2028 Claims Processing Jobs - Page 33

Analyst responsible for performing activities involved in the workflow of Reconciliation process. Ensure reconciled NAV accounts in a timely and accurate manner, reported outstanding breaks to the relevant parties as per agreed format and timelines, and communicated with Fund Accountant, client and other custodies on a daily basis Reconcile all funds on a daily basis. Research and query resolution in relation to outstanding reconciliation items, liaising with other departments and external parties Report on reconciliation items, providing detailed analysis of outstanding items. Hands on experience in using Bloomberg/Telekurs. Report on bank fees and interest charges, verifying and processing claims and quarterly trailer fee reconciliation. Interact have regular communication with on-site partners for clarifications. Ensure adherence to defined procedures. Ensure adherence to time schedules quality standards. Proactive identification and improving current core procedures. Deliver training /coaching effectively to the new joiners. Support the general principal, department leader and other team leaders to achieve stated objectives. Work closely with superiors on various projects. Respond promptly effectively to client requests. Preparing backup plan for the process. Adhere effective escalation matrix on anomaly/deviation in the process. Trouble shooting and root cause analysis

To lead and manage the claims operations by ensuring timely, fair, and compliant claim settlements, optimizing processes for efficiency, and supporting strategic goals through data-driven decision-making and cross-functional collaboration Ensure timely and accurate settlement of claims within defined turnaround times (TATs) Maintain adherence to IRDAI regulations and internal claims policies Identify and mitigate fraudulent claims through effective investigation and controls Enhance claimant experience through transparent communication and service excellence Lead, mentor, and upskill the claims team to improve performance and accountability Optimize claim payouts and reduce leakage through data-driven decision-making Collaborate with cross functional teams for complex claim resolutions Timely and accurate claim settlements to avoid interest penalties Detection and prevention of fraudulent claims to reduce financial loss Accurate payout calculations aligned with policy terms Reduction in claim rework or overpayments Minimal customer complaints or escalations Timely and empathetic communication with beneficiaries Clear guidance provided throughout the claim process Claims processed within defined turnaround time (TAT) 100% compliance with regulatory and internal audit standard Effective coordination with legal and other departments Accurate and complete documentation for each claim Contributions to process improvement initiatives

HIRING FOR US HEALTHCARE, GRAD CANDS WITH 1 YEAR EXP WITH KNOWLEDGE OF CLAIMS, CASH POSTING, AR FOLLOW UPS, DENIAL MANAGEMENT, INSURANCE CAN APPLY SAL UPTO 46K INHAND VOICE GGN CALL/WHATSAPP SAHIB 8448577782 KOMAL 9811399344 MANKIRAT 9811395705 Required Candidate profile FINE TO WORK IN 24x7 Shifts LOOKING FOR CANDS HAVING GOOD COMMS SKILLS, CABS AND SHIFTS AS PER THE COMPANY REFRENCES ARE HIGHLY VALUABLE, SHARE YOUR PROFILE - hr@head-hunters.in Perks and benefits SHIFTS, CABS, INCENTIVES AS PER THE COMPANY REQ.

# Location- Ahmedabad # Shift Timing: US Shift (Night Shift) # Facilities - Cab Facilities # 5-day work week # Saturday and Sunday are fixed off # Experienced from upto 2 years in AR calling or healthcare

