiple priorities within a changing environment. Experience in diagnosing, Isolating, and resolving complex issues and recommending and implementing Strategies to resolve problems. Ability to coordinate with US counterpart either by phone or by email. Ability to multi-task and organizational timely follow up. Ability to follow established work schedule. Excellent Analytical Skills. Should have advanced computer knowledge in MS Office Suite, pMD soft, Acumen, Athena Health, and other applications/systems preferred. Salary BOE GM Analytics Solutions is an equal opportunity employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, veteran status, or any other protected factor. Competency Requirements: Must possess the following knowledge, skills & abilities to perform this job successfully: Broad understanding of clinical operations, front office, insurance and authorizations Ability to communicate effectively and clearly with all internal and external customers Detail-oriented with excellent follow-up. Solutions-minded, compliance-minded and results-oriented. Excellent planning skills with the ability to define, analyze and resolve issues quickly and accurately Ability to juggle multiple priorities successfully. Extremely strong organizational and communication skills. High-energy, a hands-on employee who thrives in a fast-paced work environment. Familiar with standard concepts, practices, and procedures within the field. Ability to work in a fast-paced, result-driven, and complex healthcare setting. Ability to meet strict deadlines and communicate timelines Takes a sense of ownership Capable of embracing unexpected change in direction or priority. Highly motivated to solve problems; proven troubleshooting skills and ability to analyze problems by type and severity Work Environment: Extensive telephone and computer usage. Use of computer mouse requires repetitive hand and wrist motion. Time off restricted during peak periods. Regular reaching, grasping and carrying of objects This position may be modified to reasonably accommodate an incumbent with a disability. This job requires the ability to work with others in a team environment, the ability to accept direction from superiors and the ability to follow Company policies and procedures. Regular, predictable and dependable attendance is essential to satisfactory performance of this job.

Key Responsibilities: Claim Submission Insurance Verification Payment Processing Patient Communication Record Keeping Claim Follow-up Compliance Revenue Cycle Management Accessible workspace Flexi working Cafeteria Work from home Annual bonus Performance bonus

Role & responsibilities: Handle and process insurance claims (Property, Casualty, Motor, Liability, or Employee Benefits) as assigned. Serve as the primary point of contact for clients, insurers, and third parties regarding claim status and inquiries. Perform claim intakes , document claim details, and validate policy coverage. Work independently (or with the AM / CSA) to manage and resolve queries from Clients and Claims adjusters / Reinsurers, seeking assistance as required ensuring escalation where necessary and resolution with minimum delay. Evaluate and negotiate settlements , ensuring fair and timely resolution. Maintain accurate and up-to-date claim records in the system. Prepare claim reports, summaries , and assist with trend analysis. Ensure compliance with regulatory standards , internal policies, and service level agreements (SLAs) . Escalate complex or fraudulent claims appropriately. Contribute to process improvements and client retention efforts. Preferred candidate profile: Minimum 5 years of experience in claims handling , insurance operations, or related fields (freshers with strong internships may be considered for junior roles). Understanding of insurance products and claims procedures . Excellent communication and customer service skills. Strong attention to detail, organizational, and time-management abilities. Proficiency with claims management software (e.g., Guidewire, Claim Center, or similar) and MS Office tools. Interested candidates can share their cv on below mentioned mail id: sonaly.sharma@crescendogroup.in References are highly appreciated.

