2030 Claims Processing Jobs - Page 39

About the role : We are looking for a Dedicated Claims Specialist with a strong background in medical and health insurance, particularly in group medical corporate policies . The ideal candidate should have 2-4 years of experience in claims processing or CRM roles. Key Responsibilities: Handle end-to-end processing of reimbursement claims for group medical corporate policies. Provide excellent customer service by addressing claims-related queries via Freshchat, Ozontel, and Freshdesk. Analyze medical documentation, policy terms, and conditions to ensure accurate claim assessment and processing. Liaise with internal teams, insurers, TPA s, and hospitals to ensure seamless claims settlement and timely resolutions. Manage claims escalations, ensuring prompt resolution while maintaining a customer-centric approach. Required Skills: In-depth knowledge of corporate group medical insurance policies and claims processing. Ability to understand medical terminology, treatment procedures, and health-related documentation. Proficient in Ozontel, Freshdesk, or similar customer support and claims management tools. Strong communication and problem-solving skills to manage customer relationships and resolve issues effectively. Attention to detail to ensure accuracy in claim processing and documentation review. Ability to collaborate effectively with cross-functional teams, including insurance partners and hospital networks. Qualifications: Bachelor s degree in healthcare, insurance, or related field preferred. 2-4 years of experience in claims processing, CRM role preferably within group medical corporate policies.

Manage the team by determining the tasks for day to day activity within the operational context and working with the Manager and team members to ensure delegated operational goals and targets are achieved.- Monitor team performance including staff metrics (e.g. leave, attrition etc.)- Display a clear level of understanding of all performance reporting- Lead and develop a diverse workforce, drive an inclusive culture, foster a team environment where people are accountable for safety and wellbeing- Build a resilient, highly engaged/agile team, with a culture of simplicity, innovation and continuous improvement- Adhere to Suncorp Group policies including but not limited to, - Manage the team by determining the tasks for day to day activity within the operational context and working with the Manager and team members to ensure delegated operational goals and targets are achieved.- Monitor team performance including staff metrics (e.g. leave, attrition etc.)- Display a clear level of understanding of all performance reporting- Lead and develop a diverse workforce, drive an inclusive culture, foster a team environment where people are accountable for safety and wellbeing- Build a resilient, highly engaged/agile team, with a culture of simplicity, innovation and continuous improvement- Adhere to Suncorp Group policies including but not limited to, delegated authority level to mitigate risk and compliance- Works collaboratively with others to achieve team goals. Shares own knowledge, ideas and experience with others - Models and maintains a positive, enthusiastic and optimistic attitude. Remains calm and controlled in all environments - Leads and advocates change when necessary, supporting positive outcomes from change, including supporting the team through change- Efficient with time management with a high attention to detail - Proven ability to resolve customer disputes and overcome objections in a professional and solution-based manner. Ability to manage difficult conversations, irate customers and escalations- Ability to identify and analyse key and factual information, developing a range of practical and effective solutions in a timely manner and within delegated level of authority and legislation- Building a high performing team by developing collaborative relationships in line with Suncorp values- Adherence to all the regulatory bodies in Australia- Delivery of agreed service agreements with internal customers and where applicable external customers- Work closely with the team to identify and recommend opportunities to improve the effectiveness and efficiency of Business support functions- In conjunction with the Operational Heads and Leadership Teams, decide which operational strategies and initiatives best support business goals and how they are to be implemented- Determining priorities amongst strategic and tactical initiatives- Maintain and promote communication channels with key stakeholders.- Identify and address training development needs of the team including customer service principles.- Drive projects and be part of the projects that are identified in the team- Conduct regular performance reviews and feedback to develop personal performance of direct reports.- Collaborate with the Suncorp Partnering Performance team to relentlessly deliver solutions that will serve evolving customer needs and drive an exceptional customer service culture.- Accountable for Team performance Qualifications Mandatory:- Graduate in any field - Minimum 3 years' of overall experience in a service industry Internal Candidate - Demonstrates people management skills and proven ability to coach for performance and influence peers-Strong in English - verbal, written communication and interpersonal skills Strong sense of customer service excellence through previous customer facing role/s is highly desired - Self-driven and motivated Desired Skills- Prior exposure in an Insurance Claims Handling voice process would be desirable- Excellent Communication Skills- Excellent Soft Skills- Proficient in MS-Office suite- Strong sense of customer service excellence through previous customer facing role/s is highly desired - Self-driven and motivated- Demonstrable evidence of initiative and collaboration in implementing process improvements and solving problems which have delivered commercial value or customer benefits;- Able to effectively lead and manage change within the team- Experience supporting an Australian client desirable

