2028 Claims Processing Jobs - Page 4

Medical Officer (MBBS/BAMS/BHMS) at Good Health Insurance TPA. Responsible for cashless request processing, claim review, ICD coding, and policy adherence. Freshers can apply. Strong medical knowledge and computer skills required.

We are hiring for International Healthcare Customer Support. Role & responsibilities : Handle outbound calls related to healthcare services within the US healthcare system. Proactively reach out to members to provide support, resolve issues, and ensure a positive experience. Identify and address varying levels of member complexity and communicate effectively. Ensure strict compliance with HIPAA regulations and other healthcare-related guidelines. Resolve member inquiries efficiently and professionally, escalating complex cases as required. Preferred candidate profile Proven experience in outbound voice processes, preferably in the US healthcare sector. Strong verbal and written communication skills with a focus on empathy and professionalism. International Customer support experience is a must. Should be comfortable to work from office Should be comfortable working in US shift. To apply share your cv at Chhavi.goyal @careernet.in or Call/ Whatsapp @ Chhavi- 8852831923

Role Objective Identifying revenue gain opportunity or denial prevention opportunities by reviewing the open AR claims/denied claims Essential Duties and Responsibilities Denied Claim Reviews/Account level reviews Identifying themes/trends through data reviews Coordinating with requirement stakeholders on the issues/themes/trends identifies Publishing assigned reports/tasks Analysis data to identify process gaps, prepare reports and share findings for Metrics improvement. Identifying automation/process efficiencies Maintain a strong focus on identifying the root cause of denials while creating sustainable solutions to prevent future denials. Able to interact independently with counterparts if required Must operate utilizing aggressive operating metrics. Quality Maintenance as per the required standards Understanding client requests requirement and develop a solution Creating adhoc reports utilizing SQL/snowflake, Excel, PowerBI or R1 inhouse applications/tool Required Skill Set Candidate should be good in Denial Management/AR Follow up (4-8 years exp required) Ability to interact positively with team members, peer group and seniors. Good analytical skills and proficiency with MS Word, Excel and Powerpoint Good communication Skills (both written & verbal) Qualifications Graduate in any discipline from a recognized educational Certifications in Power BI, Excel, SQL/Snowflake would add advantage

Responsibilities: Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes. Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations. Follow up with the provider on any documentation that is insufficient or unclear. Communicate with other clinical staff regarding documentation. Search for information in cases where the coding is complex or unusual. Receive and review patient charts and documents for accuracy. Review the previous day's batch of patient notes for evaluation and coding. Ensure that all codes are current and active. Requirements: Education Any Graduate. Successful completion of a certification program from AHIMA or AAPC. Strong knowledge of anatomy, physiology, and medical terminology. Familiarity with ICD-10 & CPT codes and procedures. Solid oral and written communication skills. Able to work independently.

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.

Role Objective : Authorization Creation is a process where we need to coordinate with the nurses for decrypting the medical records & reports. Essential Duties and Responsibilities Interact with the US health insurance companies (Insurance Customer Care/Nurses/UM Team) Quality of Notation, Ability to read clinical documentation and data enter for payer requirements. 80%+ Calling will be involved (may vary site to site), should be open to Voice based work Would secure relevant information of Health Insurance of the patient. Work on Websites/Applicationsto perform the activity as per the SOP. Would be working in 6pm to 3 am & 9pm to 6am, Supporting US operations (in EST Zone) Should be Open to Learn & adapt as per the changing needs of the process. Will have to go thru ongoing Trainings (for performance / process needs) Should be flexible to be moved across the processes assigned by the Manager (Cater to ongoing process requirements) Will have to work as per the prescribed KPI`s / Targets assigned by the Process Manager. Maintain compliance with all company policies and procedures. Ensure - Non-Disclosure of any PHI. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel and PowerPoint Qualifications: 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) Excellent verbal and written communication skills effectively communicate with internal and external customers. Must have proven track record of performance in previous assignment. Maintaining a positive attitude and providing exemplary customer service Ability to work independently and to carry out assignments to complete within parameters of instructions / SOP. Skill Set: Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. Medical Coding and Medical transcription knowledge/experience are considered as relevant. Candidate should have good healthcare knowledge.

