2030 Claims Processing Jobs - Page 34

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.

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. Responsible for local sales for assurance business for products like (SMETA, BSCI, HIGG "“ FEM, SLCP, WRAP, GOTS, etc.) "¢ Responsible for achieving targeted revenue for North region as defined by Eurofins Management. "¢ Prepare and present sales quotations and proposals to current and prospective clients. "¢ Maintain accurate customer and sales information in CRM. "¢ Provide Monthly Sales reports to Management. "¢ Responsible for supporting marketing activities in region. "¢ Assist in payment collection for region. "¢ Assist in Scheduling the audit. "¢ Commitment to providing a consistently high standard of customer service. "¢ Demonstrable record of success in sales, product or service marketing and sales management Additional Information Good written and verbal communication skills Operational Excellence and demonstrated ability to deliver results in multiple challenging situations. Team-focused with the ability to achieve or exceed objectives while working collaboratively with other team members to achieve mutual success. Good at Presentations High leadership and supervisory skills Result oriented Problem solving Good at Retention

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 Billing Integration) Experience in SCRUM Agile, prefer Certified Scrum Master (CSM) Good written and oral communication Excellent analytical skills. 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. - Grade Specific 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 Billing Integration) Experience in SCRUM Agile, prefer Certified Scrum Master (CSM) Good written and oral communication Excellent analytical skills.

Primary Responsibilities: Solicit, review and analyze business requirements Write business and technical requirements Communicate and validate requirements with stakeholders Validate solution meets business needs Work with application users to develop test scripts and facilitate testing to validate application functionality and configuration Participate in organizational projects and/or manage small/medium projects related to assigned applications Translates customer needs into quality system solutions and ensures effective operational outcomes Focus on business value proposition*Apply understanding of As Is and To Be processes to develop solution Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Role Focus Areas: Core Expertise Required: Provider Management Utilization Management Care Management Domain Knowledge: Value-Based Care Clinical & Care Management Familiarity with Medical Terminology Experience with EMR (Electronic Medical Records) and Claims Processing Technical/Clinical Understanding: Admission & Discharge Processes CPT Codes, Procedure Codes, Diagnosis Codes Core AI Understanding AI/ML Fundamentals: Understanding of supervised, unsupervised, and reinforcement learning Model Lifecycle Awareness: Familiarity with model training, evaluation, deployment, and monitoring Data Literacy: Ability to interpret data, understand data quality issues, and collaborate with data scientists AI Product Strategy AI Use Case Identification: Ability to identify and validate AI opportunities aligned with business goals Feasibility Assessment: Understanding of whats technically possible with current AI capabilities AI/ML Roadmapping: Planning features and releases that depend on model development cycles Collaboration with Technical Teams Cross-functional Communication: Ability to translate business needs into technical requirements and vice versa Experimentation & A/B Testing: Understanding of how to run and interpret experiments involving AI models MLOps Awareness: Familiarity with CI/CD for ML, model versioning, and monitoring tools AI Tools & Platforms Prompt Engineering (for LLMs): Crafting effective prompts for tools like ChatGPT, Copilot, or Claude Responsible AI & Ethics Bias & Fairness: Understanding of how bias can enter models and how to mitigate it Explainability: Familiarity with tools like SHAP, LIME, or model cards Regulatory Awareness: Knowledge of AI-related compliance (e.g., HIPPA, AI Act) AI-Enhanced Product Management AI in SDLC: Using AI tools for user story generation, backlog grooming, and documentation AI for User Insights: Leveraging NLP for sentiment analysis, user feedback clustering, etc. AI-Driven Personalization: Understanding recommendation systems, dynamic content delivery, etc. Required Qualifications: Undergraduate degree or equivalent experience. 5+ years of experience in Business Analysis in healthcare including providing overall support, maintenance, configuration, troubleshooting, system upgrades, and more for Healthcare Applications Good experience on EMR / RCM systems Experience working with stakeholders, gathering requirements, and taking action based on their business needs Demonstrated success in running EMR / RCM / UM, CM and DM systems support in requirements, UAT, deployment supports Proven ability to work independently without direct supervision Proven ability to effectively manage time and competing priorities Proven ability to work with cross-functional teams #NJP #Gen

