2028 Claims Processing Jobs - Page 30

Job Summary As a member of the NA Client Service Teams this role supports the processing of pre renewal, broking, binding and post binding activities required for placement and service of our NA CRB clients and prospects. The work closely with Client Advocacy, Client Service and Broking on a daily basis to delivery White Glove Service to our clients and prospects Principal Duties/Responsibilities . Participate in the draft proposal creation process alongside the Client Team Collaborate with the Client Team to support the activities required to file taxes in a timely manner to avoid fines and penalties due to late fees Support the Client team in process of binding coverage with carriers by drafting of binding confirmation documents and following up with carriers for receipt of binders Support in preparation of the Summary of Insurance to facilitate Clients understanding of their coverage Arrange and facilitate internal strategy meetings to discuss insurance upcoming renewals for a specific period. Support Client Managers and Account Executives in the coordination process Monitor renewal activities and assist in the preparation, review and update of documents and data required for the renewal process Support the Client Service and Advocacy teams with reporting needs Support the Client Service and Advocacy teams in the skillful management of ad hoc and mid term requests to support such activities and endorsements, certificates, loss runs, etc Support Client Management and Client Advocacy colleagues with the preparation and management of tasks and deliverables required as part of the renewal process. Collaborate with functional teams to initiate and finalize client deliverables. Follow up and handle questions and requests for information from functional teams. E.g., Loss Runs, Policy Checking, Certificates, Accounting and Settlement. Support the billing and invoicing process by ensuring that all necessary documents and key data elements are included and accurate Support onboarding of new clients Create and manage Client Exposure details Support the renewal process with document preparation/management, data analysis/management and delivery as part of a packet to Advocacy/Service team in preparation for client renewals Schedule, attend and take minutes of Internal Strategy meetings Data entry required to load and update client details for submission, proposal, binding and billing Knowledge and Experience: 2 to 5 years for experience in the Insurance renewal cycle business US insurance experience (Must) Understanding of the end-to-end insurance renewal cycle and its stages Thorough knowledge and understanding of various insurance documents An understanding of catastrophe modelling will be useful

Location : Ahmedabad Process: International Voice Support( US Healthcare ) Salary: Up to 4.2LPA Immediate joiners Freshers and Experience Both can apply Shift: Night Shift Working Days: 5 days/week

Location : Ahmedabad Process: International Voice Support( US Healthcare ) Salary: Up to 4.2LPA Immediate joiners Freshers and Experience Both can apply Shift: Night Shift Working Days: 5 days/week

operations of the healthcare claims processing team (Mediclaim, RCM, and denial management) Ensure claims, including verification, validation, coding .Monitor & manage denials, rejections, and appeals in accordance with Payer & Provider guidelines. Required Candidate profile knowledge of healthcare claims, RCM workflows, & denial management. Should have Team Management , Client Management. Analyze RCM data to identify trends, gaps, & opportunities for process improvement

Looking Immediate joiners 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: 1-4 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.

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: 1-4 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. Interested please join the below link DATE : 25TH JULY 2025 TIMINGS : 1.00PM - 3.00 PM Microsoft Teams Need help? Join the meeting now Meeting ID: 224 320 787 832 2 Passcode: Bk7MS7fe For organizers: Meeting options Regards, Dharani Priya.S

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: 1-3 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. Interested please share resume to pushpa.shanmugam@nttdata.com

1.Evaluates and processes claims in accordance with company policies and procedures, as well as to productivity and quality standards. 2.Examine the medical documents and assess the claims admissibility. 3.Consistently maintains production and quality standards based on quality control expectations. 4.Adaptability in cross training and multiple tasking. 5. Spoke with the customer over the phone to explain the policy T&C and claim details. 6. Reviewing medical claims and verifying information for accuracy. 7. Examining claims for potential fraud 8. Resolving discrepancies and other issues 9. Complying with compliance and company regulation and policies. 10. Performing other tasks, as required 11. Adaptability in cross training and multiple tasking 12. Basic knowledge about IRDAI guidelines. 13. Processing claims payments 14. Receiving customer questions and communicating with them regarding the status of their claims 15. Conduct investigations when necessary, gathering additional information to determine the validity of claims. 16. Deliver exceptional customer service to policyholders, resolving issues and answering questions in a timely manner.