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 PowerPoint Qualifications: 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.

Role Objective: Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities:Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures.Manages people and drives retention.Analysis data to identify process gaps, prepare reports. Performance managementFirst level of escalationWork in all shifts on a rotational basisNeed to be cost efficient with regards to processes, resource utilization and overall constant cost managementMust operate utilizing aggressive operating metrics.Qualifications:Graduate in any discipline from a recognized educational institute (Except B.Pharma, M.Pharma, Regular MBA, MCA B.Tech Freshers')Good analytical skills and proficiency with MS Word, Excel and PowerPoint (Typing speed of 30 WPM)Good communication Skills (both written & verbal)Skill Set: Candidate should be good in Denial ManagementCandidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials.Ability to interact positively with team members, peer group and seniors. Subject matter expert in AR follow upDemonstrated ability to exceed performance targets.Ability to effectively prioritize individual and team responsibilities.Communicates well in front of groups, both large and small.

Role Objective: Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities: Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Manages people and drives retention. Analysis data to identify process gaps, prepare reports. Performance management First level of escalation Work in all shifts on a rotational basis Need to be cost efficient with regards to processes, resource utilization and overall constant cost management Must operate utilizing aggressive operating metrics. Qualifications: Graduate in any discipline from a recognized educational institute (Except B.Pharma, M.Pharma, Regular MBA, MCA B.Tech Freshers') Good analytical skills and proficiency with MS Word, Excel and PowerPoint (Typing speed of 30 WPM) Good communication Skills (both written & verbal) Skill Set: Candidate should be good in Denial Management Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials. Ability to interact positively with team members, peer group and seniors. Subject matter expert in AR follow up Demonstrated ability to exceed performance targets. Ability to effectively prioritize individual and team responsibilities. Communicates well in front of groups, both large and small.

Reports to (level of category) : Manager - Operations Role Objective AR is the most essential part in the RCM cycle. It is usually the last step. After Denial management (AR), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Should be able to manage a team of 25-30 FTEs FTEs will be directly reporting to AM Will be responsible to resolve queries, account reviews and provide training in case required Drive production and quality to the expected level Responsible to identify production and quality issues and to put plans in place for improvement Analyze data to identify payer issues & challenges and fixes Should work towards team engagement and retention/absenteeism Will be responsible to lead internal and external calls. Performance management. First level of escalation. Work in all shifts on a rotational basis. Need to be cost efficient with regards to processes, resource utilization and overall constant cost management. Must operate utilizing aggressive operating metrics. Skill Set Candidate should be good in Denial Management Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials Good domain knowledge Ability to interact positively with team members, peer group and seniors. Demonstrated ability to exceed performance targets Ability to effectively prioritize individual and team responsibilities Communicates well in front of groups, both large and small. Qualifications Graduate in any discipline from a recognized educational institute (Except B.Pharma, M.Pharma, Regular MCA, B.Tech & Freshers') Good analytical skills and proficiency with MS Word, Excel and PowerPoint (Typing speed of 30 WPM) Good communication Skills (both written & verbal)

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 PowerPoint Qualifications: 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.

Key Roles & Responsibilities Design, develop, implement, and maintain complex integrations between Guidewire (PolicyCenter, BillingCenter, ClaimCenter) and external systems (legacy applications, third-party services, etc.) using APIs, web services, and message queues. Analyze business requirements and translate them into technical solutions leveraging Guidewire's integration capabilities (e.g., ITypes, Business Services, Datamaps). Write clean, well-documented, and maintainable code adhering to best practices and Guidewire development standards. Conduct unit testing and participate in integration testing with QA and other teams. Troubleshoot and resolve integration issues to ensure smooth data flow between systems. Stay up-to-date on the latest Guidewire integrations features and functionalities. Estimate integration development effort and provide accurate timelines. Document technical design and implementation decisions. Participate in code deployments and support ongoing system maintenance. Contribute to the development and maintenance of integration automation tools and scripts. Stay informed about industry trends and best practices in application integration. Work effectively with business analysts, solution architects, and other developers to understand requirements and design optimal integration solutions. Participate in code reviews and provide technical guidance to junior developers. Effectively communicate complex technical concepts to both technical and non-technical audiences. Proactively identify and mitigate integration risks.

