2028 Claims Processing Jobs - Page 31

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 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 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 dataDevelop and deliver 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 Communication SkillsTeamwork & CollaborationProblem-Solving & Critical ThinkingAdaptability & Willingness to LearnTime Management & Organization 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

Role & responsibilities • To be responsible for maintaining TPA Processing of cashless and all post discharge health insurance claims. • To be responsible to maintain overall TAT entry to exit. • TPA query reply and preauthorisation follow up with insurance company / tpa. • Medical scrutiny and medical opinion for health insurance claims. • Efficient in claim adjudication and claim processing. • Maintaining and ensuring Standard Operating Procedures and protocols. • To be responsible for keeping record for all correspondence done for TPA. • Post discharge reconciliation for utilization of claims. • Timely reply to internal TPA complaint portal. • TPA discharge follow up and closure. • Mmaintenance of departmental records as per the NABH requirement. • Effective utilization of hospital information system, MIS generation of TPA patients. • To display proactive cooperation and contribute to cordial inter and intra team relations, solution orientation and team solidarity. Should be cost effective. • To participate in training programs to maintain and update your professional knowledge. • To achieve high levels of customer satisfaction at each interaction. • Any task assigned to you by your HOD from time to time. Preferred candidate profile Accuracy in invoicing / billing • Demonstrated ability to maintain confidentiality • Service Excellence • Active participation in all departmental training and development activities. • Active participation in Inventory Management. Min 2 Years of relevant experience in TPA Must be Graduate

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 admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only Pune address: C-Wing, First Floor, Manikchand Icon, Balkrishna Sakharam Dhole Patil Rd, Sangamvadi, Pune, Maharashtra 411001 Mumbai address: 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to WhatsApp to 9632777628

Degree/Diploma in Mechanical, Electrical, Electronics Engineering claim documents, images, videos, technical reports submitted by field engineers clients Interact with clients insured parties, brokers, email clarify loss details and resolve queries

Role & responsibilities : Manage end to end transactional and administration activities of insurance processes. Perform data entry and research in various systems and tracking tools. WFO/WFH - Work from Office (WFO) Work Timings 5:30 PM to 3 AM Job Description – Insurance associate, able to read, understand, apply and write basic English, MS office knowledge would be an added advantage, keyboard typing skills is mandatory. Preferred candidate profile

Focuses on resolving outstanding medical claims by contacting insurance companies and patients, ensuring timely payments and minimizing financial losses for healthcare and maintaining accurate records. Only Experience candidate in same field apply

Book your interview slot WhatsApp your profile @ 9623462146 / 7391077622 or Dipika@infiniteshr.com ******Hiring for P & C Insurance Team Manager / Sr TM , Salary upto 14.00L*** ****Hiring Team Manager Insurance process**** Salary upto 10 LPA Exp: 6 to 15 Yrs Salary : Upto 14 Lacs Regards Dipika Sharma 9623462146 7391077622 8888850831

As a Cluster Relationship Manager at Niva Bupa Health Insurance Company, your role is crucial in identifying opportunities for improvement across customer service, underwriting, and claims processes. You will be responsible for ensuring a robust Management Information System (MIS) architecture for both pre-sales and post-sales activities. Collaborating with the operational team, you will co-create and implement strategies aligned with the distribution strategy of the company. Your key responsibilities include building relationships in the region, reviewing performance periodically, and engaging with partners to establish operational specifications. By monitoring operations and recommending product strategies, you will contribute to revenue growth and profitability. Additionally, you will work closely with the regional team members to develop a common agenda and scorecard, ensuring alignment with the overall business plan. Interacting with key management members and partners, you will oversee business reviews, address deviations from the plan, and handle escalated issues to ensure smooth operations and continuous improvement in revenue generation. Your role will also involve suggesting reward and recognition platforms for bank partners" employees and leading the implementation of sales promotions to maximize marketing spends. Furthermore, you will collaborate with the training department to deploy programs, identify trainers, and deliver training to build the capacity of the sales force in the region. Your focus will also include recruitment and retention planning, implementing rewards and recognition activities, and coaching subordinates to develop a robust sales force and achieve potential sales targets. Key performance indicators for this role include Gross Written Premium (GWP) for new and renewal business, compliance, audit adherence, and claim management. The ideal candidate for this position should hold a graduate or postgraduate degree, preferably an MBA, and have 6-8 years of experience in Life Insurance, General Insurance (Bancassurance only), Relationship Management, or Investment & Wealth Advisory within the banking sector. Join us at Niva Bupa Health Insurance Company and be a part of our exciting growth journey towards achieving more than 10000 Cr GWP by 2027. As a certified Great Place to Work, we are committed to creating a collaborative and innovative work environment where you can contribute to the success of the company while developing your skills and expertise.,