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Primary Responsibilities: Solicit, review and analyze business requirements Write business and technical requirements Communicate and validate requirements with stakeholders Validate solution meets business needs Work with application users to develop test scripts and facilitate testing to validate application functionality and configuration Participate in organizational projects and/or manage small/medium projects related to assigned applications Translates customer needs into quality system solutions and ensures effective operational outcomes Focus on business value proposition*Apply understanding of ‘As Is’ and ‘To Be’ processes to develop solution Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Role Focus Areas: Core Expertise Required: Provider Management Utilization Management Care Management Domain Knowledge: Value-Based Care Clinical & Care Management Familiarity with Medical Terminology Experience with EMR (Electronic Medical Records) and Claims Processing Technical/Clinical Understanding: Admission & Discharge Processes CPT Codes, Procedure Codes, Diagnosis Codes Core AI Understanding AI/ML Fundamentals: Understanding of supervised, unsupervised, and reinforcement learning Model Lifecycle Awareness: Familiarity with model training, evaluation, deployment, and monitoring Data Literacy: Ability to interpret data, understand data quality issues, and collaborate with data scientists AI Product Strategy AI Use Case Identification: Ability to identify and validate AI opportunities aligned with business goals Feasibility Assessment: Understanding of what’s technically possible with current AI capabilities AI/ML Roadmapping: Planning features and releases that depend on model development cycles Collaboration with Technical Teams Cross-functional Communication: Ability to translate business needs into technical requirements and vice versa Experimentation & A/B Testing: Understanding of how to run and interpret experiments involving AI models MLOps Awareness: Familiarity with CI/CD for ML, model versioning, and monitoring tools AI Tools & Platforms Prompt Engineering (for LLMs): Crafting effective prompts for tools like ChatGPT, Copilot, or Claude Responsible AI & Ethics Bias & Fairness: Understanding of how bias can enter models and how to mitigate it Explainability: Familiarity with tools like SHAP, LIME, or model cards Regulatory Awareness: Knowledge of AI-related compliance (e.g., HIPPA, AI Act) AI-Enhanced Product Management AI in SDLC: Using AI tools for user story generation, backlog grooming, and documentation AI for User Insights: Leveraging NLP for sentiment analysis, user feedback clustering, etc. AI-Driven Personalization: Understanding recommendation systems, dynamic content delivery, etc. Required Qualifications: Undergraduate degree or equivalent experience. 5+ years of experience in Business Analysis in healthcare including providing overall support, maintenance, configuration, troubleshooting, system upgrades, and more for Healthcare Applications Good experience on EMR / RCM systems Experience working with stakeholders, gathering requirements, and taking action based on their business needs Demonstrated success in running EMR / RCM / UM, CM and DM systems support in requirements, UAT, deployment supports Proven ability to work independently without direct supervision Proven ability to effectively manage time and competing priorities Proven ability to work with cross-functional teams At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. #NJP #Gen External Candidate Application Internal Employee Application

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, Lakshmi PS HR Analyst Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432489/WhatsApp @7892150019 lakshmi.p@blackwhite.in | www.blackwhite.in ******DO REFER FRIENDS ******

Key Responsibilities : Lead Generation & Sales: Proactively identify and engage potential members through various channels, including walk-ins, inbound inquiries, and outbound outreach Membership Sales & Conversions: Present and sell membership options, upsell additional services such as personal training, and close sales to meet or exceed monthly targets Customer Engagement & Retention: Provide personalized tours, address member inquiries, and ensure a welcoming environment to enhance member satisfaction and retention CRM Management: Utilize CRM tools to track leads, manage follow-ups, and update member records to maintain accurate and up-to-date information Community Outreach: Build relationships with local businesses, organizations, and influencers to drive group memberships and increase brand visibility Event Management: Organize and participate in events to engage the community and generate interest in membership offerings