The staff has to perform the work of chief Contract expert and needs to monitor the EPC-Contracts Qualifications Graduate in discipline. 20+ years in railway or railway related industry, out of which minimum 10 years in Metro/MRTS. Shall have worked in atleast one metro project.

H.Sc / Graduate freshers with good communication. US healthcare Exp will be an advantage. Knowledge of basic computer operations. Willingness to work in the late evening and night shifts. Courteous with strong customer service orientation. Good listening and speaking skills. Typing speed 30/90% Work from office only Mandatory Skills: Commercial.

Position Description: Your future duties and responsibilities Job Title:Guidewire ClaimCenter Developer Position: Guidewire ClaimCenter Developer Experience:4 +yrs Category: Softare Development Main location: Chennai/Bangalore Position ID: J0725-0622 Experience: 4+ years Location: Chennai/Hyderabad/Bangalore Your future duties and responsibilities: As a Senior Lead in the Guidewire Configuration Stream of work, the role would expect you to be hands- on in delivering the following; Requirement Elicitation Have a clear understanding of Client requirement(s) and have a technical perspective aligned with Guidewire OOTB flow Prepare Unit test(gunits), Technical Design Documentation Customizing the Guidewire Product Ability to comprehend functional requirement and implement the required customization of the product in terms of UI flow Data Model Development Business Logic (Rules) Development PCF Screen ( User Interface) Development Experienced in handling requirements related to : o LOB Mapping o Localization for different Locales etc Development using Gosu for Classes and Enhancement Participate and Conduct Code reviews provide valuable design and implementation suggestions to the team Required Skill Set Extensive experience on the following GOSU, Core Java, J2EE, Web services, JMS Exposure and Awareness of Property and Casualty Insurance Business RDBMS concepts and SQL knowledge Working and delivering in the Agile/Scum practice is highly desirable Guidewire Certifications highly preferred Experience in Tools such as JIRA/SVN/GIT, Ant, Maven, Hudson/Jenkins, SonarQube Required Experience: 4 to 7 years overall IT Experience - At least 3 years actively in the role of a Guidewire Configurator Skills: Insurance Java

We are seeking an experienced and dynamic professional to lead our Claims Operations team for US Healthcare Will be responsible for managing end-to-end claims processing operations, driving service excellence, ensuring compliance with client SLAs and regulatory standards, and leading high-performing teams in a fast-paced BPO environment Manage day-to-day operations of the claims processing department, including adjudication, adjustments, rework, and quality control Serve as the primary point of contact for client operations teams Conduct regular client calls, business reviews, and performance reporting Must Have Skillset Looking for candidates with good experience in Claims - managing a large scale business team

Location: Ahmedabad Profile: US Voice Process (AR Caller , Dental Billing , Medical Billing ) Shift: Night shift Salary for Freshers : 20,000 Experienced : Upto 40K(Relevant in RCM Process ) Benefits: 1 way Cab Working Days: 5 days

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or deny the claims as per the terms and conditions within the TAT. Handle escalations and responding to mails accordingly. Work from Office only 4th floor, AARPEE Chambers, Off Andheri-Kurla Road Industrail Estate Marol, Andheri East, , Marol Cooperative Next To Times Square, Shagbaug, Gamdevi, Marol, Mumbai, Maharashtra 400059 Interested candidates can share their resumes to varsha.kumari@mediassist.in