About Client Hiring for one of the most prestigious multinational corporations !!! Job Title : AR Caller Denial Management Qualification : Any Graduate and Undergraduate Relevant Experience : 1 to 3 Years Must Have Skills : 1. Experience as an AR Caller in Denial Management. 2. Good understanding of denial reasons (CO, OA, PR codes) and appeal processes. 3. Familiarity with healthcare insurance terminology, CPT/ICD coding basics. 4. Strong analytical and problem-solving skills. 5. Excellent communication skills (both verbal and written). 6. Proficiency in working with RCM software/tools like EPIC, Athena, eClinicalWorks, etc. 7. Typing speed of at least 30 WPM with accuracy. 8. Ability to multitask and meet deadlines under pressure. Good Have Skills : Knowledge and expertise AR Caller in Denial Management. Roles and Responsibilities : 1. Review and analyze insurance claim denials from payers. 2. Make outbound calls to insurance companies to resolve denied or unpaid claims. 3. Identify the root cause of denials (e.g., coding errors, eligibility issues, authorization lapses). 4. Take appropriate actions such as appeal filing, claim corrections, or rebilling. 5. Document all activities accurately in the client system or internal tools. 6. Follow-up on pending claims within the specified TAT. 7. Communicate effectively with insurance representatives and escalate complex issues when needed. 8. Work collaboratively with internal teams (coding, billing) to resolve denial trends. 9. Stay updated with payer-specific guidelines and industry regulations (HIPAA compliance). Location : Bangalore CTC Range : 3 to 4.8 LPA (Lakhs Per Annum) Notice Period : Immediate Mode of Interview : Virtual Shift Timing : Night Shift Mode of Work : Work From Office -- Thanks & Regards, Amala Subject Matter Expert Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432406 amala@blackwhite.in | www.blackwhite.in

Skills: Guidewire Architect/Developer(Policy + claim) Guidewire Architect Experience: 15-20 Years Guidewire Developer Experience: 5-11 Years Location: Pune, Bengaluru, Noida, Gurugram Looking for immediate to 30 Days notice period candidates.

Design, develop,& maintain automated test scripts for Guidewire applications (PolicyCenter, BillingCenter, ClaimCenter) using appropriate automation tools. Build & enhance the existing test automation framework to improve efficiency and reusability. Required Candidate profile Write clear &concise test cases,Develop & execute test plans, test cases, and test scripts for functional, regression, and performance testing. Java, Python, or C# for test automation scripting,QA

About Company Injala is a leading enterprise software company revolutionizing the insurance industry with our cutting-edge technology solutions. As a multi-national corporation headquartered in Dallas, USA, and with a significant presence in India, we are committed to transforming risk management through innovative software. Our growth trajectory has been impressive, achieving 30+% annual growth for the last five years. Company Website : https://www.injala.com / We are looking for a detail-oriented and proactive Client Service Specialist to support our administrative and operational activities. This internship offers hands-on experience in office management, coordination, and day-to-day business support functions in a professional corporate environment. Responsibilities: Assist in managing business documentation related to insurance, finance, or legal sectors. Work closely with senior team members to learn and support business processes and client interactions. Handle customer support inquiries and provide assistance as needed. Support the team in managing software systems for business process operations. Use Microsoft Office tools such as Word, Excel, and PowerPoint to create reports, presentations, and documentation. Participate in training sessions to improve knowledge of business processes and BPO operations. Requirements: Basic understanding or interest in administrative operations and business support services. Familiarity with Microsoft Office tools Word, Excel, Outlook, and PowerPoint. Good written and verbal communication skills in English. Ability to handle documentation, coordination, and follow-up tasks effectively. Prior internship or part-time work experience in admin, operations, or customer support is a plus. Benefits: Open Door working culture Recognition and rewards Festival and team celebrations Flexible work timings No Sandwich Leave Policy Referral Bonus Program Medical Insurance.