Role : Guidewire developer PC Role & responsibilities : • 5 to 8 years of experience in Guidewire PolicyCentre Integration/Configuration development • Proven experience with Guidewire Cloud is required • Experience integrating Guidewire products, GW Inbound/outbound frameworks, GCC &Runtime properties. • GW ACE Certification • Ability to work independently as an individual contributor • Strong communication and coordination skills • Experience in Gosu Queries, Batch/work queues • Experience in P&C Insurance domain with respect to personal line & commercial of business • Experience Agile/Scrum Project Experience • Good conceptual, analytical, mathematical skills.

You will be working in Bengaluru at the PhonePe Office located in Salarpuria Softzone, Bellandur, for 6 days a week. The employment type for this role is contractual. As a PhonePe Claims Specialist, your main responsibility will be to assist customers in filing claims on the PhonePe platform or Insurer portal. You will guide customers through the claims process, ensure proper documentation, and efficiently resolve any issues. It is essential to be detail-oriented, organized, possess excellent communication skills, and have the ability to find innovative solutions to expedite claim resolutions. Your responsibilities will include managing and processing PhonePe insurance claims from start to finish, organizing all required documentation, ensuring accurate data entry into management systems, and providing exceptional customer service to PhonePe users. You will communicate with customers via phone, email, and chat, explaining claim procedures, addressing inquiries, and proactively updating stakeholders to ensure customer satisfaction. In this role, you will need to identify and implement creative solutions to overcome obstacles, leverage resources to resolve complex cases efficiently, streamline processes, and communicate complex information clearly. Building rapport with customers, understanding their needs, and handling difficult conversations effectively are also crucial aspects of this position. The ideal candidate should have proficient written and verbal communication skills, the ability to manage stakeholders effectively, work both independently and within a team, multitask effectively, and possess basic to advanced knowledge of tools like Microsoft Excel, Google Docs, and Google Sheets. Basic SQL knowledge is required, and experience in reporting, automation, dashboarding, and monitoring would be advantageous. Industry/domain understanding and experience are significant differentiators. To qualify for this role, you should have 1-3 years of work experience with a willingness to work in rotational shifts.,

Genpact (NYSE: G) is a global professional services and solutions firm delivering outcomes that shape the future. Our 125,000+ people across 30+ countries are driven by our innate curiosity, entrepreneurial agility, and desire to create lasting value for clients. Powered by our purpose the relentless pursuit of a world that works better for people we serve and transform leading enterprises, including the Fortune Global 500, with our deep business and industry knowledge, digital operations services, and expertise in data, technology, and AI. We are inviting applications for the role of Process Associate/ Process Developer - Insurance Claims In this role, you will be responsible for the function of the position, which is to transcribe inventories into Excel sheets while researching the Like, Kind, Quality of replacements and the understanding of product categories in a time sensitive manner. This position is responsible for accuracy, efficiency and retrieval of processed data. Responsibilities Transaction processing for Insurance Claims process Transaction processing for Claims Support Teams. Client interactions via trainings, conference calls, emails etc. Manage MIS activities and data collation Work towards driving process improvements and initiatives Experience in Claims Background preferably in Commercial Lines of business in the US/UK market. Knowledge of Insurance and Reinsurance domain along with Claims knowledge preferred Should know functioning of Broker and Underwriters Minimum Qualifications Qualifications we seek in you Any Graduate except Technical Insurance domain certification will be an added advantage Preferred Qualifications Claims processing knowledge with Insurance/ Reinsurance Domain awareness Good Communication Skills Good working knowledge of MS Office London Insurance market knowledge will be more preferable. Job Process Associate Primary Location India-Jaipur Schedule Full-time Education Level Bachelor's / Graduation / Equivalent Job Posting Jul 12, 2024, 11:29:53 AM Unposting Date Sep 10, 2024, 1:29:00 PM Master Skills List Operations Job Category Full Time,

Looking for doctors who have experience in processing Cashless And Reimbursment Claims (Group or Retail) Experience - 2+ years in claim processing

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.

