3165 Claims Processing Jobs - Page 29

JOB DESCRIPTION FOR ASSISTANT MANAGER - BILLING POSITION : - ASSISTANT MANAGER DEPARTMENT : - BILLING REPORTING TO : - HEAD - FINANCE & ACCOUNTS QUALIFICATION : - GRADUATE /B.COM PREFFERED EXPERIENCE : - MINIMUM 5 TO 8 YEARS OF EXPERIENCE IN HOSPITAL BILLING JOB RESPONSIBILITIES : - The Billing Staff is responsible for managing all aspects of billing related to CGHS, MJPJAY patients, TPA & OTHER billing related work in the hospital. This includes verifying patient details, ensuring the correct application of health scheme policies, preparing and processing bills, as per agreed tariffs and maintaining records for these specific patient categories. Job Description: 1. CGHS & MJPJAY Billing: - ...

POSITION : - OFFICER DEPARTMENT : - BILLING REPORTING TO : - HEAD - FINANCE & ACCOUNTS QUALIFICATION : - GRADUATE /B.COM PREFFERED EXPERIENCE : - MINIMUM 4 YEARS OF EXPERIENCE IN HOSPITAL BILLING JOB REPOSIBILITIES : - The person of this designation will be responsible for auditing/entering/modifying services in order to generate accurate patient bill as per the policies and protocols of the hospital in the TAT as described by the Billing Incharge /Manager/CFO. JOB DUITIES & RESPONSIBILITY : To ensure that bills are generated as per SOP. To ensure that outstanding follow-up is done regularly and any discrepancies in outstanding amounts, as described in policy, are immediately reported to the...

Claims Processing: Monitor and convert the summons issued and intimation received at the location to claims by registering on the Claims Legal module within the given TAT. Make payments as required to the claimants within the TAT. Review the MIS on an on-going basis for claims closure, claim size and settlement ratio for the allocated region. Ensure that all regional team members follow the TAT Data Maintenance & Reporting: Collaborate with Execution and approval teams to maintain the accuracy of data entered in the system Share Claim payment status and claim growth analysis reports monthly. Ensure complete and clear documentation of all claims cases for the region by coordinating with the O...

All Risk Claims Management Implement Claims SOP within the team and service network and ensure adherence of the same in region Monitoring day to day claims activities and ensure claim settlement as per agreed TAT at region Guide and direct the team member in handling critical claims End to End claims processing, approving/repudiating claims considering policy terms and conditions Ensure up to date data entry in Claims Module by ASPs/Self and team members and document collections required for claims processing Interact with Service Providers /logistic partners for timely service delivery and monitor service providers payments Updating customers about the claim s status ACS Control and Loss Mi...

Job Title : Insurance Process Qualification : Any Graduate and Above Relevant Experience : 4 8 Years Must Have Skills : 1.US Insurance domain expertise. 2.Experience working in US Insurance processes in a BPO, KPO, or shared services setup. 3.Knowledge of US insurance regulatory and compliance standards. 4.Proficient in insurance platforms/tools. 5.Strong analytical skills with attention to detail and accuracy. 6.Excellent verbal and written communication skills to interact with clients and internal stakeholders. 7.Ability to manage multiple processes and priorities effectively. 8.Familiarity with lean/process improvement methodologies is a plus. 9.Intermediate to advanced skills in MS Excel...

HIRING FRESHERS ALSO Role & responsibilities Medical Adjudication of Health Claims Identifying Frauds Adhering to SLAs and processing the claims within the TAT as per policy Support CRM, provider, sales and grievance team QUALIFICATION - MBBS, BAMS AND BHMS ONLY. Rest won't be considered. Work from Office only. Candidate should be comfortable with Roaster timings.

You have a minimum of 5 years of experience in the US Healthcare industry. Your expertise includes: - Claims processing - Medical Billing experience in Medicare or commercial line - Experience in Contract configuration, with specific knowledge on Division of Financial responsibility work - Strong knowledge of Managed Care, specifically Medicare Advantage, Commercial, or Medi-cal - Ability to translate agreements/contracts into a matrix for codification - Contract interpretation - Understanding of financial responsibility related to healthcare (Division of Financial Responsibility) - Understanding of contracting - Extensive understanding of billing including service code, rev code, diagnosis,...