Job Title: Business Analyst (Candidate must have experience in to US Healthcare Domain Adjudication System) Job Summary: We are seeking a motivated and detail-oriented Business Analyst with 3+ years of experience, preferably in the US healthcare domain , to join our dynamic team in Pune. This is a full-time, on-site position ideal for someone who thrives in a collaborative environment and is passionate about driving process improvement and delivering value through data-driven insights. The ideal candidate will work closely with cross-functional teams including operations, technology, and client stakeholders to understand business needs, analyze processes, and contribute to high-impact healthcare solutions. Key Responsibilities: Collaborate with stakeholders to gather, analyze, and document business requirements. Translate business needs into functional specifications for technical teams. Analyze healthcare claims, eligibility, and enrollment data to identify patterns and opportunities. Support project delivery by coordinating with development QA and configuration teams. Participate in client meetings, requirement walkthroughs, and status updates. Develop and maintain process documentation, user stories, workflow diagrams etc. Assist in UAT planning, execution, and issue tracking. Continuously monitor industry trends and regulatory changes in US healthcare. Mandatory Requirements: 3+ years of experience as a Business Analyst, with a strong understanding of US healthcare processes . Hands-on experience working with claims, eligibility, EDI 837/835/270/271 or other healthcare-related data sets. Experience in requirement elicitation , documentation , and business process mapping . Proven ability to work independently and in a team environment. Willingness to work from the Pune office on a full-time basis. Required Skills: Strong analytical and problem-solving skills. Proficiency in tools such as MS Excel, Visio , MS Word or similar. Excellent written and verbal communication skills. Attention to detail with strong organizational skills. Understanding of Agile/Scrum methodologies . Preferred Qualifications: Bachelor's degree in Computer science, IT, Healthcare Management, Information Systems, or a related field. Experience with HIPAA regulations , healthcare compliance, or payer-provider workflows. Exposure to reporting tools is a plus. Certification in Business Analysis (e.g., CBAP, CCBA) or Healthcare IT (e.g., CPHIMS) is a plus.

Key Roles : Ensure accurate documentation and timely claim settlement Follow up with TPA and Govt. bodies for approvals/payments Strong knowledge of Govt. healthcare panels (ECHS, CGHS, ESIC, etc.) Experience in hospital billing & claim processing Annual bonus Provident fund Health insurance

Managing CGHS, ECHS, CAPF and Ayushman Bharat Government Portals: Claim Processing Audit Uploading Query Management Reconciliation and Recovery Management. Annual bonus Provident fund Health insurance

Responsible to ensure quality of service given is equivalent to the set standards. Responsible to maintain payable status at its minimum; close follow up on critical issues. Random checking of bills in terms of their accuracy and make sure the corporate bills are prepared as per the agreements and prompt dispatch of the same with the help of credit cell. Responsible to record department MIS reports and submission of the same to higher authority Responsible to monitor the surgical package limits in terms of material consumption and professional charges. Systems & Procedures: Responsible to design, implement and refine systems to manage processes and to optimize performance. Responsible to develop innovative ideas break through advancements and innovative solutions to problems Should be aware of all the Corporate Tariffs as agreed and ensure an error free billing from our end Should be able to prepare a complete billing kit and transfer the same to the submissions department as per the TAT Liaisoning Responsible to have regular interaction with consultants in regard to the bills and their payments. Responsible to coordinate and maintain good relations with corporate clients, patients, doctors, and public. Feedback to the Management Responsible for providing feedback to the management on customer/ patient requirements/expectations by maintaining constant relation with patients, visiting operational environment; conducting surveys etc.

Job Tile : Claims processing Job Description: Medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility , the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance. With the medical expertise ,need to master the various products and to apply the same during claim processing. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. List of Responsibilities: To validate the authenticity and the credibility of the claims. To coordinate with various persons (Claimant, Treating Physician, Hospital insurance desk, Field Visit Drs, Investigation officers)for hassle-free claim processing . To expertise ,the process of negotiation when necessitated. The claim handler owes a duty of care to the patient, ensuring that their needs are being met and that they re receiving the treatment or medicine they need. Job Qualifications and Requirements: Required Medical Graduates. Adapt and inbuilt the process of communication and coordination across the zones and the supporting verticals accordingly.

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, Thanks & Regards, HR Manasa.S Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432417 |manasa.s@blackwhite.in | www.blackwhite.in ******DO REFER FRIENDS ******

Manage & track productivity of team & ensure health of client's Accounts Receivable Providing management, oversight & assurance that clients' cash collections and AR is in good standing and communication with clients is timely and proactive. Required Candidate profile Atleast 1-year exp. in medical collections in a team lead or supervisory role Well-versed in the details of all levels and functions within the full scope of the Revenue Cycle of US Healthcare.