Prepare final bill when cash/TPA/corporate/fund cards come for discharge. In the case of TPA credit patients, if the bill exceeds the approval final bill with discharge summary is send it to the insurance dept for the final approval. If there is any collection to be done from patient it is done (E.g. co-payment, room restriction, non applicable charges etc). Every day morning all the previous day discharged cards are to be cross checked whether they have paid the bill and show discharge in the HIS. In case of cash patient if they have not paid who has given permission should give a letter which should be attached with the card & it is filed in the billing dept. In case of credit bills after receiving the payment it is been settled against the respective credit bills and the same is sent to accounts. Attending to patient/company queries as and when it is required. Give them the information required. Any other jobs to be attended as and when there is an instruction from the Senior Associate/H.O.Ds.

Must be prepared to work night-shift Must have good knowledge of written and spoken English. Ability to use computer and latest OS systems and Application software. Outstanding communications and interpersonal skills. Required Candidate profile Strong knowledge of all types of Insurance plans, Eligibility verification Appeal for denied claims in order to receive payment. basic knowledge of RCM. • AR calling experience

Claims processing Doctor 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 BDS, BHMS, BAMS, MD, Pharm D Graduates. Adapt and inbuilt the process of communication and coordination across the zones and the supporting verticals accordingly.

Claims processing Doctor 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 BDS, BHMS, BAMS, MD, Pharm D Graduates. Adapt and inbuilt the process of communication and coordination across the zones and the supporting verticals accordingly.

Primary Responsibilities: Lead a team of 25 – 30 certified coders. Maintains staff by orienting and training employees; maintains a safe, secure, and legal work environment Performance Management – Timeliness, Quality and Productivity metrics Planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards Maintains quality service by enforcing quality and customer service standards; analyzing and resolving quality and customer service problems; identifying trends; recommending system improvements Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies Drive employee engagement and retention activities by sharing company’s vision and goals, empowering employees on tasks as per their skill set, providing regular feedback etc. 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: Graduate in any discipline Certified coder from AAP/AHIMA 2+ years of experience as Team leader or Assistant Manager Experience in handling a team of minimum 15 Experience from medical coding background only Experience in performance management, coaching, supervision, quality management, results driven, foster teamwork, handles pressure, giving feedback Proven ability to use Microsoft Office Products (Excel, PowerPoint etc.) Proven ability to operate basic office equipment (copier and facsimile machine) 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 #SSCorp External Candidate Application Internal Employee Application

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. r1rcm.com Facebook

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. r1rcm.com Facebook

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and Responsibilities: Process Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualifications: Graduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill Set: Candidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. r1rcm.com Facebook

Role Objective:To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers.Essential Duties and ResponsibilitiesProcess Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPointQualificationsGraduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill SetCandidate should have good healthcare knowledge. Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

General Application If you dont see any relevant open job on our career site which matches your skillset or career preferences, please submit you application to this prospect job post. This will help us to consider your application whenever there is a suitbale opening which matches your skillset and career preferences. PhonePe Full Time Employee Benefits (Not applicable for Intern or Contract Roles) Insurance Benefits - Medical Insurance, Critical Illness Insurance, Accidental Insurance, Life Insurance Wellness Program - Employee Assistance Program, Onsite Medical Center, Emergency Support System Parental Support - Maternity Benefit, Paternity Benefit Program, Adoption Assistance Program, Day-care Support Program Mobility Benefits - Relocation benefits, Transfer Support Policy, Travel Policy Retirement Benefits - Employee PF Contribution, Flexible PF Contribution, Gratuity, NPS, Leave Encashment Other Benefits - Higher Education Assistance, Car Lease, Salary Advance Policy Working at PhonePe is a rewarding experience! Great people, a work environment that thrives on creativity, the opportunity to take on roles beyond a defined job description are just some of the reasons you should work with us. Read more about PhonePe on our blog. Life at PhonePe PhonePe in the news

