2028 Claims Processing Jobs - Page 28

Primary Responsibilities: To be an effective participant in Class room training and clear the training assessments with 85% quality Consistently meet the targets set for MOCK charts Eligible employee will get confirmed as Junior Coder within a max of 6 months from the Joining Punctuality, Attendance and General Adherence to company policies, procedures and practices Strives to provide ideas to constantly improve the process Ensure adherence to external and internal quality and security standards (HIPPA/ISO/ISMS) Be an effective team player Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so #NTRQ Eligibility To apply to an internal job, employees must meet the following criteria SG 22 can apply will move laterally Performance rating in the last common review cycle of Meets Expectations or higher Not be on any active CAP (Corrective Action Plan) or active disciplinary action Time in Role Guidelines Should have been in your current position for a minimum of 12 months, if you have not met the recommended minimum time in role, discuss your career interest with your manager and gain alignment prior to applying. And share the alignment email with respective recruiter while applying Required Qualifications: Any degree in Life Science or Bio-Science Any degree in Pharmacy or Pharmaceutical Sciences Any degree in Nursing or Allied Health Any degree in Medicine At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone of every race, gender, sexuality, age, location and income deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission. #NJP

Job Description Your mission at IntegriChain: To help ensure success of high quality and on time delivery of rebate claims processing for IntegriChain s BPSaaS Customers. What this role entails: Processing of Managed Care and/or Medicaid Rebates Download, log and track data and contract submissions Run and create reports/analysis in Excel spreadsheets and other software packages to support payment reviews and approvals Ensure calculations are in compliance with contractual terms Reconcile and document any rebate variances Resolve errors and disputes within the rebate system based on defined set of rules and procedures Follow and ensure compliance with defined business processes and pre-established guidelines to perform the functions of the job Provide updates to management as required on delivery status of assigned work Ensure department SLA s are met for delivery Prepare and analyze ad hoc reporting Support ad hoc projects What success looks like in this role: Rebate claims are delivered on time and are of high quality Data and contracts are downloaded within required SLAs Compliance with department business processes Proactive and clear communication with Team Lead and other business partners Qualifications What you ll need to thrive in this role: Ability to prioritize and manage multiple tasks effectively and work in a fast paced environment Attention to detail, along wi

About the Team The Claims team at Navi is responsible for delivering a fast, transparent, and customer-first claims experience. From initial intimation to final settlement, whether cashless or reimbursement, they manage the end-to-end process with a strong focus on accuracy and turnaround time. The team works closely with the Hospital Partnerships team to streamline coordination and use data-driven insights and process automation to improve claim resolution speed and customer satisfaction. About the Role The role involves end-to-end medical claims adjudication, including reviewing treatment records, verifying eligibility, identifying potential fraud, and making informed claim decisions. It requires coordination with providers, customers, and internal stakeholders to ensure TAT and SLA adherence. The Medical Officer is also expected to support cost negotiations and assist in claim analytics. Strong communication, regulatory knowledge, and problem-solving skills are essential, along with a background in medicine. What We Expect From You Reviewing and evaluating medical claims to determine their eligibility for payment Investigating medical claims to identify fraud Communicating with claimants, providers, and other parties involved in the claim Making decisions about medical claims, such as whether to approve or deny a claim Negotiate with the treating doctor/ hospital to reduce the unjustified hospitalization cost Automate the system and bring in improvements to claims processes Monitoring systems and processes to ensure sustained levels of performance Liaison with internal stakeholders to ensure the deadlines of TATs and SLAs & Work towards the designated Tasks Tracking of customer communication for effective grievance resolution within TAT & SLAs Knowledge of products, regulations, and guidelines is a must to ensure process compliance. Claim Analytics- Periodical claim analysis to identify fraud and monitor claim performance metrics. Informing the customer about the rejection of their claim through a call Team Management- Build and manage a team of processing doctors supporting the function Must Haves Ability to handle independent assignments & having the acumen to draw logical conclusions He/she 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. Medical Graduate in any stream (MBBS/BHMS/BAMS/BUMS/BDS) Candidates having data analytics experience would be an added advantage. Knowledge of different languages would be an added advantage. Proficiency in Hindi and English is mandatory. Inside Navi We are shaping the future of financial services for a billion Indians through products that are simple, accessible, and affordable. From Personal & Home Loans to UPI, Insurance, Mutual Funds, and Gold, we are building tech-first solutions that work at scale, with a strong customer-first approach. Founded by Sachin Bansal & Ankit Agarwal in 2018, we are one of India's fastest-growing financial services organisations. But we are just getting started! ` Our Culture The Navi DNA Ambition. Perseverance. Self-awareness. Ownership. Integrity. We are looking for people who dream big when it comes to innovation. At Navi, you'll be empowered with the right mechanisms to work in a dynamic team that builds and improves innovative solutions. If you're driven to deliver real value to customers, no matter the challenge, this is the place for you. We chase excellence by uplifting each otherand that starts with every one of us. Why You'll Thrive at Navi At Navi, it's about how you think, build, and grow. You'll thrive here if: Youre impact-driven : You take ownership, build boldly, and care about making a real difference. You strive for excellence : Good isn’t good enough. You bring focus, precision, and a passion for quality. You embrace change : You adapt quickly, move fast, and always put the customer first.

