1012 Claims Processing Jobs - Page 35

Hiring for a Record Retrieval Specialist #Shift-Us Shift Timing #Location: Ahmedabad, Gujarat # Minimum 6 months of Experience Required in the International Voice process #Fluent English Required Meal Facility is also available One-month Bonu

Designation/ Role: Trainee Department: Accounts Receivable Work Timing: Night Shift Qualifications: Minimum HSC/10+2 Equivalent (Any Graduate Preferred) Skills: Good verbal and written communication Skills. Able to build rapport over the phone. Strong analytical and problem-solving skills. Be a team player with positive approach. Good keyboard skills and well versed with MS-Office. Able to work under pressure and deliver expected daily productivity targets. Ability to work with speed and accuracy. Medical billing AR or Claims adjudication experience will be an added advantage. Experience 01-year experience US calling process will be an added advantage. Job Description The job involves an analysis of receivables due from healthcare insurance companies and initiation of necessary follow-up actions to get reimbursed. This will include a combination of voice and non-voice follow-up along with undertaking appropriate denial and appeal management protocol. Job Responsibilities 1) Analyses outstanding claims and initiates collection efforts as per aging report. So that claims get reimbursed. 2) Undertakes denial follow-up and appeals work wherever required. 3) Documents and takes appropriate action of all claims which has been analyzed and followed-up in the clients software. 4) Build good rapport with the insurance carrier representative. 5) Focuses on improving the collection percentage. Desired Qualities Behavior: Discipline, Positive Attitude & Punctuality

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. Process - Postpay Clinical Primary Responsibilities This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. Keen eye for detail. Knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies Adherence to state and federal compliance policies and contract compliance 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 Required Qualifications Medical degree - BHMS/BAMS/BUMS/BPT/MPT/B.Sc. Nursing Knowledge of US Healthcare and coding desirable Proven attention to detail & Quality focused Proven good Analytical & comprehension skills Basic Computer Skills Preferred Qualifications 6+ months of clinical review experience Extensive knowledge on ISET/UNET/FACETS/COSMOS platform used to perform research as part of the clinical investigation process Claims processing experience Medical record familiarity Knowledge of ICD-10 Intermediate skill level with MS Office 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.

: Preferred Knowledge/ Skills: Demonstrates extensive abilities and/or a proven record of executing the following areas: Guidewire PolicyCenter, development experience; Knowledge of P&C Insurance domain (Policy, Claims, and Billing applications as per product requirements); Designing, developing, modifying, and deploying software, including object-oriented programming concepts with using design standards and best practices; Planning, designing, developing, modifying, testing, debugging, and maintaining GOSU language application code within Guidewire Policy Center Configuring screen layouts, including creation of new screens (PCFs); Configuring operational and administration related parameters such as roles and permissions, user attributes regions, and activity patterns; 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 Resolving issues identified during testing of the configuration requirements; Handling the responsibility of organizing code merges and environment management tasks; Performing minor and major Guidewire software upgrades; Developing GUnit/Junit tests for testing business logic; Managing projects, programs, and teams of various sizes; Architecting and creating solution designs and effectively presenting solution architecture with various options and estimates; Assisting in GOSU code reviews, code cleanups and helping to perform sprint demos; Technology: HTML. CSS,React.js, Guidewire Portal, Edge Framework, Jutro Framework, GOSU, API Certification(s) Preferred: Guidewire Certifications in PolicyCenter, Skills (competencies) Verbal Communication

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 logicalskills. Mandatory Skill 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 Skills (competencies) Verbal Communication Written Communication API integration JavaScript Policy Development Analytical Thinking

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. Mandatory Skill 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. Skills (competencies) JavaScript Analytical Thinking Verbal Communication Policy Development API integration

SUMMARY Opening for experience AR Caller / Denial Management experience candidates in Kolkata, Salary upto 3.60 lpa Job Title:** AR Caller / Denial Management Executive Location:** Salt Lake, Kolkata (Work from Office) Working Days:** 5 Days a Week Weekly Off:** 2 Rotational Offs Shift Timings:** Rotational Shifts Joining:** Immediate Joiners to Candidates with Max 15 Days’ Notice JOB DESCRIPTION: We are hiring for the position of **AR Caller / Denial Management Executive** for a reputed US healthcare BPO in **Salt Lake, Kolkata**. This is a **full-time, outbound calling process**, requiring follow-up with US-based insurance companies to resolve pending or denied claims. Requirements Good command of **spoken and written English**. Prior experience in **AR Calling** or **Denial Management** is preferred. Basic knowledge of US healthcare revenue cycle, CPT/ICD codes is an added advantage. Open to work in **rotational shifts**. Must be ready to **work from office** (Salt Lake, Kolkata). Only **immediate joiners or up to 15 days’ notice** candidates will be considered. Benefits Salary:** Up to 3.60 lpa annual CTC Drop Cab Facility** (as per shift timing and company policy) Work from Office (No WFH) Stable weekday schedule with 2 rotational offs