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Position : Operations - Investigation Brief Job Profile : Claims adjudication, fraud and leakage control, client/provider feedback, team training and retention, Investigation Career Level : Medical Officer/ Deputy Manager/ Manager Medical Graduate Minimum Mandatory Qualification : BAMS, BHMS, BDS, For Manager MBBS (Preferred) Experience (in years) : 3 - 7 years of experience in investigation Minimum Mandatory Skill Set : Knowledge of Processing of claims, quality check and adherence to TAT, computer skills, excel. Candidate should be open to work in 24X7X365 shifts Desired Competencies/ Skill Set : MS Excel and MIS skills, Candidate having work experience of claim processing, Investigation, computer skills. Preferred Industry : Health Insurance, TPA, Hospitals, Healthcare

Customer Service Representative JD Customer Service Representative Position Summary: This position is responsible for providing a variety of services and information regarding products, prices, availability, product use and technical support for customers. Responsibilities: Comprehend customer needs (via conversation, architectural drawings, and written specifications) and recommend a product configuration to meet those requirements Provide pricing, quotes, product information, literature, samples, and support for customers Process orders Arrange deliveries Process product returns Confirm customer information Identify and close additional purchases of products and services Respond to requests from customers for information (via email / call/ Engage in technical discussions with customers Promote solutions and services Resolve customer complaints Remain knowledgeable and up to date on product changes and developments Answer questions about warranties or terms of sale Inform customer of deals and promotions Continuously evaluate and identify opportunities to drive process improvements that positively impact the customer's experience Work with customer service manager to ensure proper customer service is being delivered Implement suggestions based on customer feedback (e.g. product enhancements, web site improvements) Perform other related duties as assigned Knowledge, Skills and Abilities: Excellent written and oral communication skills Should have experience of international voice process Proficient in MS Office, specifically Excel, Word and Outlook Excellent customer relationship skills Flexible to work in US shift timings Able to perform basic mathematical calculations Self-motivated, with high energy and an engaging level of enthusiasm Organized with an ability to know reseller activities and status on an ongoing basis Ability to read and interpret documents such as procedure manuals, work instructions, software manuals Strong problem identification and resolution skills Able to build and maintain lasting relationships with customers High level of integrity and work ethic Working knowledge of Kerridge / K8 will be an added advantage Minimum Qualifications: Graduate in any stream 2 - 5 years of work experience in a customer service capacity Strong knowledge of retail and/or wholesale sales principles, methods, practices, and techniques EOE: We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. Key Skills: Communication Skills, Customer Relationship, MS Office, MS Office, Outlook, Mathematical Analysis

Education: Graduation Mandatory Role & responsibilities: Looking for Assistant Manager (US Healthcare) with good experience at provider side & MediClaims. Should have good team management experience Good communication skills Good experience in healthcare Shift details: US Shifts

Responsibilities: Prepare ILAs, Final Survey Reports, and requirement letters Maintain records of claim intimation, surveyor visits, documents, and reports Follow up with insured/internal teams to reduce TAT Enter claims data into CMS software Provident fund Health insurance

Job Summary We are seeking a skilled professional with 3 to 5 years of experience in the Life and Annuity domain for the role of SPE-Ins Claims. The candidate will work from our office during night shifts focusing on claims processing and analysis. This role requires a strong understanding of Life and Annuities Insurance to ensure accurate and efficient claims management contributing to the companys success and customer satisfaction. Responsibilities Analyze and process insurance claims in the Life and Annuity domain to ensure timely and accurate resolution. Collaborate with team members to identify and resolve discrepancies in claims documentation. Utilize domain knowledge to enhance the efficiency of claims processing and improve customer satisfaction. Maintain up-to-date records of claims and ensure compliance with company policies and industry regulations. Provide insights and recommendations to improve claims processing workflows and reduce processing times. Communicate effectively with internal and external stakeholders to facilitate smooth claims handling. Monitor claims trends and provide reports to management for strategic decision-making. Ensure adherence to quality standards and regulatory requirements in all claims processing activities. Support the development and implementation of new claims processing tools and technologies. Participate in training sessions to stay updated with industry trends and best practices. Assist in the preparation of claims-related documentation and reports for audits and reviews. Contribute to team meetings and discussions to share knowledge and improve processes. Engage in continuous learning to enhance domain expertise and professional growth. Qualifications Possess strong analytical skills and attention to detail for accurate claims processing. Demonstrate excellent communication skills for effective stakeholder interactions. Have a solid understanding of Life and Annuities Insurance to apply domain knowledge effectively. Show proficiency in using claims processing software and tools. Exhibit problem-solving abilities to address and resolve claims issues efficiently. Display a commitment to maintaining high-quality standards and compliance with regulations. Be open to working night shifts and adapting to a dynamic work environment. Certifications Required Certified Life and Health Insurance Specialist (CLHIS) or equivalent certification in Life and Annuities.