About The Role Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years Language - Ability: English(International) - Intermediate About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com 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.The business processes, operations and interactions of third party administrators of prescription drug programs, understanding of the processes used to manage programs for payers, process and pay prescription drug claims, develop and maintain the formulary, contract with pharmacies and negotiate discounts and rebates with drug manufacturers. What are we looking for Ability to perform under pressureAdaptable and flexibleAbility to establish strong client relationshipWritten and verbal communicationPrioritization of workload 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 Any Graduation

About The Role Skill required: Supply Chain - Automotive Supply Chain Designation: Business Advisory Associate Qualifications: BE/Diploma in Automobile Years of Experience: 1 to 3 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do To maintain quality and service standards of the Warranty Claims processing team in support of the contracted Service Level AgreementInvestigate and Verify warranty claims based on available external support resources (Parts catalog, Dealer Assist & Standard labor time) & take appropriate decisionImplement practices to improve operational efficienciesAnalyze, improve and optimize automotive supply chains to make them more effective, efficient and resilient through digitization. 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 Roles and Responsibilities: Mechanical knowledge of machinery/auto-componentInvestigate and Verify warranty claims based on available external support resources (Parts catalog, Dealer Assist & Standard labor time) & take appropriate decision Qualification BE,Diploma in Automobile

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Business Requirements Analysis Good to have skills : Insurance Claims, Guidewire BillingCenter BAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. Your typical day will involve collaborating with various stakeholders to gather requirements, ensuring that the applications meet business needs, and overseeing the development process to deliver high-quality solutions. You will also engage in problem-solving and decision-making to guide your team effectively, fostering an environment of collaboration and innovation. Roles & Responsibilities:- Expected to be an SME.- Collaborate and manage the team to perform.- Responsible for team decisions.- Engage with multiple teams and contribute on key decisions.- Provide solutions to problems for their immediate team and across multiple teams.- Facilitate knowledge sharing and mentoring within the team to enhance overall performance.- Monitor project progress and ensure alignment with business objectives. Professional & Technical Skills: - Must To Have Skills: Proficiency in Business Requirements Analysis.- Good To Have Skills: Experience with Guidewire BillingCenter BA, Insurance Claims.- Strong analytical skills to assess business needs and translate them into technical requirements.- Ability to communicate effectively with both technical and non-technical stakeholders.- Experience in project management methodologies to ensure timely delivery of projects. Additional Information:- The candidate should have minimum 5 years of experience in Business Requirements Analysis.- This position is based at our Hyderabad office.- A 15 years full time education is required.- Resource need to work in Shift B(12:30pm till 10:00pm) Qualification 15 years full time education

Role & responsibilities Greetings from The Job Factory !! Job Summary: We are seeking highly motivated and enthusiastic undergraduate or graduate freshers/ experience to join our team as International Process Associates. The successful candidates will work on international processes, providing exceptional service to our global clients. For more details Call : HR Shruthi 9008812627 (call or whatsapp) Email id - shruthic@thejobfactory.co.in Role & Responsibilities: 1. Handle customer inquiries and resolve issues via phone, email, or chat 2. Provide product information and support to customers 3. Manage and document customer interactions 4. Meet productivity and quality standards 5. Collaborate with internal teams to resolve complex issues Preferred Candidate Profile: 1. Undergraduate or graduate degree in any discipline 2. Excellent communication and interpersonal skills 3. Ability to work in a fast-paced environment and manage multiple priorities 4. Strong analytical and problem-solving skills 5. Willingness to learn and adapt to new processes and technologies What We Offer: 1. Competitive salary and benefits 2. 2-way cab facility for commute 3. Opportunities for growth and development in a global company 4. Collaborative and dynamic work environment 5. Training and support to help you succeed in your role 6. Incentives and Allowance's Skills: 1. Good communication skills (written and verbal) 2. Basic computer knowledge and typing skills 3. Ability to work independently and as part of a team 4. Strong attention to detail and organizational skills For more details Call : HR Shruthi 9008812627 (call or whatsapp) Email id - shruthic@thejobfactory.co.in Preferred candidate profile