Shift - UK Shift immediate to 60 Days NP (nego) Handle non-voice back office operations related to US insurance and healthcare benefits. Process transactions and updates for 401(k), defined benefit, and defined contribution retirement plans. Required Candidate profile Experience Required: 1 to 8 Years of exp in any US/UK process/ int bpo will be considered (Freshers are also welcome) only international process can be considered Notice Period: 0 to 45 Days Preferred

Dear Candidate, We are hiring an OCaml Developer to build functional and type-safe applications for fintech, compilers, or language tooling projects. Key Responsibilities: Write and maintain applications using OCaml Design algorithms and data structures for high-performance tasks Work on compilers, static analysis tools, or financial systems Interface with C bindings and build cross-platform binaries Contribute to code quality through tests and formal methods Required Skills & Qualifications: Proficient in OCaml , functional programming , and type systems Familiarity with Jane Streets Core , Dune , and OPAM Understanding of immutability , pattern matching , and functors Bonus: Experience in ReasonML or formal verification Note: If interested, please share your updated resume and preferred time for a discussion. If shortlisted, our HR team will contact you. Kandi Srinivasa Delivery Manager Integra Technologies

* Review AR claims, understand the denial reason, call the payers if required resolve the issue. *Research and interpret from the available data in billing software, EOB, MR, authorization & understand the reasons for denial/underpayment/no response. Required Candidate profile * All kinds of Denials * Strong Technical Knowledge * RCM * Authorization * Timely Filed Limit * Phyician Billing/Hospital billing * Commercial/Federal Payers * AR CALLER Contact Info - 9384813917

Job description Team Executive - Payment Integrity Location : Chennai & Bangalore Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 9 years of experience in Claims Adjudication(Payment Integrity,PrePay audit,Postpay audit) . With over 1 year of experience as a Team leader Proven track record in managing processes, streamlining workflows and excellent people management skills. Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals. Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Adhering to various regulatory and compliance practices. Maintaining and Ownership of reports both internal as well as for the clients. Presenting the data and provide deep insights about the process to the clients as well as Internal Management. Managing and co - ordinating training programs. Excellent in Coaching and providing feedback to the team. Take necessary HR actions as part of the Performance Improvement Process Key Performance Indicators Ensuring that the key Service Level Agreements are met consistently without any exceptions. Leverage all Operational metrices to ensure that the Revenue and Profitability targets are met and exceeded . Work in tandem with all Business functions to ensure smooth business process. Retention of key team members Interested Candidates share your CV - deepalakshmi.rrr@firstsource.com / 8637451071 Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or deepalakshmi.rrr@firstsource.com

Job Title: RCM AR Caller (1-4 Years Experience) Job Location: Chennai, (Thoraipakkam) Job Type: Full-time Shift: Night Requirement : Immediate Joiners Job Description: We are looking for 3 AR Callers with analytical knowledge of 1 to 4 years of experience in US healthcare billing. The ideal candidates should be client-centric , goal-oriented, and committed to delivering high-quality work and resolutions. Key Responsibilities: Manage End-to-End medical billing, accounts receivable (AR), and claims processing Work towards both office goals and self-improvement objectives Ensure timely and accurate claim submissions, follow-ups, and appeals Address and resolve denials and rejections effectively Maintain compliance with HIPAA regulations and payer policies Required Skills & Qualifications: Experience: 1 to 4 years in US healthcare medical billing Knowledge of EHR/PMS systems : Tebra is an added advantage Strong analytical and problem-solving skills Excellent communication skills to handle client interactions and resolve queries Ability to work in a night shift with flexibility What We Offer: Competitive salary and performance-based incentives Career growth opportunities A collaborative and professional work environment If you are passionate about medical billing and revenue cycle management and are committed to delivering results, we would love to hear from you! How to Apply? Apply below or Call: Mario (6381472178 ) Email us: Hrm@arcrcm.com

Would be part of the US Insurance delivery team & responsible & accountable for the entire process. He/ She would ensure that the process is running smoothly & all the process deliverables are delivered as per the SLA. Required Candidate profile should have a min 10 - 12 yrs of management experience in a P&C or Specialty Insurance BPO service provider. Expert in US P&C Insurance. Understanding of end to end Claims handling.