: Job Title: Client On Boarding, NCT Location: Jaipur, India Corporate TitleNCT Role Description The Analyst will be responsible for completion of day-to-day activity as per standards and ensure accurate and timely delivery of assigned production duties. The role is required to verify account opening documents for PWM US client against the KYC. And also ensure correct FATCA reporting to comply with regulatory requirement. Candidate/Applicants would need to ensure adherence to all cut-off times and quality of processing as maintained in SLAs. What well offer you 100% reimbursement under childcare assistance benefit (gender neutral) Sponsorship for Industry relevant certifications and education Accident and Term life Insurance Your key responsibilities Ensure quality/quantity of processing is maintained as per the SLA. Should be capable to handle multiple deadlines Ensure to process and approve all cases in given TAT. Knowledge of AML and ABR procedure and roles. Knowledge of various Regulations like REG E, D, and Volker is required. Ensure timely completion of all request and adhere to ClientConfidentiality. Flexible with business hours respective to volume received. Update volumes in various spreadsheets/work logs accurately and on time. Ensure team work culture is practiced. Escalate all issues in time, to the appropriate level, to avoid any adverse impact on the business. Functional Skills Have fundamental knowledge of KYC, FATCA Account opening, Banking etc Have understanding of Business Information search for prospect clients. Understand important of transactions approval procedure to control risk of fraud and error. Knowledge on different client documentation across geographies. Knowledge of the life cycle of the on-boarding process. Your skills and experience In-depth knowledge of KYC, ABR, FATCA & COB. Needs to be a self-starter with significant ability to undertake initiatives. Should have Effective communication skills and fluency in Microsoft Office skills. Should be open to work in night shift. Education / Certification Graduates with good academic records with relevant experience. Needs to be a self-starter with significant ability to undertake initiatives. Should have Effective communication skills and fluency in Microsoft Office skills. Should be open to work in night shift. Knowledge of various banking products, KYC, AML, FATCA, equity market and their flow would be an added advantage. How well support you About us and our teams Please visit our company website for further information: https://www.db.com/company/company.htm We strive for a culture in which we are empowered to excel together every day. This includes acting responsibly, thinking commercially, taking initiative and working collaboratively. Together we share and celebrate the successes of our people. Together we are Deutsche Bank Group. We welcome applications from all people and promote a positive, fair and inclusive work environment.

Responsibilities Review, analyze, make appropriate and accurate decisions on dental claims in accordance with policy and state/federal law and regulations. Analyze claim detail and apply knowledge of claims procedures, product design, contract provisions and state and federal regulations to make appropriate, accurate, and timely claim decisions. This includes having a knowledge of plan provisions, determination of eligibility, verification of data input, identification of correct benefit level, coordination of benefits, and corrections. Qualifications 0-1 work experience, (Upto 1-year related work experience required in financial services, insurance industry, claims processing, or dental insurance experience preferred). Dentist by qualification - BDS / MDS degree. Ability to maintain a high degree of accuracy and pay strict attention to detail. Must have excellent written and verbal communication skills. Ability to use basic math skills to determine claim payment. Work independently with good time management skills as well as in a team environment. Must have the ability to efficiently navigate and use multiple technology solutions. Ability to maintain confidentiality. Ability to thrive in a fast-paced, production environment. Additional Information Must have: Bachelor of Dental Surgery (BDS). Minimum of 0-1 years experience in medical/dental terminology, and/or industry courses (i.e., LOMA). Prior claim paying, and/or medical/dental industry experience preferred. Ability to work in night shift during the training time (5:30pm to 2:30AM) and in 1:30pm to 10:30pm in as regular work timings. Proficient in MS Office, written and verbal communication skills.

Educational Bachelor of Engineering,BCA,BTech,MBA,MTech,MCA Service Line Application Development and Maintenance Responsibilities A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your teams towards developing optimized high quality code deliverables, continual knowledge management and adherence to the organizational guidelines and processes. You would be a key contributor to building efficient programs/ systems and if you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you!If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Technical and Professional : Domain experiencePayer core – claims/Membership/provider mgmt. Domain experienceProvider clinical/RCM, Pharmacy benefit management Healthcare Business Analysts - with Agile/Safe-Agile Business analysis experience Medicaid, Medicaid experienced Business Analysts FHIR, HL7 data analyst and interoperability consulting Healthcare digital transformation consultants with skills/experience of cloud data solutions design, Data analysis/analytics, RPA solution design KeywordsClaims, Provider, utilization management experience, Pricing,Agile, BA Preferred Skills: Domain-Healthcare-Healthcare - ALL Technology-Analytics - Functional-Business Analyst