Role & responsibilities Greetings from The Job Factory !! Job Summary: We are seeking highly motivated and enthusiastic undergraduate or graduate freshers/ experience to join our team as International Process Associates. The successful candidates will work on international processes, providing exceptional service to our global clients. For more details Call : HR Devishree 9901195084(call or whatsapp) Email id - devishreethejobfactory@gmail.com Role & Responsibilities: 1. Handle customer inquiries and resolve issues via phone, email, or chat 2. Provide product information and support to customers 3. Manage and document customer interactions 4. Meet productivity and quality standards 5. Collaborate with internal teams to resolve complex issues Preferred Candidate Profile: 1. Undergraduate or graduate degree in any discipline 2. Excellent communication and interpersonal skills 3. Ability to work in a fast-paced environment and manage multiple priorities 4. Strong analytical and problem-solving skills 5. Willingness to learn and adapt to new processes and technologies What We Offer: 1. Competitive salary and benefits 2. 2-way cab facility for commute 3. Opportunities for growth and development in a global company 4. Collaborative and dynamic work environment 5. Training and support to help you succeed in your role 6. Incentives and Allowance's Skills: 1. Good communication skills (written and verbal) 2. Basic computer knowledge and typing skills 3. Ability to work independently and as part of a team 4. Strong attention to detail and organizational skills For more details For more details Call HR Gayathri @ 9538878905 Email ID - gayathri@thejobfactory.co.in Preferred candidate profile

Role & responsibilities Greetings from The Job Factory !! Job Summary: We are seeking highly motivated and enthusiastic undergraduate or graduate freshers/ experience to join our team as International Process Associates. The successful candidates will work on international processes, providing exceptional service to our global clients. For more details Call : HR Devishree 9901195084(call or whatsapp) Email id - devishreethejobfactory@gmail.com Role & Responsibilities: 1. Handle customer inquiries and resolve issues via phone, email, or chat 2. Provide product information and support to customers 3. Manage and document customer interactions 4. Meet productivity and quality standards 5. Collaborate with internal teams to resolve complex issues Preferred Candidate Profile: 1. Undergraduate or graduate degree in any discipline 2. Excellent communication and interpersonal skills 3. Ability to work in a fast-paced environment and manage multiple priorities 4. Strong analytical and problem-solving skills 5. Willingness to learn and adapt to new processes and technologies What We Offer: 1. Competitive salary and benefits 2. 2-way cab facility for commute 3. Opportunities for growth and development in a global company 4. Collaborative and dynamic work environment 5. Training and support to help you succeed in your role 6. Incentives and Allowance's Skills: 1. Good communication skills (written and verbal) 2. Basic computer knowledge and typing skills 3. Ability to work independently and as part of a team 4. Strong attention to detail and organizational skills For more details For more details Call : HR Devishree 9901195084(call or whatsapp) Email id - devishreethejobfactory@gmail.com Preferred candidate profile

Review and interpret diagnostic and clinical reports Summarize patient findings in a standard reporting format for clients/insurance partners. Ensure accuracy and consistency in medical terminology and conclusions.