Scrutiny of medical documents and adjudication Assess the eligibility of medical claims and determine financial outcomes. Ideinform the concerned department. Determine accuracy of medical documents Required Candidate profile Job Profile : Medical Officer Qualification : BHMS, BAMS, BDS Industry : Health Care Experience: 0 to 2 year Exp

Role Overview: We are seeking a Quality Analyst in the US Healthcare domain (RCM). While youll begin performing QA responsibilities from Day 1, the official designation will be confirmed after 6 months based on performance and company policies. Key Responsibilities: Monitor and evaluate calls, claims, and transactions for adherence to RCM quality standards. Conduct regular audits and provide actionable feedback. Identify process gaps and recommend improvement strategies. Collaborate with operations to meet client and compliance standards. Generate detailed quality reports and insights. Support training and mentoring initiatives to uplift overall quality metrics. Required Skills & Qualifications: Minimum 1 year of experience in US Healthcare RCM . Strong understanding of medical billing, coding , and claims processing . Proven analytical and problem-solving abilities. Effective verbal and written communication skills. Hands-on experience in quality audits, reporting, and feedback systems . Ability to thrive in a fast-paced, detail-oriented work environment.

AR Caller - Noida The successful candidate will be responsible for handling and resolving claims, managing account receivables, and ensuring prompt collections in line with US healthcare policies and regulations. Contact:- Jasmine HR (8586072614)

Role & responsibilities Review incoming healthcare claims for accuracy and completeness, ensuring all necessary information is provided for adjudication. Analyze claims data against payer policies and industry regulations to determine eligibility for payment or denial. Communicate effectively with healthcare providers, policyholders, and internal teams to resolve discrepancies or gather additional information. Utilize claims processing systems and software to enter, update, and retrieve claims information accurately. Identify and report any trends or patterns in claims submissions that may indicate potential fraud or abuse. Ensure timely processing of claims to meet internal and external deadlines, maintaining high levels of productivity and accuracy. Collaborate with team members to improve claims adjudication processes and contribute to departmental goals. Maintain up-to-date knowledge of healthcare regulations, payer policies, and industry best practices through ongoing training and development. Preferred candidate profile 0 to 3 years of experience in healthcare claims adjudication or a related field. Strong analytical and problem-solving skills. Excellent verbal and written communication skills. Proficiency in using claims processing systems and software. Ready to work at night shift

Business Analyst : Healthcare Business Analyst (BA) with functional testing experience and basic SQL knowledge. The ideal candidate will be responsible for interaction with Business team regular and gather requirements , perform User Acceptance Testing (UAT), handling support tickets related to process and feature queries, and assisting in production verification . Timing: Daily availability until 5PM CST (or at least 12PM CST) Quarterly availability until 8PM CST for production deployment verification. Key Responsibilities: Gather and document Requirements from Business team Conduct functional testing and validate healthcare-related processes. Perform basic SQL queries to support testing and data validation. Lead User Acceptance Testing (UAT) and ensure business requirements are met. Manage and resolve support tickets related to processes and feature queries. Collaborate with the team on the Onbase Document Repository Migration project. Provide timely support and troubleshooting for student resource-related issues . Participate in quarterly production deployment verification (availability until 8PM CST). Required Skills & Experience: 3+ years of experience as a Healthcare Business Analyst . Hands-on experience in functional testing and UAT execution . Familiarity with basic SQL queries for data validation. Strong analytical, communication, and problem-solving skills. Ability to handle support tickets efficiently and provide solutions . Role & responsibilities Please share cv on -samiksha.abhijitkasar@wipro.com