Educational Bachelor of Engineering,BCA,BTech,MCA,MTech,MBA Service Line Application Development and Maintenance Responsibilities As a ‘Senior Product Manager’ you will be pivotal to creating roadmap, owning release plan for multiple capabilities that is futuristic and meets industry and client needs. You will be responsible for continuous backlog management, prioritizing the backlog considering the needs and objectives of every stakeholder. As a thought leader in your business domain, bring in industry best practices, learnings from client demos and interactions into designing. You will anchor business pursuit initiatives, sales demo. You will have the opportunity to shape the Infosys platform that enables payers and providers to deliver better care. Additional Responsibilities: Experience in market leading healthcare products (key emphasis). Proven track record of at least 8 years in software product management roles. Capability/Feature planning and design, manage the specifications of their development, and monitor their on-going operation to better understand customer experiences. Clearly communicating progress towards delivery, technical challenges that may occur. Act as a thought leader and subject matter expert in the assigned product area, develop essential product documentation including business case, business requirements and use cases. Own product backlog and collaborate closely with the platform engineering team. Create Journey Maps that re-imagine/re-define the healthcare problematic process areas. Understanding of trends affecting customer adoption. Experience of working with enterprise customers, both technical and business, and at all levels. Influence leaders in diverse functional areas Strong business acumen including experience in estimation and pricing, market research. Demonstrated ability to navigate ambiguity and adapt quickly to modern technology and processes. Strong analytical ability with exposure to data science and automation Teaming/Collaboration - Demonstrates exceptional leadership and team management skills, with a collaborative and empowering approach to achieve results through influence. Excellent communication, presentation, and interpersonal skills to develop lasting relationships with senior business or technical leaders with the highest levels of business acumen and technical expertise. Technical and Professional : Payer/ Provider/ PBM organizations Product Management/Product Engineering /Healthcare Operations Experience working with industry leading Enrollment, Claims, Billing or EHR systems. Managing product lifecycle in whole – from ideation, exploration, approval, development, implementation, measurement, and ongoing development. Expertise in US Government Program Line of Business - Medicare, Medicaid, Duals, Marketplace Plan Sponsor & Product, Enrollment & Billing, Provider Data Management, Provider Network Management, Claims, Encounters, Medicare, and Marketplace Risk Adjustment. Developing results-oriented strategies to solve complex and open-ended business problems. Market Analysis and Product fitment Communicating and facilitating architecture design discussions/decisions and impacts to key stakeholders. Customer success on managing customer engagements and requirements. Leading business pursuits and product demonstrations. Agile Product Development Methodology Preferred Skills: Domain-Healthcare-Healthcare - ALL

Basic Function Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems. Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision. Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc. Update systems to accurately reflect leave status and ensure appropriate diary documentation exists Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures The position is expected to do absence management and adjudication on Federal, State and company leaves. Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physicians office Essential Functions: Analyze, validate and process transactions as per Desktop procedures (L3 & L4) Analyze and research all discrepancies Research & Investigate and resolve outstanding items Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls Establish action plans for each file to bring claims to resolution Utilize internal and external specialty resources to maximize impact on each claim file Use PC programs to increase productivity and performance Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence Work as a team member to meet office goals to obtain disabilitys vision while demonstrating core values and meeting key measures Ensure adherence to established attendance schedules Close visual activity - viewing a computer terminal and extensive reading To apply call Miss Jaspreet Kaur at 9667037957