Responsibilities: Process and review Life insurance claims, ensuring adherence to company policies and guidelines. Verify claim documentation, including Death certificate , Employment details, medical records to rule out cause of death and co-morbidities, PMR, FIR , and other supporting documents. Examine insurance applications and documents to ensure accuracy. Communicate with claimants to obtain necessary information and explain the claim process. Assess the validity and coverage of claims, determining eligibility for reimbursement or settlement. Collaborate with claimants, insurance agents, and medical professionals to gather necessary information and resolve any claim-related queries or issues. Keep claim files organized, documenting all actions and decisions. Decision-Making: Determine claim payouts by verifying coverage and assessing the insurance policy. Collaborate with internal teams, such as underwriters and legal departments, to evaluate complex claims and ensure compliance with regulatory requirements. Keep up-to-date with insurance industry trends, policies, and regulations related to Life insurance claims. Requirements: DOCTORS Preferable. Degree in BMS/BAHMS/MBBS, etc (medical background) Previous experience in Life claims processing or a similar role within the insurance industry. In-depth knowledge of insurance principles, policies, and procedures, specifically related to Life Term insurance. Strong understanding of Life claim processing and settlement methodologies. Excellent analytical and problem-solving skills, with the ability to make sound decisions regarding claim eligibility and coverage. Attention to detail and accuracy in reviewing and processing claim documentation. Exceptional communication skills to interact effectively with claimants, insurance agents, and internal stakeholders. Proficient in using relevant software applications and tools for claim processing and record-keeping. Ability to work independently, manage multiple tasks, and prioritize workload effectively. Familiarity with regulatory guidelines and compliance requirements related to Life insurance claims. In addition to the above requirements, as an executive-level profile, the ideal candidate should also possess: Leadership skills to oversee and mentor a team of claims processors. Proven experience in managing and optimizing claims processing workflows. Strong problem-solving and decision-making abilities, particularly in complex or high-value claim scenarios. Excellent interpersonal skills to collaborate with senior management, stakeholders, and external partners. Demonstrated ability to analyze data, generate reports, and present findings to senior executives. Knowledge of strategic planning and business development concepts within the insurance industry.

Job Description Coordinate with patients, insurance companies, and internal departments for smooth processing of cashless claims. Facilitate timely pre-authorization approvals and ensure all required documents are submitted. Maintain records of all TPA communications and claim documents. Handle queries from patients and their attendants regarding insurance claims. Follow up with TPAs/insurance companies for pending approvals and payments. Reconcile TPA receivables and ensure timely payment posting and recovery. Assist the billing team in preparing final bills for insured patients. Ensure compliance with hospital policies and insurance guidelines. Regularly update TPA software and internal MIS systems with accurate information. Required Candidate Profile: Any Graduate with 14 years of experience in hospital insurance. Pleasant personality with good communication and interpersonal skills. Basic computer proficiency and familiarity with hospital billing/TPA processes. Ability to work in a fast-paced hospital environment. Interested candidates please forward your resume to the below mentioned contact number Thanks & Regards, HR Team- 7299052617. Miot International.

Hiring for AR caller profile for One of the leading MNC's. Required 12 months of experience in AR follow-up for US healthcare. Salary Up-to 45K In-hand Saturday Sunday Fix Off Both side Cabs To Apply, Call or WhatsApp CV on ANISHA - 9354076916 Required Candidate profile 1. Minimum 12 months of experience in AR Calling. 2. Excellent communication skills, both verbal and written. 3. Familiarity with medical billing and Denial Management. Perks and benefits Both side Cabs, Meals and Medical Insurance.