As a Senior Associate in Revenue Cycle Management, you will be responsible for ensuring the efficient and effective functioning of the revenue cycle processes within a healthcare organization You will oversee various aspects of revenue cycle operations, including patient registration, charge capture, coding, billing, claims processing, denial management, and accounts receivable follow-up Your primary goal will be to optimize revenue generation, maximize collections, and minimize denials to ensure the financial health of the organization Responsibilities: Revenue Cycle Oversight: Manage and supervise the revenue cycle operations, ensuring compliance with regulatory requirements and industry best practices Develop and implement strategies to optimize revenue generation and enhance cash flow Monitor key performance indicators (KPIs) and financial metrics to identify trends, areas for improvement, and potential revenue leakage Collaborate with cross-functional teams, such as clinical departments, finance, coding, and compliance, to streamline revenue cycle processes Billing and Claims Management: Oversee the timely and accurate submission of claims to third-party payers, including Medicare, Medicaid, commercial insurance companies, and self-pay patients Monitor claim status and work closely with the billing team to resolve any coding or billing discrepancies Analyze denial patterns, identify root causes, and implement corrective measures to minimize denials and maximize collections Stay updated with changes in healthcare regulations, payer policies, and coding guidelines to ensure compliance and accurate billing Accounts Receivable Management: Review and analyze accounts receivable aging reports to identify delinquent accounts and take appropriate actions for timely payment Implement strategies for effective accounts receivable follow-up, including phone calls, appeals, and negotiations with payers and patients Collaborate with the finance team to reconcile payments, identify posting errors, and resolve outstanding balances Provide guidance and support to the team in resolving complex billing and reimbursement issues Process Improvement: Continuously assess revenue cycle processes, identify inefficiencies, and recommend process improvements to enhance operational efficiency and revenue integrity Implement automation and technology solutions to streamline workflows and reduce manual intervention Conduct regular audits and reviews to ensure compliance with coding guidelines, billing regulations, and internal policies Develop and deliver training programs to educate staff on revenue cycle best practices, coding updates, and compliance requirements Qualifications: Bachelors degree in Healthcare Administration, Business Administration, or a related field (master's degree preferred) Experience in revenue cycle management or healthcare finance Strong knowledge of healthcare reimbursement systems, billing regulations, and coding guidelines (eg, CPT, ICD-10, HCPCS) Proficiency in using revenue cycle management software and electronic health record (EHR) systems Familiarity with third-party payer requirements, including Medicare, Medicaid, and commercial insurance Excellent analytical and problem-solving skills with the ability to interpret financial data and identify trends Strong leadership and team management abilities Effective communication and interpersonal skills to collaborate with various stakeholders Certified Professional Biller (CPB) or Certified Revenue Cycle Specialist (CRCS) certification is a plus Note: The above job description is a general outline and may vary depending on the organization and its specific requirements

Manage insurance policies and claims for the organization. Develop and implement insurance strategies to mitigate risks. Collaborate with insurance providers to negotiate terms and coverage. Monitor and analyze insurance performance and make improvements as needed. Provide training and support to staff on insurance policies and procedures. Prepare and present reports on insurance activities and outcomes to senior management. Ensure compliance with regulatory requirements and industry standards.

Manage insurance policies and claims for the organization. Develop and implement insurance strategies to mitigate risks. Collaborate with insurance providers to negotiate terms and coverage. Monitor and analyze insurance performance and make improvements as needed. Provide training and support to staff on insurance policies and procedures. Prepare and present reports on insurance activities and outcomes to senior management. Ensure compliance with regulatory requirements and industry standards.

Manage insurance policies and claims for the organization. Develop and implement insurance strategies to mitigate risks. Collaborate with insurance providers to negotiate terms and coverage. Monitor and analyze insurance performance and make improvements as needed. Provide training and support to staff on insurance policies and procedures. Prepare and present reports on insurance activities and outcomes to senior management. Ensure compliance with regulatory requirements and industry standards.

Manage insurance policies and claims for the organization. Develop and implement insurance strategies to mitigate risks. Collaborate with insurance providers to negotiate terms and coverage. Monitor and analyze insurance performance and make improvements as needed. Provide training and support to staff on insurance policies and procedures. Prepare and present reports on insurance activities and outcomes to senior management. Ensure compliance with regulatory requirements and industry standards.

Manage insurance policies and claims for the organization. Develop and implement insurance strategies to mitigate risks. Collaborate with insurance providers to negotiate terms and coverage. Monitor and analyze insurance performance and make improvements as needed. Provide training and support to staff on insurance policies and procedures. Prepare and present reports on insurance activities and outcomes to senior management. Ensure compliance with regulatory requirements and industry standards.