Fairmont Hotels & Resorts is looking for Finance Associate (Fresher) - Navi Mumbai to join our dynamic team and embark on a rewarding career journey Assisting with the preparation of operating budgets, financial statements, and reports Processing requisition and other business forms, checking account balances, and approving purchases Advising other departments on best practices related to fiscal procedures Managing account records, issuing invoices, and handling payments Collaborating with internal departments to reconcile any accounting discrepancies Analyzing financial data and assisting with audits, reviews, and tax preparations Updating financial spreadsheets and reports with the latest available data Reviewing existing financial policies and procedures to ensure regulatory compliance Providing assistance with payroll administration Keeping records and documenting financial processes Excellent collaboration and communication skills

Roles and Responsibilities Handle claims from intake to settlement, ensuring timely processing and quality service delivery. Conduct thorough investigations into insurance claims, gathering relevant evidence and interviewing witnesses as needed. Analyze complex data sets to identify trends, patterns, and areas for improvement in claims processing. Desired Candidate Profile Strong understanding of US healthcare industry regulations and practices. Excellent analytical skills for conducting thorough investigations into complex cases. Ability to work effectively under pressure to meet tight deadlines while maintaining high-quality output.

""" 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. """

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.

Company: Marsh Description: Ensures timely and accurate production/processing of complex documents/information (includes report preparation) Maintains a basic understanding of the core aspects of relevant Insurance and related legislation (customer awareness) and strengthen established relationships Adheres to Company policies and performance standards Contributes to the achievement of Operations team Service Level Agreements (SLA) , Key Performance Indicators (KPI) and business objectives Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age, background, caste, disability, ethnic origin, family duties, gender orientation or expression, gender reassignment, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law. Marsh McLennan is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one anchor day per week on which their full team will be together in person.

Company: Marsh Description: Position Overview: We are seeking a dedicated and detail-oriented Claim Servicing Executive to join our Employee Benefits team in Marsh India. The ideal candidate will be responsible for managing and servicing claims related to employee benefits, ensuring a seamless experience for our clients and their employees. This role requires strong communication skills, a customer-centric approach, and the ability to work collaboratively within a team. Key Responsibilities: Claims Management: Process and manage employee benefits claims efficiently and accurately. Review and assess claims documentation to ensure compliance with policy terms and conditions. Liaise with clients, insurance providers, and internal teams to resolve claims-related inquiries and issues. Client Communication: Serve as the primary point of contact for clients regarding claims inquiries and updates. Provide timely and clear communication to clients about the status of their claims. Educate clients on the claims process and employee benefits policies. Documentation and Reporting: Maintain accurate records of all claims transactions and communications. Prepare and submit reports on claims activity and trends to management. Ensure all documentation is compliant with regulatory requirements and company policies. Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age, background, caste, disability, ethnic origin, family duties, gender orientation or expression, gender reassignment, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, or any other characteristic protected by applicable law. Marsh McLennan is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh McLennan colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one anchor day per week on which their full team will be together in person.

Guidewire PC Configuration Job Description: - 5 to 15 Years of Guidewire experience - GW Configuration Development Experience. - Experience in GW Configuration Development (GOSU, Rules Engine, Data Model, PCF, Workflow, Product Model development) - Exposure and experience using Design Patterns and Enterprise Integration patterns - Experience with XML Parsing, Junit, SoapUI, Maven, Jenkins, GIT/Subversion/TFS, Code Coverage and Code Scan Plugin/Tools. - Experience with Application Servers like WebSphere, WebLogic, JBoss and/or Tomcat - Experience with Database Servers like SQL Server, Oracle - Good communication skills - Insurance Industry and Domain Knowledge Roles & Responsibilities - Work closely with clients and team members to understand and identify issues with integration design. - Assist, Prepare/Enhance Detailed Design Documentation for integrations using UML Notations - Build/Develop GW Configuration components in support of Integration (Using GOSU, Rules Engine, Data Model, PCF, Workflow, Product Model etc.) - Unit and Functional Test developed Configuration and Integration Solutions using GUnit, Mockito - Automated and SoapUI - Manual. - Configure and Develop screens using Guidewire Studio - Develop Business Rules and Business Logic in GOSU - Debug and resolve issues in a fast-paced environment