Role: Back End Operations Experience: 0-4 years' work experience in back office/BPO/Customer Service or similar transaction BPO processing Shift Timing- 1.30pm to 11.30pm IST (Only fixed shift /Mon-Fri) Cab -One Way Cab drop Work from Office: From Day 2 Onwards (Work from office -5days) Permanent work profile with Wipro Education - B.com, BA, BBA, Any B.sc (graduates only)/ NO BE/B TECH will be eligible for this hiring Note - No Remote from Work /Hybrid for this position, Monday -Friday (Work from office) Work Location: Wipro Kolkata salt lake Application Link to apply - https://forms.office.com/r/XJfNfVxYPM Get application filled from 26th May - 28th May Job Summary Strong understanding of client plan provisions/product & processing guidelines and SLA metrics Able to manually perform Benefit processes and complex tasks/calculations that require plan knowledge, analysis, and interpretation Research complex Benefits issues and formulates resolutions/ recommendations by analyzing fact patterns and applying plan provisions and best practices Resolve tasks in accordance with due dates and ensure process is well documented Create adhoc reports as required to support client service delivery functions Provide day-to-day client and third party administrator contact for participant processing inquiries Participate & contribute in daily huddles and status meetings Document task/ workflow analysis and comments in a concise, effective manner such that it can be easily understood by participant Develop and deliver client-specific operational training; monitor ongoing adherence to SOPs to ensure high quality Work with the client team across shores to deliver against client requirements Proactively identify training needs and provide necessary coaching as required to BOAs Proactively seek performance feedback to build & enhance knowledge Build and leverage partnerships across shores to deliver against client requirements Create robust documentation & SOPs for transition of activities between Ops and Shared Services, combined with ongoing coaching Document task/ workflow analysis and comments in a concise, effective manner such that it can be easily understood by the broader team Actively listens to all stakeholder/ team members to understand their perspective and ensure continuous understanding regardless of communication channels Interview Rounds GATE -online assessment HR/GD Ops Manager connect

Specialists Hospital is looking for Nursing Supervisor to join our dynamic team and embark on a rewarding career journey Supervising and coordinating the work of nursing staff, including registered nurses, licensed practical nurses, and nursing assistants Assigning patient care duties and ensuring that staff have the necessary resources and support to provide safe and effective care Monitoring and evaluating the performance of nursing staff, providing feedback and coaching as needed Ensuring compliance with all applicable regulations, standards, and policies related to nursing practice and patient care Collaborating with other healthcare professionals, such as physicians, social workers, and therapists, to ensure coordinated and effective patient care Participating in the development and implementation of nursing policies and procedures, as well as quality improvement initiatives Facilitating communication and teamwork among nursing staff and other members of the healthcare team Serving as a resource and mentor for nursing staff, providing guidance and support as needed Responding to patient and family concerns and complaints and ensuring that appropriate action is taken Maintaining accurate records and documentation of nursing staff activities and patient care Strong knowledge of nursing practice, regulations, and standards Excellent communication, leadership, and interpersonal skills

Job Summary We are seeking a Process Specialist with 5 to 8 years of experience in Facets - Claims and Claims Adjudication. The ideal candidate will have expertise in Dental Claims and Commercial Claims. This role requires working from the office during day shifts. The candidate must be a native English speaker with strong reading writing and speaking skills. Responsibilities Oversee the claims adjudication process to ensure accuracy and compliance with company policies and regulations. Provide expertise in Facets Claims to streamline and optimize claims processing workflows. Analyze and resolve complex claims issues related to Dental Claims and Commercial Claims. Collaborate with cross-functional teams to improve claims processing efficiency and effectiveness. Develop and implement best practices for claims adjudication to enhance overall process quality. Monitor and report on key performance indicators to track the effectiveness of claims processing. Conduct regular audits of claims to identify and address any discrepancies or errors. Train and mentor junior team members on claims adjudication processes and best practices. Ensure all claims are processed within the established turnaround times and service level agreements. Participate in continuous improvement initiatives to enhance the claims processing function. Maintain up-to-date knowledge of industry trends and regulatory changes impacting claims adjudication. Provide exceptional customer service by addressing and resolving claims-related inquiries and issues. Contribute to the development of policies and procedures to support the claims adjudication process. Qualifications Possess strong technical skills in Facets Claims and Claims Adjudication. Have in-depth knowledge and experience in Dental Claims and Commercial Claims. Demonstrate excellent analytical and problem-solving abilities. Exhibit strong communication skills both written and verbal in English. Show proficiency in training and mentoring team members. Display a commitment to continuous improvement and process optimization. Maintain a high level of attention to detail and accuracy in all tasks. Have the ability to work effectively in a fast-paced dynamic environment. Demonstrate strong organizational and time management skills. Possess a customer-focused mindset with a dedication to providing exceptional service. Show proficiency in using relevant software and tools for claims processing. Exhibit a strong understanding of industry regulations and compliance requirements. Demonstrate the ability to work collaboratively with cross-functional teams. Certifications Required Certified Professional Coder (CPC) or equivalent certification in claims processing.