We are seeking a dynamic and detail-oriented Insurance Professional for the Legal Department to manage end-to-end insurance policy administration, claims processing, and risk management across multiple sites. The ideal candidate will have experience in insurance handling, preferably in the solar sector, and the ability to manage and coordinate across teams and insurance partners. COMPENSATION & BENEFITS: Medical Insurance Performance Incentives Cool Work Environment Travel Reimbursement (as per company policy) Exposure to challenging legal and insurance portfolios Supportive team and professional development ABOUT SADBHAV FUTURETECH LIMITED: Company Size - ~100 employees Headquarters - Gurgaon, Haryana Company Turnover - 300-350 Cr. Founded Since - Year 2020 Sadbhav Futuretech is committed to providing comprehensive and end to end solutions for farmers across India. Sadbhav addresses the major challenges of farmers through its three service verticals while ensuring value creation for all stakeholders. Our endeavor is to establish Sadbhav Futuretech as Indias first choice for solar project execution, co-operative farming, and cold chain management. We project to become the largest aggregator of farmers in India over the next 5 years. VISION: To be the largest Renewable and Agri-Tech based platform in the country impacting the lives of more than 1 million farmers over the next 10 years. OUR SPECIALITIES: Solar Agricultural Pumps, PM KUSUM Scheme, Kusum Component C, Kusum Component B, FaaS - Farming as a Service, Empowering Farmers, Solar Rooftop Solutions, Solar EPC, Solar Ground Mounted, Solar Rooftop, and Solar Solutions JOB RESPONSIBILITY: Manage complete insurance policy lifecycle, including issuance, renewals, and cancellations for company assets and projects Handle insurance claims for assets, equipment, and warehouse-related incidents Coordinate with internal stakeholders and insurance service providers for smooth claims resolution Ensure timely documentation and submission of all claims and follow-ups until settlement Analyze claim trends and risk exposure and recommend strategies for risk mitigation Maintain updated insurance-related records and compliance documentation Assist in risk assessments and inspections at warehouses and project sites Generate periodic reports and MIS on insurance coverage, claims status, and premium schedules Support internal legal compliance initiatives related to insurance law and statutory obligations DESIRED PROFILE: Minimum 3 to 4 years of experience in insurance handling and claim settlements Must hold a Diploma in Insurance or equivalent certification Experience in the solar sector or renewable energy is preferred Willingness to travel across India (30% to 40%) for on-site inspections and audits Proficient in Hindi and English (spoken and written) Strong coordination and analytical skills DESIRED SKILLS: Knowledge of general & property insurance policies (fire, asset, liability, etc.) Excellent written and verbal communication Hands-on experience in claims documentation and settlement Sound understanding of insurance laws, contracts, and coverage terms Proficient in MS Excel, Word, and reporting tools Strong negotiation and relationship management skills WHY JOIN US? • Work with a fast-growing leader in renewable energy • Be part of an organization making a sustainable impact across India • Dynamic and inclusive work culture • Opportunity to lead key insurance and legal operations independently PREFERENCE: Corporate Office; Unicorn Start-Up; Young Energetic Person

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, Hemalatha HR Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 080-67432492/Whatsapp @9900261540 Hemalatha.c@blackwhite.in | www.blackwhite.in ******DO REFER FRIENDS ******

Prepare ILAs, Final Survey Reports, and requirement letters. Maintain records of claim intimation, surveyor visits, document status, and report. Follow up with insured and internal teams to minimize TAT Update data in CMS software Health insurance Provident fund

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 : 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 ************** Please refer your Friends***************

TATA AIG General Insurance Company Limited is looking for Deputy Manager - Claims Special Investigation Unit to join our dynamic team and embark on a rewarding career journey Assist the Manager in the day-to-day operations of the business, including setting goals, developing strategies, and overseeing the work of team members Take on leadership responsibilities as needed, including managing team members and making decisions in the absence of the Manager Identify and address problems or challenges within the business, and develop and implement solutions Collaborate with other departments and teams to ensure smooth and efficient operations Maintain accurate records and documentation Contribute to the development and implementation of business plans and goals