Group Manager - UK Operations (Insurance Claims) - Bengaluru Location: Bangalore An exciting opportunity for a seasoned operations leader to head large-scale UK motor insurance claims operations. This role involves managing a 100+ FTE team, driving performance, ensuring regulatory compliance, and leading strategic initiatives in a fast-paced, client-centric environment. Your Future Employer A leading global business process management company known for innovation, analytics, and digital transformation. The organization partners with Fortune 500 clients across sectors including Insurance, Banking, Healthcare, Travel, and more enabling operational excellence and business efficiency. Responsibilities Leading end-to-end operations for UK motor insurance claims with a team of 100+ FTEs. Overseeing Bodily Injury and Motor Claims processes while ensuring SLA and compliance adherence. Managing senior stakeholders and external partners including legal entities and clients. Driving operational performance, capacity planning, and workforce optimization. Leading transformation, automation, and process improvement initiatives. Coaching and mentoring senior team leads and managers for performance excellence. Monitoring KPIs, conducting root-cause analysis, and implementing action plans. Ensuring strict compliance with UK insurance regulations and internal governance frameworks. Requirements Graduate degree in Business Administration, Insurance, or related discipline. 10+ years of experience in operations management within the insurance domain, with at least 3 years in a leadership role managing large teams. Deep expertise in UK motor insurance claims (including bodily injury claims). Strong command over process improvement methodologies, stakeholder management, and digital tools. Excellent interpersonal, analytical, and leadership skills. Proven track record in leading high-performing teams and transformation programs. Whats in it for you? Leadership role with high visibility and decision-making authority. Opportunity to lead strategic projects and drive digital transformation. Exposure to global insurance operations and best practices. Be part of a growth-oriented, innovation-driven environment. Reach us: If this role aligns with your career goals, email your updated resume to vasu.joshi@crescendogroup.in for a confidential discussion. Disclaimer: Crescendo Global specializes in Senior to C-level niche recruitment. We are committed to enabling job seekers and employers with a professional and equitable recruitment experience. Scam Alert: We never charge fees or request purchases. Please visit our verified jobs at www.crescendo-global.com . Keywords: Group Manager Jobs, UK Insurance Operations, Motor Claims, Bodily Injury Claims, Large Team Management, Claims Transformation, Client Engagement, Process Excellence, Insurance BPM Jobs, SLA & Compliance Management.

Hiring for a Record Retrieval Specialist #Shift-Us Shift Timing #Location: Ahmedabad, Gujarat #Freshers can apply # Minimum 6 months of Experience Required in the Intl Voice process(for hike) #Fluent English Required Meal Facility is also available

Walkin : Mon to Sat between 11am to 3pm - Siruseri Unit Job Title: Insurance Co-ordinator Role & responsibilities: List out the total Number Of credit patients (All Insurance). To send the Pre- Authorization form to the concern insurance company. Explain the Admission & Discharge procedure to the patient & attenders also. All data's and activities should be computerized. Watch the approval status and query reply to be update shortly. To Proper communication about the patient Admission, Approval, Enhancement procedure, Discharge, Payment, and cancellation process. The most common job duties for a health unit coordinator are clerical tasks like answering phones and processing paperwork, including discharge, transfer, and admittance forms. Health unit coordinators also often act as a liaison between patients, nurses, doctors, and different departments within the hospital or care facility. Other tasks can include scheduling procedures like tests and x-rays, transcribing doctors' orders, and ordering medical and office supplies. Health unit coordinators are a part of a broader medical team, and are expected to keep pace with the potentially hurried and stressful environments in which they work. Heath care coordinators work closely with patients on a one-on-one basis. They provide guidance, support, and advice to patients dealing with complex medical issues. These professionals can help their clients navigate through a medical care scenario that may involve a variety of different doctors and treatment methods. Duties can include scheduling appointments, assisting with major decisions, helping patients understand complex medical information, evaluating care quality, and working with other health care professionals to ensure that the correct path is being taken. To Properly Intimate the consultants about credit limits. To make sure the Surgery details, Summary follow ups with consultants. To maintain the good rapport with consultants. Follow ups for consultant Payments. Reporting to Head of the department. Job Title: Executive - Credit Recovery Role & responsibilities: Marking Despatch details & updating claim details in KMH Internals Combinedly doing OS reconciliations as required with TPA/Corporates Sending out monthly OS statements / letters to TPA. / Corporates as may be agreed from timeline Marking Despatch details & updating claim details in KMH Internals Delivering Doctor's cheque with in time line Receiving acknowledgements for cheques submission from doctor & closing the entry in KMH DERN Collecting our Hospital other unit bills & submitting at agreed corporates. Follow up with TPA/Corporates for refund of collectible disallowance Regular follow up for renewing for MOU with TPA/Corporates Submitting Hospital Revised Tariff list to TPA / Insurance Reporting to Senior Officer - Credit Recovery Preferred candidate profile: Any Degree Holder (UG/PG Arts & Science) A minimum of 2 to 10 years of experience in Insurance. Working knowledge of Insurance standards Proficient in Microsoft Office. Strong attention to details. Perks and benefits: ESI, EPF Gratuity Contact person: Naveenkumar - HR - omrhr@drkmh.com