Description - External Job Summary We are seeking a dedicated Policy Servicing Specialist with 1 to 5 years of experience to join our team. The ideal candidate will possess strong English communication skills and proficiency in MS Office. Experience in Property & Casualty Insurance is a MUST. This role requires working from the office during night shifts with no travel obligations. Responsibilities Manage and process policy servicing tasks efficiently to ensure timely completion of assignments. Communicate effectively with clients and internal teams to address policy-related inquiries and issues. Utilize MS Office tools to maintain accurate records and documentation of policy changes and upd...

As an Insurance Support at our company, you will be responsible for assisting the Insurance Manager in overseeing insurance operations. This includes ensuring proper risk management, policy administration, and claims processing. Your role will involve coordinating with insurance providers, managing compliance with regulatory requirements, and contributing to the development of insurance strategies to minimize risk exposure. **Key Responsibilities:** - Assist the Insurance Manager in overseeing insurance operations - Ensure proper risk management, policy administration, and claims processing - Coordinate with insurance providers - Manage compliance with regulatory requirements - Contribute to...

Job Title: Quality Auditor / Analyst AR (Denial Management, EV, BV Audit) Position Type: Full-Time, Work From Office (WFO) Location: Near Madhavaram Tabbal Petti, Chennai 600051 Preferred Candidates: Immediate joiners located nearby Openings: 1 We are looking for a highly skilled Quality Auditor with strong expertise in AR – Denial Management , and exposure to Eligibility and Benefits Verification (EV/BV) audit processes . This role involves working closely with AR Callers and AR Analysts , ensuring process quality, audit accuracy, and continuous performance improvement across AR functions. Key Responsibilities Conduct in-depth quality audits of AR Callers’ and Analysts' performance in Denia...

Exp- 1-2 years of US Mortgage Default Mortgage Claims Essential Functions Perform Claims processing as per Investor and Industry guidelines. Pulling all relevant Servicing document Pulling all relevant Origination/ collateral documents Requesting additional or missing documents. Ensures all documentation, acknowledgement and review done on time. What we're Looking For 1-2 years of FHA, VA, USDA, PMI, Fannie Mae, and Freddie Mac claims experience required. Should have experience of working FHA Part A, Part B-E, PFS CWCOT Experience with FNMA 571 is preferred Knowledge of Microsoft Office, specifically Excel, Word, Outlook Knowledge of Excel related to formulas, formatting, and data sorting Ba...

NO SALES , NO TARGET JOB Hiring For AR Caller In US Healthcare(Blended Process) #Shift: US Shift #5days working #Salary: 20k CTC #Location: Ahmedabad, Gujarat >> Fresher Also Apply << >> Fluent English Required <

Retail Claims - Automation ProjectsKey Responsibilities1. Automate Claims Processes- Design anddevelop automated workflows and business rules to streamline claims processing. 2. Integrate with Existing Systems- Integrateautomated claims processing solutions with existing systems and technologies. 3. Testing and UAT - Test and validateautomated claims processing solutions to ensure accuracy and efficiency. 4. Daily production issue - Troubleshootissues and resolve problems related any day-to-day production issues across allclaim systems for death and health claims5. Collaborate with IT stakeholders, claim team and other requiredstakeholders to understand requirements and implement solutions6....

myG is looking for TRAINEE - SCHEMES & CLAIMS to join our dynamic team and embark on a rewarding career journey Assisting experienced employees with their daily tasks and responsibilities Observing and gaining hands-on experience in various aspects of the job Receiving feedback and guidance from supervisors and mentors Completing assigned projects and tasks under the supervision of experienced employees Collaborating with team members and contributing to team projects Demonstrating a strong work ethic, positive attitude, and a willingness to learn and grow Disclaimer: This job description has been sourced from a public domain and may have been modified by Naukri.com to improve clarity for ou...

Primary Source Verification (PSV): Verify professional licenses, board certifications, and educational qualifications directly from the issuing authorities. Contact previous employers, educational institutions, and licensing bodies to confirm credentials. Document Management: Maintain organized and up-to-date files of all credentialing documents. Ensure timely renewals of certifications and licenses, and track expiration dates. Update and maintain credentialing software/databases with all relevant information. Compliance and Accreditation: Ensure that all credentialing activities meet the requirements of regulatory agencies, such as The Joint Commission and state medical boards. Prepare cred...