Hope you are looking for a job change. We have opening for Duck Creek Claims Developer & Lead for an MNC in Greater Noida, Pune, Mumbai, Hyderabad & Bhubaneswar Locations., I'm sharing JD with you. Please have a look and revert with below details and Updated Resume to rejeesh.s@jobworld.jobs. Apply only if you can join in 20 Days and Serving Notice Period. Initially It's 5-Days from Office. Role : Duck Creek Claims Developer & Lead Experience: 3-14 Years Mode: Permanent Work Location: Greater Noida, Pune, Mumbai, Hyderabad & Bhubaneswar Notice Period: immediate to 20 Days Work Mode : 5-Days Work from Office Mandatory Skills: Duck Creek Claims, Claim, Claims Centre, Dot Net & Dot net Framework Full Name: Email ID: Mobile Number: Alternate No: Alternative Mail: Qualification: Regular Course: Graduation Year: Total Experience: Relevant experience: Current Organization: Working as Permanent Employee: Payroll Company: Experience in Duck Creek: Experience in Duck Creek Claims Development : Experience in Claims Centre : Experience in Dot net Framework: You are Certified in Duck Creek: Current location: Preferred location: Current CTC: Exp CTC: Pan Card Number : Date of Birth: Any Offer in Hand: Serving Notice Period: Official LWD: Can you join immediately : Job Description- Required Skills.: Duck Creek Claims, Claim, Claims Centre, Dot Net & Dot net Framework. Experience 3- 14 Years Location- Hyderabad Interview Mode: For Pune candidates F2F on 02-Aug-25 and other location candidates Virtual Notice periods-Immediate to 20 Days Responsibilities: Candidate should have strong experience in Duck creek Claims V11 / V12. Candidate should have strong experience in .net and .net Frame work. Hands-on experience in Claims Configuration and Console modules, Configuring /Customizing Party. Hands on Exp in Module, Task Creation, Configuring/Customizing, Extension and Advanced Extension points etc... Good Knowledge of customizing Automated Reserves. Good understanding of underwriting, rating, insurance rules, forms Experience in Insurance / P&C insurance domain. Must have excellent Communication Skills Regards, Rejeesh S Email : rejeesh.s@jobworld.jobs Mobile : +91- 9188336668

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. Client Servicing Responsible for developing the corporate customer base for MDIndia Health Insurance Services. Map the territory and maintain a strong pipeline of potential customers. Establish Contacts with key persons at the corporate and understand the current levels of Health Insurance services and needs. Develop strong relationship with Insurance Companies/Brokers. Promptly attending Emails, Phone calls, Whats App messages of Clients. Maintain proper MIS & Internal reports and present it to the management. Ability to work independently, achieve targets and be absolutely result oriented Open to travel. Desired Candidates Profile Qualification Any Graduate Experience Fresher - 2 Years Exp. Profile Executive Two wheeler is Mandatory If interested kindly share your resume to ta4@mdindia.com

Roles and Responsibilities: Process Adjudication claims and resolve for payment and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Ensuring accurate and timely completion of transactions to meet or exceed client SLAs Organizing and completing tasks according to assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines. Requirements: 1-5 years of experience in processing claims adjudication and adjustment process Experience of Facets is an added advantage. Experience in professional (HCFA), institutional (UB) claims (optional) Both under graduates and post graduates can apply Good communication (Demonstrate strong reading comprehension and writing skills) Able to work independently, strong analytic skills **Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.

Job Summary Join our dynamic team as a PE-Enrollment & Billing specialist where you will utilize your skills in Benefits open enrollment MS Excel and UiPath to streamline processes in the Payer domain. This hybrid role offers the opportunity to work night shifts ensuring smooth operations and efficient billing processes. With a focus on innovation and accuracy your contributions will enhance our service delivery and impact the healthcare industry positively. Responsibilities Oversee the enrollment and billing processes to ensure accuracy and compliance with industry standards. Utilize MS Excel to analyze and manage data effectively ensuring all records are up-to-date and accurate. Implement UiPath automation to streamline repetitive tasks increasing efficiency and reducing errors. Collaborate with team members to resolve any discrepancies in billing and enrollment processes promptly. Provide support during the benefits open enrollment period ensuring a smooth and efficient process for all stakeholders. Monitor and report on key performance indicators to identify areas for improvement and implement necessary changes. Communicate effectively with internal and external stakeholders to address any issues or concerns related to enrollment and billing. Maintain a thorough understanding of the Payer domain to ensure all processes align with industry regulations and standards. Assist in the development and implementation of new strategies to enhance the enrollment and billing processes. Ensure all documentation is complete and accurate adhering to company policies and procedures. Support the team in achieving departmental goals and objectives contributing to the overall success of the organization. Participate in training and development opportunities to enhance skills and knowledge in relevant areas. Contribute to a positive work environment by promoting teamwork and collaboration. Qualifications Demonstrate proficiency in Benefits open enrollment processes ensuring a seamless experience for all participants. Exhibit strong skills in MS Excel for data management and analysis contributing to accurate and efficient operations. Show experience in using UiPath for automation enhancing process efficiency and reducing manual workload. Possess knowledge of the Payer domain ensuring compliance with industry standards and regulations. Display excellent communication skills facilitating effective collaboration with team members and stakeholders. Demonstrate problem-solving abilities addressing any issues in the enrollment and billing processes promptly.