Job Summary: We are looking for a skilled Guidewire Claim Center Integration Developer to design and implement integration solutions between Claim Center and external/internal systems. The role requires deep knowledge of Guidewire integration architecture, Gosu scripting, Java, and service-based communication protocols. This individual will be responsible for building scalable and reliable integration layers to support claims processing workflows. Key Responsibilities: Develop and maintain integrations between Guidewire ClaimCenter and third-party/internal systems using web services (SOAP/REST), JMS, and batch processes. Customize and extend Guidewire integration points (plugins, messaging, event handlers). Develop and deploy APIs and middleware components to facilitate data exchange. Work with Guidewire Integration Architecture and SOA best practices. Collaborate with business analysts and architects to understand integration requirements. Implement data transformations and mappings between systems. Troubleshoot integration issues and support ongoing enhancements. Contribute to integration testing, performance tuning, and deployment planning. Required Qualifications: Bachelor's degree in Computer Science, Information Technology, or a related field. 3+ years of hands-on experience in Guidewire ClaimCenter integration development. Strong proficiency in Gosu, Java, and XML/JSON. Experience with Guidewire Messaging, Web Services, Plugins, and Batch Processes. Familiarity with middleware and integration platforms (e.g., MuleSoft, Apache Camel). Experience with SOAP/RESTful services and related tools (e.g., Postman, SoapUI). Solid understanding of enterprise integration patterns and security (OAuth, SSL). Preferred Qualifications: Guidewire Certified Integration Developer (ClaimCenter). Experience integrating with policy, billing, document management, and payment systems. Knowledge of CI/CD processes and tools (Git, Jenkins, Maven). Familiarity with containerization and cloud environments (AWS, Azure). Background in the property & casualty insurance domain. Soft Skills: Strong problem-solving and debugging skills. Effective written and verbal communication. Ability to work in Agile/Scrum teams and meet tight deadlines. Self-motivated with attention to detail and quality. Benefits: Competitive salary and annual bonus Health, dental, vision, and life insurance 401(k) with employer match Flexible work hours and remote work options Training and certification support

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management Associate Manager Qualifications: Any Graduation Years of Experience: 10 to 14 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 "As a Travel Claims Team Manager, you will be responsible for managing a team of Travel Claims adjusters, this might also involve investigating, evaluating, and processing travel insurance claims. Your role will involve assessing the validity of claims, ensuring timely and accurate resolution, and providing outstanding customer service throughout the process.Review and process travel insurance claims, including medical, trip cancellation, and baggage loss claims. Investigate claims by gathering and analyzing relevant information and documentation. Communicate with policyholders, healthcare providers, and other stakeholders to obtain necessary information. Evaluate claims to determine coverage, validity, and appropriate compensation. Resolve disputes and provide clear explanations of claim decisions to policyholders. Maintain accurate and detailed records of claim activities and decisions. Stay updated on industry trends, regulations, and best practices.Review and process travel insurance claims, including medical, trip cancellation, and baggage loss claims. Investigate claims by gathering and analyzing relevant information and documentation. Communicate with policyholders, healthcare providers, and other stakeholders to obtain necessary information. Evaluate claims to determine coverage, validity, and appropriate compensation. Resolve disputes and provide clear explanations of claim decisions to policyholders. Maintain accurate and detailed records of claim activities and decisions. Stay updated on industry trends, regulations, and best practices." What are we looking for " - Bachelors degree in Business, Insurance, or related field preferred. Proven minimum 7 years of experience in claims adjusting or a similar role, ideally within the travel insurance sector. Strong analytical skills and attention to detail. Excellent communication and interpersonal skills. Ability to handle multiple claims simultaneously in a fast-paced environment. Proficiency in claims management software and Microsoft Office Suite. Bachelors degree in Business, Insurance, or related field preferred. Proven minimum 7 years of experience in claims adjusting or a similar role, ideally within the travel insurance sector. Strong analytical skills and attention to detail. Excellent communication and interpersonal skills. Ability to handle multiple claims simultaneously in a fast-paced environment. Proficiency in claims management software and Microsoft Office Suite." Roles and Responsibilities: "In this role you are required to do analysis and solving of moderately complex problems Typically creates new solutions, leveraging and, where needed, adapting existing methods and procedures The person requires understanding of the strategic direction set by senior management as it relates to team goals Primary upward interaction is with direct supervisor or team leads Generally interacts with peers and/or management levels at a client and/or within Accenture The person should require minimal guidance when determining methods and procedures on new assignments Decisions often impact the team in which they reside and occasionally impact other teams Individual would manage medium-small sized teams and/or work efforts (if in an individual contributor role) at a client or within Accenture Please note that this role may require you to work in rotational shifts" Qualification Any Graduation