Job Summary: The Business Analyst will play a key role in supporting finance and management information (MI) systems for an insurance company. The individual will bridge the gap between business operations, finance, and IT, ensuring the successful implementation and optimization of finance-related systems and management reporting tools. The role involves gathering business requirements, facilitating communication between stakeholders, and analyzing data to improve decision-making processes within the insurance domain. Key Responsibilities: Requirements Gathering: Collaborate with stakeholders (finance teams, insurance operations, and IT) to gather, document, and translate business requirements into functional specifications. Process Improvement: Identify inefficiencies in finance and reporting processes, recommending and implementing improvements to streamline workflows in the current system Data Analysis: Analyze finance and MI data of the current state systems System Implementation & Support: Support the implementation, integration, and optimization of finance and reporting systems, ensuring alignment with business processes for the new system. Reporting & MI Development: Design & Develop financial reports and dashboards using MI tools, providing detailed analysis and insights into key performance indicators (KPIs) on the new system Stakeholder Communication: Act as a liaison between finance, insurance operations, and IT teams, ensuring clear communication and alignment on project goals and timelines. Documentation: Create detailed documentation including business requirements, process flows, and functional specifications. Compliance & Risk Management: Ensure that finance and MI systems adhere to regulatory and compliance standards within the insurance industry. Required Qualifications: Bachelors degree in Finance, Accounting, Business, or a related field. Proven experience as a Business Analyst in the insurance domain, with a focus on finance and MI. Strong understanding of insurance products, underwriting, claims processes, and financial reporting. Proficiency in data analysis tools (e.g., Excel, Power BI, Tableau) Experience with Agile methodologies and familiarity with project management tools (e.g., JIRA, Confluence). Excellent problem-solving skills and the ability to analyze complex data sets. Strong communication skills to work with cross-functional teams and present findings to stakeholders. Preferred Qualifications: Experience with regulatory reporting (e.g., Solvency II, IFRS 17) in the insurance industry. Knowledge of management information systems and their role in insurance operations. Familiarity with financial modeling and forecasting techniques. Key Competencies: Analytical thinking and attention to detail. Strong business acumen with the ability to understand the financial implications of insurance operations. Ability to work in a fast-paced environment and manage multiple priorities. Collaborative mindset with the ability to influence and negotiate with stakeholders.

Job Summary: The Business Analyst will play a key role in supporting finance and management information (MI) systems for an insurance company. The individual will bridge the gap between business operations, finance, and IT, ensuring the successful implementation and optimization of finance-related systems and management reporting tools. The role involves gathering business requirements, facilitating communication between stakeholders, and analyzing data to improve decision-making processes within the insurance domain. Key Responsibilities: Requirements Gathering: Collaborate with stakeholders (finance teams, insurance operations, and IT) to gather, document, and translate business requirements into functional specifications. Process Improvement: Identify inefficiencies in finance and reporting processes, recommending and implementing improvements to streamline workflows in the current system Data Analysis: Analyze finance and MI data of the current state systems System Implementation & Support: Support the implementation, integration, and optimization of finance and reporting systems, ensuring alignment with business processes for the new system. Reporting & MI Development: Design & Develop financial reports and dashboards using MI tools, providing detailed analysis and insights into key performance indicators (KPIs) on the new system Stakeholder Communication: Act as a liaison between finance, insurance operations, and IT teams, ensuring clear communication and alignment on project goals and timelines. Documentation: Create detailed documentation including business requirements, process flows, and functional specifications. Compliance & Risk Management: Ensure that finance and MI systems adhere to regulatory and compliance standards within the insurance industry. Required Qualifications: Bachelors degree in Finance, Accounting, Business, or a related field. Proven experience as a Business Analyst in the insurance domain, with a focus on finance and MI. Strong understanding of insurance products, underwriting, claims processes, and financial reporting. Proficiency in data analysis tools (e.g., Excel, Power BI, Tableau) Experience with Agile methodologies and familiarity with project management tools (e.g., JIRA, Confluence). Excellent problem-solving skills and the ability to analyze complex data sets. Strong communication skills to work with cross-functional teams and present findings to stakeholders. Preferred Qualifications: Experience with regulatory reporting (e.g., Solvency II, IFRS 17) in the insurance industry. Knowledge of management information systems and their role in insurance operations. Familiarity with financial modeling and forecasting techniques. Key Competencies: Analytical thinking and attention to detail. Strong business acumen with the ability to understand the financial implications of insurance operations. Ability to work in a fast-paced environment and manage multiple priorities. Collaborative mindset with the ability to influence and negotiate with stakeholders.

Manage and lead a team of claims specialists, providing guidance, mentorship, and support to ensure exceptional customer service and efficient claims processing. Oversee the end-to-end claims process, from initial claim submission to resolution, ensuring accuracy, compliance, and timely processing. Implement and maintain quality control measures to uphold the highest standards of claims handling Interact with policyholders, agents and other stakeholders to address claim related inquiries and concerns. Utilize claims data and analytics to identify trends, patterns and opportunities for process improvement. Ensure compliance with insurance regulations and company policies in all claims processing activities. Monitor and report on departmental performance metrics, including claims processing times, customer satisfaction and efficiency. Identify and implement process enhancements to streamline claims operations and enhance the customer experience. Provide training and development opportunities for team members to enhance their skills and knowledge.