Immeadiate joiners preferred AR caller Experience - 1- 4years location - Chennai, Trichy salary - 20000 - 40000 per month contact - 7904990032 *4- 8 months of gaps accepted

Managing office administration assets and upkeep of the same. Agents Contracting New Business Processing Banking of Initial & Renewal Premium Managing Petty cash & vendor payments Retention of Surrender Requests Execution of all Service Requests - Post Policy Issuance Reverting on customer queries and complaints Maintaining high NPS Scores Life and Health Claims processing Handling compliance issues Audit Rating Preferred candidate profile Graduate / Post-Graduate in any discipline. 2-3 years experience handling front end customer services Knowledge of service quality is required Language's required Malayalam Tamil English

Managing office administration assets and upkeep of the same. Agents Contracting New Business Processing Banking of Initial & Renewal Premium Managing Petty cash & vendor payments Retention of Surrender Requests Execution of all Service Requests - Post Policy Issuance Reverting on customer queries and complaints Maintaining high NPS Scores Life and Health Claims processing Handling compliance issues Audit Rating Preferred candidate profile Graduate / Post-Graduate in any discipline. 2-3 years experience handling front end customer services Knowledge of service quality is required Language's required Malayalam Tamil English

Managing office administration assets and upkeep of the same. Agents Contracting New Business Processing Banking of Initial & Renewal Premium Managing Petty cash & vendor payments Retention of Surrender Requests Execution of all Service Requests - Post Policy Issuance Reverting on customer queries and complaints Maintaining high NPS Scores Life and Health Claims processing Handling compliance issues Audit Rating Preferred candidate profile Graduate / Post-Graduate in any discipline. 2-3 years experience handling front end customer services Knowledge of service quality is required

Managing office administration assets and upkeep of the same. Agents Contracting New Business Processing Banking of Initial & Renewal Premium Managing Petty cash & vendor payments Retention of Surrender Requests Execution of all Service Requests - Post Policy Issuance Reverting on customer queries and complaints Maintaining high NPS Scores Life and Health Claims processing Handling compliance issues Audit Rating Preferred candidate profile Graduate / Post-Graduate in any discipline. 2-3 years experience handling front end customer services Knowledge of service quality is required

Key Responsibilities: Hands-on management of end-to-end Revenue Cycle Management activities with both commercial and federal payors. Mentor and guide associates on QA guidelines, software navigation, new product features, and quality administration. Develop and implement employee schedules to align with forecasted operational demands. Conduct weekly staff meetings to motivate teams, review performance, and address concerns. Monitor and ensure achievement of daily targets, KPIs (Quality, SLA), and overall client metrics. Identify process improvement areas, drive efficiency, and implement customer-impacting projects. Collaborate with Quality, Training, and other stakeholders for seamless delivery as per SOW requirements. Conduct performance reviews, KRA delivery tracking, and feedback mechanisms. Set up, monitor, and improve internal processes related to transactional quality, training, and target achievement. Develop metrics and reporting systems to monitor quality performance and highlight areas of improvement. Take ownership of escalation management, including root cause analysis and preventive action planning. Lead and supervise a team of process analysts, ensuring motivation and productivity. Required Skills and Experience: Proven experience in Denial Management and AR follow-up. Strong knowledge of RCM processes and guidelines. Prior experience in managing or training freshers in accordance with client-set guidelines. Excellent communication and organizational skills. Proficient in Windows OS and application troubleshooting. Demonstrated ability to work independently and with minimum supervision. Strong analytical skills and a proactive approach to problem-solving. Experience with developing and leading process improvement initiatives. Capable of aligning team performance with client and internal goals. Knowledge of quality frameworks and tools for performance monitoring. Preferred Qualifications: Bachelors Degree or equivalent in a relevant field. Minimum 5-8 years of relevant work experience, with at least 2-4 years in a leadership or mentoring role. Familiarity with client metrics and delivery expectations in BPO or healthcare support environments.

Job Description for Freshers Position: US Healthcare Trainee claim processing Executive Location: Saidapet-old no.21 new no. 41,3rd FLOOR,VLV COMPLEX,MOUNT , Chennai, Tamilnadu, India Experience: Freshers (Graduates from 2024- 2025) Only Freshers Job Description: Verify insurance eligibility by checking through insurance websites Charge entry and submit claims. Post payment from both insurance companies and patients Meet quality and productivity benchmarks. Maintain confidentiality and adhere to healthcare compliance standards. Key Requirements: Graduate in any discipline (2024-2025). Excellent verbal and written communication skills. Basic understanding of US healthcare processes (preferred but not mandatory). Quick learner with attention to detail. Send your Resume in WhatsApp: HR @7358188804