Job Summary We are seeking a Subject Matter Expert in Claims HC with 4 to 6 years of experience to join our team. The ideal candidate will have expertise in UiPath and Claims Adjudication along with domain experience in Provider and Payer. This hybrid role requires working night shifts and does not involve travel. The candidate will play a crucial role in optimizing claims processes and enhancing operational efficiency. Responsibilities Lead the automation of claims processes using UiPath to improve efficiency and accuracy. Oversee the end-to-end claims adjudication process to ensure timely and accurate resolution. Provide expert guidance on claims management to both provider and payer teams. Collaborate with cross-functional teams to streamline claims operations and reduce processing times. Analyze claims data to identify trends and implement strategies for process improvement. Ensure compliance with industry regulations and standards in all claims-related activities. Develop and maintain documentation for claims processes and automation workflows. Train and mentor junior staff on best practices in claims adjudication and automation. Monitor and report on key performance indicators related to claims processing. Work closely with IT teams to integrate UiPath solutions with existing systems. Facilitate communication between provider and payer teams to resolve claims issues. Participate in continuous improvement initiatives to enhance claims operations. Support the development of new claims adjudication policies and procedures. Qualifications Possess strong technical skills in UiPath with a proven track record in automation. Demonstrate expertise in claims adjudication with a deep understanding of industry practices. Have substantial experience in the provider and payer domains ensuring comprehensive knowledge. Exhibit excellent analytical skills to interpret claims data and drive improvements. Show proficiency in collaborating with cross-functional teams to achieve common goals. Display strong communication skills to effectively liaise with various stakeholders. Maintain a proactive approach to problem-solving and process optimization.

Urgent requirement for BDS/MBBS-Chennai( Kilpauk ) Freshers/candidate with clinical or TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: MBBS / BDS graduate. MBBS Candidate Should be MCI Registered BDS Candidate Should be DCI Registered Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Venue details: MDIndia Health Insurance TPA Pvt. Ltd. No: 226 , OM Sakthi Towers Kilpauk Garden road, Kilpauk, Chennai-600010.

Urgent requirement for BHMS,BDS,BAMS -Hyderabad Fresher/Expereince candidate should have atleast 1 year of TPA experience. Interested candidates can call on 9371762436 or share their updated resumes to career@mdindia.com Job Description: Scrutiny of medical documents and adjudication. Assess the eligibility of medical claims and determine financial outcomes. Identification of trigger factors of insurance related frauds and inform the concerned department. Determine accuracy of medical documents. Required Candidate profile: BHMS,BDS,BAMS graduate Male candidate prefer. Good Medical & basic computer knowledge Should have completed internship (Permanent Registration number is mandatory) Freshers can also apply. Work from office. Only Male Doctor required for Field Investigation

Job Responsibilities: Computation and timely settlement of Trade Channel Schemes including Price Drop settlement Timely processing of the Channel Scheme Exceptions Drive reconciliation with Channel partners and ensure closure of all recon items Ensure the collection of the No Dues Certificate (NDC) from Chanel partners on Quarterly basis Provide support to External customers (Channel partners) and Internal customers (Regional Sales teams, business teams & finance team) through coordinating actions on Claims process improvements and Claims Settlement Handle timely communication of monthly channel schemes through SMS system. Ensure accurate monthly provisioning of Channel spends and closure of books of accounts Handle automation initiatives/projects that help drive productivity and simplify Commercial processes. Audit Coordination with HQ auditors, Internal Auditors and statutory auditors Review of internal controls and ensure no surprises/leakages in controls. Co-ordination with the BI team for issues in data through DMS Next, GMCS etc. Execute Market visits to get the feedbacks from the Channel Partners on Scheme payout settlements & related issues. Key Competencies required- Working Knowledge of relevant commercial laws / statutes Business Acumen and excellent relationship management skills Positive attitude and strong desire to automate processes Knowledge of SAP, ERP system, Excel . Communication skills both with internal teams and external customers