Description The Claim Analysis role involves evaluating and processing insurance claims to ensure accurate and fair assessments, contributing to the overall efficiency of the claims department. Responsibilities Analyze and assess insurance claims to determine validity and coverage based on policy terms. Investigate claims by gathering relevant information, interviewing claimants, and consulting with medical professionals when necessary. Prepare detailed reports documenting findings and recommendations for claim resolution. Collaborate with underwriting and legal teams to ensure compliance with policies and regulations. Communicate effectively with clients, claimants, and colleagues to provide updates and resolve issues promptly. Skills and Qualifications Bachelor's degree in Finance, Business Administration, or a related field. Strong analytical skills with the ability to interpret complex data and make informed decisions. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and experience with claims management software. Excellent verbal and written communication skills for effective interaction with clients and stakeholders. Attention to detail and strong organizational skills to manage multiple claims efficiently. Minimum 2-3 years of experience in insurance claims handling Proven track record of successful claim resolutions and customer satisfaction. Strong knowledge of insurance regulations, policies, and procedures. Interested Candidates can drop the resume on 7338191537 or [HIDDEN TEXT]

As an Order Processing Engineer within the Water and Industrial Business Unit at Sulzer, a leading engineering company dedicated to innovation, you will play a crucial role in processing product and spare parts orders while ensuring customer satisfaction. Join our global team based in Pune, India, and contribute to the development of innovative solutions that promote a prosperous and sustainable society. Your responsibilities will include liaising with factory logistics to secure effective delivery dates, updating customer delivery information, maintaining product records, and managing order flows in alignment with stock levels. Your attention to detail will be essential in ensuring compliance with customer service standards and efficiently handling claims processes, bank guarantees, letter of credits, and delivery time monitoring. In addition to your technical duties, you will be responsible for coordinating with factories, providing information to stakeholders, and maintaining the SAP customer register. Your role will also involve training new SAP users, adhering to health, safety, quality, and environmental standards, and ensuring compliance with corporate directives and local legislation. To excel in this position, you should hold a Bachelor's or Master's degree in Engineering, Commerce, or a related field, along with over 5 years of relevant experience. Strong communication skills, accuracy, self-motivation, and a proactive approach are essential qualities for success in this role. Proficiency in Excel, Word, SAP, and data input systems, as well as a good telephone manner and teamwork abilities, will be advantageous. At Sulzer, we value diversity and offer an inclusive work environment where all employees have the opportunity to thrive. Join us in our mission to drive innovation and make a positive impact on society.,

Shift: Night | Mon–Fri Work Mode: On-site (Office-based) Salary Structure: Freshers: 23,000 CTC/month Experienced: 28,000 – 35,000 CTC/month Incentives: Increment after 3 months based on performance

TATA AIG General Insurance Company Limited is looking for Manager - Commercial Claims to join our dynamic team and embark on a rewarding career journey Delegating responsibilities and supervising business operations Hiring, training, motivating and coaching employees as they provide attentive, efficient service to customers, assessing employee performance and providing helpful feedback and training opportunities. Resolving conflicts or complaints from customers and employees. Monitoring store activity and ensuring it is properly provisioned and staffed. Analyzing information and processes and developing more effective or efficient processes and strategies. Establishing and achieving business and profit objectives. Maintaining a clean, tidy business, ensuring that signage and displays are attractive. Generating reports and presenting information to upper-level managers or other parties. Ensuring staff members follow company policies and procedures. Other duties to ensure the overall health and success of the business.