Skill required: Supply Chain - Automotive Supply Chain Designation: Business Advisory Associate Qualifications: BE/Diploma in Automobile Years of Experience: 1 to 3 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do To maintain quality and service standards of the Warranty Claims processing team in support of the contracted Service Level AgreementInvestigate and Verify warranty claims based on available external support resources (Parts catalog, Dealer Assist & Standard labor time) & take appropriate decisionImplement practices to improve operational efficienciesTo maintain quality and service standards of the Warranty Claims processing team in support of the contracted Service Level AgreementInvestigate and Verify warranty claims based on available external support resources (Parts catalog, Dealer Assist & Standard labor time) & take appropriate decisionImplement practices to improve operational efficiencies What are we looking for BE Automobile Graduate/Diploma with or without Automotive experienceBE Mechanical Graduate/Diploma with Automotive experienceExperience in WarrantyExperience with Auto componentsInterpersonal skills to deal with dealers, warranty engineers, etcData processing accuracy, detail oriented, and ability to evaluate/research a warranty claimExpert level capability in use of desktop software (MS Office Suite, with focus on Excel)Organized, timely, pro-active and highly productiveStrong written communication in EnglishAttention to detail and ability to multi-taskExperience in Warranty /Auto Dealership Roles and Responsibilities: Investigate and Verify warranty claims based on available external support resources (Parts catalog, Dealer Assist & Standard labor time) & take appropriate decision Qualification BE,Diploma in Automobile

Skill required: Reinsurance - Collections Processing Designation: Claims Management Senior Analyst Qualifications: Any Graduation Years of Experience: 7 to 11 years Language - Ability: English(International) - Intermediate About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do You will be aligned with our Risk and Compliance vertical and help us perform compliance reviews, publish reports with actions and provide closure guidance as needed. We design & recommend effective controls to mitigate risks and help service delivery team prepare for upcoming client / external audits.You will be working as a part of the Risk & compliance team which is responsible for helping clients and organizations identify risks and create mitigation plans.The Operational Audit & Compliance team focuses on auditing and managing effective implementation and delivery of functional processes within operations to mitigate risks. The role may require for you to have a good understanding of anti-corruption, BCM and infosec policies, records management and contractor controls. The team is responsible for establishing processes to validate the effectiveness and drive improvements wherever required. What are we looking for 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.Canceling and rewriting insurance policies and endorsementsManage OTC collection/disputes such as debt collection, reporting on aged debt, dunning process, bad debt provisioning etc. Perform Cash Reconciliations and follow up for missing remittances, prepare refund package with accuracy and supply to clients, record all collections activities in a consistent manner as per client process (tool), delivery of process requirements to achieve key performance targets, ensure compliance to internal controls, standards, and regulations (Restricted countries) Roles and Responsibilities: In this role you are required to do analysis and solving of moderately complex problems May create new solutions, leveraging and, where needed, adapting existing methods and procedures The person would require understanding of the strategic direction set by senior management as it relates to team goals Primary upward interaction is with direct supervisor May interact with peers and/or management levels at a client and/or within Accenture Guidance would be provided when determining methods and procedures on new assignments Decisions made by you will often impact the team in which they reside Individual would manage small teams and/or work efforts (if in an individual contributor role) at a client or within Accenture Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Responsible for overseeing and managing the claims process and ensures all claims are handled efficiently. Act as the main point of contact for customer inquiries,work to resolve issues promptly and Prepare regular reports on claims status.

POSITION: MEDICAL OFFICER/CONSULTANT PA/RI APPROVER PURPOSE OF ROLE: To scrutinize and process the claims within the agreed TAT by having an understanding of the policy terms & conditions while applying their domain medical knowledge. Designation Function Medical Officer/Consultant Claims PA/RI Approver Reporting to Location Assistant Manager Claims Mumbai Educational Qualification Shift BHMS, , BAMS, MBBS(Indian registration Required) Rotational Shift (for female employee shift ends at 8:30 PM) 6 rotational week offs Provided per month Week offs Related courses attended None Management Level Junior Management Level Industry Type Hospital/TPA/Healthcare/Insurance Roles and 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. • • • Responsibilities 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. • • • • Error-free processing (100% Accuracy) Maintaining TAT Productivity (Achieve the daily targets) Key Results and Outcomes driven by this role: 0- 5 years Relevant Experience No of years of experience 0-5 years None Demonstrated abilities if any Technical Competencies • Analytical Skills • • Basic Computer knowledge Type writing skills • • Communication skills Decision Making Behavioral competencies