DesignationMedical Billing Role Full Time Opportunity LocationMultiple : - Maximize insurance reimbursement for Healthcare practice owners - Analyze and discover root causes for medical insurance claim denial, underpayment, or delay - Monitor and reconcile all over age accounts - Interact with the US-based insurance carriers to follow-up on unpaid claims, delayed processing, and underpayment - Analyze data to discover denial patterns, plan and execute medical insurance claim denial appeal process - Interact with US-based practice owners and clinicians on completing and correcting any missing or incorrect data on their insurance claims Skills/Experience : - Minimum of 1 Year experience in US-based AR follow-up and charge entry - Familiar with US medical insurance industry and insurance claims processing cycle - Excellent Listening, Communication, and Problem-solving skills - Self-motivated and able to work autonomously - Comprehensive knowledge of the A/R process This job opening was posted long time back. It may not be active. Nor was it removed by the recruiter. Please use your discretion.

DesignationMedical Billing Role Full Time Opportunity LocationMultiple : - Maximize insurance reimbursement for Healthcare practice owners - Analyze and discover root causes for medical insurance claim denial, underpayment, or delay - Monitor and reconcile all over age accounts - Interact with the US-based insurance carriers to follow-up on unpaid claims, delayed processing, and underpayment - Analyze data to discover denial patterns, plan and execute medical insurance claim denial appeal process - Interact with US-based practice owners and clinicians on completing and correcting any missing or incorrect data on their insurance claims Skills/Experience : - Minimum of 1 Year experience in US-based AR follow-up and charge entry - Familiar with US medical insurance industry and insurance claims processing cycle - Excellent Listening, Communication, and Problem-solving skills - Self-motivated and able to work autonomously - Comprehensive knowledge of the A/R process This job opening was posted long time back. It may not be active. Nor was it removed by the recruiter. Please use your discretion.

Roles and Responsibilities: 1. Product Strategy and Vision Define and drive product strategy for CAS integration focusing on enrollment, claims, and payment functions. Align product vision with organizational objectives and regulatory requirements (HIPAA, CMS). Conduct market and competitor analysis to inform product direction and enhancements. Identify opportunities for innovation and process optimization within payer workflows. 2. Stakeholder Management Serve as a key liaison between business, IT teams, and external vendors to align integration goals. Facilitate communication between stakeholders to define product requirements and share updates. 3. Requirements Gathering and Analysis Work with business analysts, product owners, and architects to gather, analyze, and document requirements. Prioritize product features based on business needs, customer feedback, and technical feasibility. 4. Roadmap and Agile Execution Lead PI (Program Increment) planning sessions in accordance with SAFe (Scaled Agile Framework). Develop and maintain product roadmaps aligned with Agile delivery cycles and integration milestones. Collaborate with project managers to track progress, allocate resources, and resolve dependencies. 5. Cross-Functional Collaboration Partner with technical teams to design and implement integration solutions. Support QA teams in test planning and performance validation of integrated systems. 6. Compliance and Risk Management Ensure all integration solutions comply with regulatory standards like HIPAA. Regularly report on performance, risk, and compliance metrics to stakeholders. Must-Have Skills: 5+ years of experience in product management or business analysis in the US Healthcare payer domain . Strong domain expertise in Core Administration Systems , specifically in enrollment, claims, and payments . Knowledge of EDI, HL7 , and API integration standards. Hands-on experience with Agile methodologies and SAFe framework. Strong communication and stakeholder management skills. Proven experience in roadmap planning , PI planning , and requirements documentation . Deep understanding of healthcare regulations including HIPAA . Good-to-Have Skills: Experience with specific Core Admin platforms like Facets, QNXT, HealthRules . Masters degree in Healthcare Management, Business Administration, or Information Technology . Familiarity with CMS compliance guidelines. Ability to manage multiple concurrent projects in a fast-paced environment. Proficiency in tools like JIRA, Confluence , and Productboard .

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. 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. Mandatory Skills 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 Skills (competencies) Verbal Communication JavaScript API integration Policy Development Critical Thinking

Follow up with payers to obtain claim status updates Identify reasons for denials and work towards resolution Must have Voice Experience Work on billing scrubbers and make necessary edits Handle contractual WhatsApp cv 7696517849 Required Candidate profile AR Caller With Experience for Hyderabad, Bangalore Night Shifts Cab Yes Excellent English Speaking WhatsApp cv 7696517849 Register For Call Back https://callcenterjobs.anejabusinessgroup.com/ Perks and benefits https://callcenterjobs.anejabusinessgroup.com/