Guidewire Tester with ACE Certification

About The Role Design, develop, and configure Policy Center, Claim Center, and Billing Center applications in Guidewire. Customize Guidewire applications to meet specific business needs, including creating and modifying workflows, rules, and integrations. Develop and maintain integrations between Guidewire applications and other systems using APIs and web services. Develop and execute test plans, perform unit testing, and ensure the quality of the solutions delivered. Provide ongoing support and troubleshooting for Guidewire applications, addressing any issues that arise in production. Create and maintain technical documentation, including design specifications, user guides, and process flows. Work closely with business analysts, project managers, and other stakeholders to gather requirements and ensure alignment with business objectives. Works in the area of Software Engineering, which encompasses the development, maintenance and optimization of software solutions/applications.1. Applies scientific methods to analyse and solve software engineering problems.2. He/she is responsible for the development and application of software engineering practice and knowledge, in research, design, development and maintenance.3. His/her work requires the exercise of original thought and judgement and the ability to supervise the technical and administrative work of other software engineers.4. The software engineer builds skills and expertise of his/her software engineering discipline to reach standard software engineer skills expectations for the applicable role, as defined in Professional Communities.5. The software engineer collaborates and acts as team player with other software engineers and stakeholders. Primary Skills Extensive experience with configuring and improving Policy Center, including workflows, rules, and integration points. Proficiency in developing and configuring Claim Center, including claim processing and integration with external systems. Strong background in Billing Center configuration and customization, including payment processing and billing rules. Expertise in using Guidewire Studio for application development and debugging.

- Grade Specific Guidewire Developer guidewire Policy integration /guidewire Policy configuration OR guidewire billing integration / guidewire billing configuration OR guidewire claims integration /guidewire claims configuration OR PC/CC/BC/Integration/Configuration PCPolicyCenter CCClaimCenter BCBillingCenter About The Role Guidewire Developer guidewire Policy integration /guidewire Policy configuration OR guidewire billing integration / guidewire billing configuration OR guidewire claims integration /guidewire claims configuration OR PC/CC/BC/Integration/Configuration PCPolicyCenter CCClaimCenter BCBillingCenter Skills (competencies) (SDLC) Methodology Verbal Communication Inclusive Communication Written Communication Policy Development

Role & responsibilities Good knowledge in Claims Adjudication - US healthcare With Basic Competency Level: 1. Excellent interpersonal skills 2. Ability to understand and interpret policy provisions. 3. Product knowledge 4. Typing Skills 5. Problem Solving Skills Education, Experience and Flexibility: Under-Graduate or Any Graduate Minimum of 1 2 years of Customer Service experience. Flexible to work in US Shifts with rotational week offs. Preferred candidate profile pls share your CV to nishidha.kumar@sagilityhealth.com

START YOUR CAREER AS FRESHERS INTO AR MEDICAL BILLING???? !!Hiring for Medical Billing! !???????? Telephonic interviews Location : AIROLI & SAKINAKA Salary: 13.2k +5k incentives (Freshers) ???? Upto 15k-17k+5k incentives (Min 6 Months Bpo/Non Bpo Domestic Exp) ???? Hsc/Graduate freshers can apply Experience into BPO can apply Night shifts With cab facility.... Sat and Sun fixed off???? ??CONTACT?? HR SHUBHADA 7710015943 Great Opportunity For international Medical biling Experience

About Client Hiring for one of the most prestigious multinational corporations !!! Job Title : AR Caller Denial Management Qualification : Any Graduate and Undergraduate Relevant Experience : 1 to 3 Years Must Have Skills : 1. Experience as an AR Caller in Denial Management. 2. Good understanding of denial reasons (CO, OA, PR codes) and appeal processes. 3. Familiarity with healthcare insurance terminology, CPT/ICD coding basics. 4. Strong analytical and problem-solving skills. 5. Excellent communication skills (both verbal and written). 6. Proficiency in working with RCM software/tools like EPIC, Athena, eClinicalWorks, etc. 7. Typing speed of at least 30 WPM with accuracy. 8. Ability to multitask and meet deadlines under pressure. Good Have Skills : Knowledge and expertise AR Caller in Denial Management. Roles and Responsibilities : 1. Review and analyze insurance claim denials from payers. 2. Make outbound calls to insurance companies to resolve denied or unpaid claims. 3. Identify the root cause of denials (e.g., coding errors, eligibility issues, authorization lapses). 4. Take appropriate actions such as appeal filing, claim corrections, or rebilling. 5. Document all activities accurately in the client system or internal tools. 6. Follow-up on pending claims within the specified TAT. 7. Communicate effectively with insurance representatives and escalate complex issues when needed. 8. Work collaboratively with internal teams (coding, billing) to resolve denial trends. 9. Stay updated with payer-specific guidelines and industry regulations (HIPAA compliance). Location : Bangalore CTC Range : 3 to 4.8 LPA (Lakhs Per Annum) Notice Period : Immediate Mode of Interview : Virtual Shift Timing : Night Shift Mode of Work : Work From Office -- Thanks & Regards, Amulya G HR Analyst Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432435/Whatsapp @6366979339 amulya.g@blackwhite.in | www.blackwhite.in