Ready to shape the future of work? At Genpact, we don't just adapt to change we drive it. AI and digital innovation are redefining industries and were leading the charge. Genpacts AI Gigafactory, our industry-first accelerator, is an example of how were scaling advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. From large-scale models to agentic AI, our breakthrough solutions tackle companies most complex challenges. If you thrive in a fast-moving, tech-driven environment, love solving real-world problems, and want to be part of a team thats shaping the future, this is your moment Genpact (NYSE: G) is an advanced technology services and solutions company that delivers lasting value for leading enterprises globally. Through our deep business knowledge, operational excellence, and cutting-edge solutions we help companies across industries get ahead and stay ahead. Powered by curiosity, courage, and innovation , our teams implement data, technology, and AI to create tomorrow, today. Get to know us at genpact.com and on LinkedIn, X, YouTube, and Facebook Inviting applications for the role of Process Developer Broker Technical Support Specialist|| Property & Casualty & Underwriting || Madurai Location Your role will require you to utilize your experience in and knowledge of insurance/reinsurance and underwriting processes to process transactions for the Underwriting Support Teams and communicate with the Onsite Team. Responsibilities • Perform necessary activities to support broking teams in collaborating with account management to initiate a renewal, preparing and submitting marketing proposals to underwriters, processing endorsements and policy checking along with other requests • Identify and retrieve relevant compliance documentation necessary to process new policies and policy renewals, changes, additions, deletions and cancellations. • Calculating adjustments and premiums on policies and other insurance documents. • Ensure repository of record is accurate and current to ensure outputs and client deliverables will be produced according to guidelines and policy detail. • Communicating directly with underwriters/brokers/account executives to follow up or obtain additional information. • Monitor and attend to requests via client service platform that require action in a timely manner. • Help colleagues troubleshoot and resolve basic issues and perform other related duties as required. Qualifications we seek in you! Minimum Qualifications • Graduate with an excellent interpersonal, communication and presentation skills, both verbal and written • Relevant and meaningful years of experience of working in US P&C insurance lifecycle pre-placement, placement, and post-placement activities (such as endorsements processing, policy administration, policy checking, policy issuance, quoting, renewal prep, submissions, surplus lines, licensing, agency admin, inspections and so on. • Demonstrate and cultivate customer focus, collaboration, accountability, initiative, and innovation. • Proficient in English language- both written (Email writing) and verbal • A strong attention to detail; analytical skills and the ability to multi-task are important Preferred Qualification and Experience • Relevant years of insurance experience and domain knowledge, especially P&C insurance • Candidate having Broker (US P&C insurance) experience would be an asset • Proficient with Microsoft Office (Word, PowerPoint, Excel, OneNote) • A strong attention to detail; analytical skills and the ability to multi-task are important • Should be a team player with previous work experience in an office environment required • Client focused with proven relationship building skills • Ability to work collaboratively as a key member of a team and independently with minimum supervision • Highly organized with a proven ability to prioritize competing requirements and deadlines under pressure Why join Genpact? Be a transformation leader Work at the cutting edge of AI, automation, and digital innovation Make an impact Drive change for global enterprises and solve business challenges that matter Accelerate your career Get hands-on experience, mentorship, and continuous learning opportunities Work with the best Join 140,000+ bold thinkers and problem-solvers who push boundaries every day Thrive in a values-driven culture Our courage, curiosity, and incisiveness - built on a foundation of integrity and inclusion - allow your ideas to fuel progress Come join the tech shapers and growth makers at Genpact and take your career in the only direction that matters: Up. Lets build tomorrow together. Genpact is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion or belief, sex, age, national origin, citizenship status, marital status, military/veteran status, genetic information, sexual orientation, gender identity, physical or mental disability or any other characteristic protected by applicable laws. Genpact is committed to creating a dynamic work environment that values respect and integrity, customer focus, and innovation. Furthermore, please do note that Genpact does not charge fees to process job applications and applicants are not required to pay to participate in our hiring process in any other way. Examples of such scams include purchasing a 'starter kit,' paying to apply, or purchasing equipment or training.

Role & responsibilities: Analyzing and summarizing medical records for pre and post settlement projects. Interpreting clinical data in terms of medical terminology and diagnosis. Adhering to company policies/ARCHER principles and hence taking good care of Archer culture. Adhere to Health Insurance Portability and Accountability Act (HIPPA) all the time. Daily reporting to Medical team lead for productivity & quality EDUCATIONAL QUALIFICATION AND EXPERIENCE REQUIRE: MBBS graduate (No experience required) BHMS/BAMS graduate (Minimum 2 years of experience with Claims Processing in the Insurance sector).