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, Thanks & Regards, HR Deekshitha Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432405| deekshitha@blackwhite.in | www.blackwhite.in ******DO REFER FRIENDS ******

Hiring Clinical Doctors for Medical coding role in Mohali !! Job Location - Mohali Role : Auditor I (IPDRG) Eligibility Criteria: Education BHMS,BAMS,MBBS,BPT Candidates with prior US Healthcare or Clinical experience will be preferred. Fresher Physicians can also apply with good clinical knowledge. Noncertified Physicians can apply however should be ready to complete the same within specified timeline. (CIC) Good communication skills. Candidates with corporate experience will be preferred. Immediate joiners preferred. Should be ready to work from office. Should be ready to work in night shift. Interested candidates can share resume - abdul.rahuman@cotiviti.com Regards, Abdul Rahuman 9080276094

Hello, Greeting from Kotak Life Insurance! Location - Goregaon Job Role - MIS Candidate Location - Mumbai preferred Contact person - Sangita Mandal (8369252270) Interested candidate can mail their resume at " kli.sangita-manadal@kotak.com" JOB DESCRIPTION: Group Business, Claims & MIS 1. Timely and accurate reporting of Gorup Business, Claims 2. Ensuring Regulatory Compliance 3. Overall Claims MIS, BAP & IRDA Reporting 4. Collaborate with various stakeholders like Finance, Legal, Actuary, Compliance team to ensure MIS are shared in time and discrepencies are resolved. 5. Ensuring Regulatoty and other reporting are done from time to time. Managing Ad hoc data requirements with accuracy

What this job involves: Responsibilities: Daily Cash Application. Handle mailbox for request and query management Perform daily transactions as per standard operating procedures Allocating work to the team and ensuring service delivery as agreed norms and SLAs Creation of Statement of Accounts and Refund Packets Update process documents and capture the exceptions while processing as and when required Provide support during internal/ external audits Provide new hire orientation and process training Ability to multi-task and work in a dynamic and fast paced environment Team player and yet able to work independently Perform other duties assigned as and when required i.e. process improvement initiatives, system implementation and ad-hoc projects Sounds like you To apply, you need to have: Requirements: Ability Degree in Accounting or relevant professional accountancy qualification. Shift timings: 5:30 pm IST 02:00 am IST. Minimum 18 months of experience at current role within JLL. Preferably, 3-5 years of working experience in AR in MNC. Good knowledge of Accounts Receivable is an added advantage. Ability to multi-task and work in a dynamic and fast paced environment Team player and yet able to work independently On-site Gurugram, HR Scheduled Weekly Hours: 40

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers. Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education.

Eurofins Assurance India Pvt Ltd is a leading certification body providing Audit & Certification , Inspections , and other services covering the broad spectrum of sustainable supply chain. Eurofins will help the customers to mitigate risks in their supply chain and to ensure the benchmarking performance with operations, processes, systems, people or capabilities. Whether you are in Food, Cosmetics, Consumer products or Health care sector, our global auditor and technical expert network will help to mitigate/eliminate your risks against supply chain and distribution flows: Regulatory and Industrial standards . We have accreditations for a number of different industry standards/memberships to ensure we service the entire supply chain. TC application review "¢ Preparation of draft manual transaction certificate "¢ Issuing TC or rejecting TC "¢ Client Coordination related to the TC application. "¢ Compile the GMO related data for GOTS and TE using applicable templates. "¢ Compile the monthly TC data for TE. Qualifications Any graduate can apply.