""" Checks for completeness and appropriateness of source data. Involved in fact finding, information search and data gathering. Verifies and compiles data. Identifies and resolves routine and recurring problems. Skills Required Ability to analyze and process transactions based on rules. Able to integrate knowledge as a skilled specialist. Possess strong domain knowledge in Healthcare and Insurance domain. """

Job Summary Join our dynamic team as a Claims Processing Specialist where you will play a crucial role in ensuring the accuracy and efficiency of claims adjudication. With a focus on Medicare and Medicaid claims you will contribute to the seamless processing of claims enhancing our service delivery. This hybrid role offers the flexibility of working both remotely and on-site during night shifts. Responsibilities Process claims with precision ensuring adherence to Medicare and Medicaid guidelines. Analyze claims data to identify discrepancies and resolve issues promptly. Collaborate with team members to streamline claims adjudication processes. Utilize claims adjudication software to enhance processing efficiency. Provide feedback on process improvements to enhance service delivery. Maintain up-to-date knowledge of industry regulations and compliance standards. Communicate effectively with stakeholders to ensure clarity and resolution of claims issues. Document claims processing activities accurately for audit and reporting purposes. Support the team in achieving departmental goals and objectives. Participate in training sessions to stay informed about the latest claims processing techniques. Ensure confidentiality and security of sensitive claims information. Contribute to a positive work environment by supporting colleagues and fostering teamwork. Adapt to changing priorities and work effectively under pressure. Qualifications Demonstrate proficiency in claims adjudication processes and software. Possess strong analytical skills to identify and resolve claims discrepancies. Exhibit excellent communication skills for effective stakeholder interaction. Show a keen understanding of Medicare and Medicaid claims requirements. Display attention to detail in processing and documenting claims activities. Have the ability to work independently and collaboratively in a hybrid work model. Certifications Required Not required

Davies is looking for an experienced Processing Specialist to join our growing team! As a Processing Specialist, you will assist the claims departments with general clerical functions. Reporting to the Processing Supervisor, you will open and scan mail documents, including attaching scanned documents in the claims system.

"Positions General Duties and Tasks: Process Insurance Claims timely and qualitatively Meet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job Be a team player and work seamlessly with other team members on meeting customer goals Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function Handle reporting duties as identified by the team manager Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and customer service skills. Able to work independently; strong analytic skills. Detail-oriented; ability to organize and multi-task. Ability to make decisions. Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. Ability to work in a team environment. Handling different Reports - IGO/NIGO and Production/Quality. To be in a position to handle training for new hires Work together with the team to come up with process improvements Strictly monitor the performance of all team members and ensure to report in case of any defaulters. Encourage the team to exceed their assigned targets. Candidate should be flexible & support team during crisis period Should be confident, highly committed and result oriented Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts. ***Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend s basis business requirement."

Insurance Verification Associate Desired Candidate Profile: Should be having excellent communication skills with Dental billing experience and willing to work in night shift. Minimum 1 Year of experience in AR is Mandatory. Only Experience from US Healthcare Medical or Dental Billing Will be Considered. Location : Mohali ( TDI Business Center near VR Punjab Mall) Exp : 1 ?? 3 Years Week Off : Saturday & Sunday Salary : Best In The Industry/Night Meals and refreshments Notice Period : One Month Preferable Shift : Night Shift Apply Now

Job Summary Claims Adjudication Responsibilities Process claims using ClaimsExchange and Facets ensuring accuracy and compliance with company standards. Collaborate with team members to resolve any discrepancies or issues related to claims processing. Maintain up-to-date knowledge of industry regulations and company policies to ensure compliance. Provide timely and accurate responses to inquiries from internal and external stakeholders. Analyze claims data to identify trends and areas for improvement in processing efficiency. Assist in the development and implementation of process improvements to enhance claims processing. Participate in training sessions to stay informed about new technologies and procedures. Support the team in meeting departmental goals and objectives through effective claims management. Communicate effectively with team members and management to ensure smooth workflow. Utilize problem-solving skills to address and resolve claims-related issues promptly. Ensure all claims are processed within the designated timeframes to meet service level agreements. Contribute to the overall success of the claims department by maintaining a high level of accuracy and efficiency. Engage in continuous learning to enhance skills and knowledge in claims processing. Qualifications Demonstrate proficiency in using ClaimsExchange and Facets for claims processing. Possess a basic understanding of Medicare and Medicaid claims processes. Exhibit strong analytical skills to identify and resolve claims discrepancies. Show effective communication skills for interacting with team members and stakeholders. Display a keen attention to detail to ensure accuracy in claims processing. Have a willingness to work night shifts in an office environment. Be eager to learn and grow in the field of claims processing.

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