About The Job Role Experience 3 to 15 years Skills Guidewire Developer experience with any of the detailed skill like (Policy / Billing / Claims / Integration / Configuration / Insurance Now / Portal / Rating) Insurance domain knowledge with Property & Casualty background Hands on experience in at least one of the Guidewire products (Claim/Policy/Billing) Should have knowledge on Admin data loading. Good knowledge in Web services, XML, GxModel, Messaging, Batch implementation, Integrating with 3rd Party Systems and Document composition tools like Xpressions, Thunderhead Experience on any database Oracle / SQL Server and well versed in SQL Designed & modified existing workflows (required for ...

About The Job Role Experience 3 to 15 years Skills Guidewire Developer experience with any of the detailed skill like (Policy / Billing / Claims / Integration / Configuration / Insurance Now / Portal / Rating) Insurance domain knowledge with Property & Casualty background Hands on experience in at least one of the Guidewire products (Claim/Policy/Billing) Should have knowledge on Admin data loading. Good knowledge in Web services, XML, GxModel, Messaging, Batch implementation, Integrating with 3rd Party Systems and Document composition tools like Xpressions, Thunderhead Experience on any database Oracle / SQL Server and well versed in SQL Designed & modified existing workflows (required for ...

About The Job Role Experience 3 to 15 years Skills Guidewire Developer experience with any of the detailed skill like (Policy / Billing / Claims / Integration / Configuration / Insurance Now / Portal / Rating) Insurance domain knowledge with Property & Casualty background Hands on experience in at least one of the Guidewire products (Claim/Policy/Billing) Should have knowledge on Admin data loading. Good knowledge in Web services, XML, GxModel, Messaging, Batch implementation, Integrating with 3rd Party Systems and Document composition tools like Xpressions, Thunderhead Experience on any database Oracle / SQL Server and well versed in SQL Designed & modified existing workflows (required for ...

1.Coordinate with insurance companies and third-party administrators (TPAs) for processing patient claims. ECHS/ESIC/CGHS 2.Ensure accurate and timely submission of insurance claims and necessary documentation.

Job Description: We are seeking a detail-oriented and proactive AR Follow-up Executive to join our dynamic revenue cycle team. The ideal candidate will be responsible for timely follow-up on outstanding claims with insurance companies to ensure maximum reimbursement. Youll work closely with billing and coding teams to resolve denials, track claims, and reduce aging accounts. Key Responsibilities: Review and analyze unpaid or denied claims. Initiate calls or work on web portals to follow up with insurance companies. Resolve claim discrepancies and ensure proper documentation. Update systems with claim statuses and next action steps. Meet daily and weekly productivity and quality targets Requi...

Position: Product Analyst / Business Analyst (US Healthcare) About the job The Product Analyst plays a crucial role in driving product development and strategy within the US healthcare sector. They possess a strong understanding of healthcare systems and help organizations achieve their business goals by analyzing product requirements, identifying opportunities for enhancement, and collaborating with cross-functional teams. They support product lifecycles by aligning product strategies with business objectives and regulatory compliance, ensuring seamless execution of product initiatives. Responsibilities Collaborate with internal teams and external stakeholders to gather and analyze product ...

About Us At CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities, and shareholders every day. One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We are devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being. CIGNA Healthcare belie...

Responsibilities: Manage insurance cases from intake to settlement Collaborate with medical providers on claims resolution Ensure timely claim processing and payment distribution Health insurance Annual bonus

Required Skills & Qualifications: Bachelors degree in any discipline (preferred: Insurance, Business, or related fields). 2–5 years of experience in transaction quality or process audit roles, preferably in the insurance industry. Strong understanding of insurance processes (Life, Health, P&C, or Reinsurance). Proficiency in MS Excel, PowerPoint, and quality monitoring tools. Excellent analytical, communication, and documentation skills. Familiarity with quality frameworks like Six Sigma, COPC, or ISO (preferred). Preferred Qualifications: Certification in Quality (e.g., Six Sigma Yellow/Green Belt, Lean). Certification in Insurance domain (e.g., LOMA) Experience with workflow tools like BPM...

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...