Job Title: Term Insurance Operations Specialist Experience: 1 - 3 Years in insurance operations Education: Any Graduate Location: Gurugram About the Role: As a Term Insurance Operations Specialist, you will be responsible for ensuring a smooth post-payment customer journey by managing documentation, medical scheduling, and verification processes. You will coordinate with insurers, underwriters, TPAs, and internal stakeholders to drive timely case issuance while meeting monthly issuance targets with minimal TAT and high FTR rate. This role demands strong communication, stakeholder management, and process improvement skills, along with a basic understanding of insurance underwriting and proficiency in Excel. Responsibilities: Take complete ownership of post-payment cases and ensure a smooth customer journey. Connect with customers (via calls & emails) to update them on next steps and pending requirements such as document collection, verification, scheduling medicals, and retention. Coordinate with stakeholders (Insurers, TPA’s, underwriters, business SPOCs, etc.) to ensure timely case issuance. Achieve monthly issuance targets with minimal TAT (Turnaround Time) and high FTR (First Time Right) rate. Work closely with Insurers to improve operational processes for better issuance rates, reduced TAT, and improved FTR. Requirements: Strong written and verbal communication skills. Basic understanding of insurance underwriting and decision-making processes. Ability to handle customers patiently, including difficult conversations. Proven stakeholder management skills to push cases forward. Minimum 1+ year of experience in Insurance operations. Basic computer and Excel skills. About Hireginie: Hireginie is a prominent talent search company specializing in connecting top talent with leading organizations. We are committed to excellence and offer customized recruitment solutions across industries, ensuring a seamless and transparent hiring process. Our mission is to empower both clients and candidates by matching the right talent with the right opportunities, fostering growth and success for all.

Role & responsibilities We are hiring for the position of Trainee Process Consultant for our International Voice Process in the US Healthcare sector. As a Trainee Process Consultant, you will be responsible for processing claims, handling customer inquiries, and ensuring customer satisfaction through timely and accurate resolutions. BTECH NOT ALLOWED REACH OUT TO HR SUSMITA - 9903486610 Preferred candidate profile - Process claims according to established guidelines and procedures. - Maintain customer satisfaction ratings by adhering to client SLAs. - Utilize company policies to resolve customer issues efficiently. - Input and update customer records in the company platform. - Ensure quick and accurate decision-making to resolve customer queries. Perks and benefits Skills Required: Excellent Communication Candidate should be willing to work in US shift. Eligibility Criteria: - Must have completed 10+2/Intermediate schooling from an English medium school. (pass out year Only 2019 to 2022) - Candidates should not be pursuing any higher education. - Freshers or with a maximum of 1 year of experience in a BPO are eligible. - Graduates only REACH OUT TO HR SUSMITA - 9903486610 - Pursuing Graduation or Graduation Backlog holders are not eligible. Shifts: Candidate should be flexible with any given shifts. Working Days: Five days working (Saturday & Sunday fixed week off) Transportation: Two Way Cab provided

Company Profile At Edify Insurance Brokers Pvt Ltd, our Client Service team is the engine that drives our customer satisfaction and query solutions. We are seeking a qualified Client service - manager to help our clients in claims and any other query solution through their own skills. Our ideal CS manager has to have indepth knowledge of and experience with the Claim process, Policy terms and conditions, relationship building and MIS management. We are seeking a quick learner with strong communication skills, and someone with a track record of success who can inspire the same in others Objective of this Role One stop solution for all client queries and requirements Represent our company, with a comprehensive understanding of our services in the area of claim process and policy terms and conditions including conducting orientation for employees. Providing the timely help to clients in claim settlements in both cashless and reimbursements. Co-ordinating with Insurance company in updating endorsements, CD Balance and other MIS reports. Co-ordinating with TPA in claim settlements, in solving the issues due to any calculation error and any data error with the MIS reports. Team Management and Leading the team by Co-ordinating with the team members for updating the MIS reports. Reporting any issues to the sales team to help them maintain the relationship with clients. Co-ordinating with clients, HR Head and Finance Head in resolving any issues. Maintaining MIS reports Co-ordinating with the Retention team. Visiting clients to understand if they have any concerns and help them in fixing the issues. Visiting the TPA and Insurance company to maintain good relationship with the customer relation team. Resolving the clients queries. Skills and Qualification Bachelors degree in any field 1-6 years of experience in Client Service management in Insurance Industry Leadership qualities with Excellent communication, interpersonal skills and proactive approach Ability to learn and update the knowledge of insurance products Understanding of policy and products Flexibility with calls and mails Expertise in Excel, Word and PPT

Claims Executive Responsibilities: Receiving and answering emails, telephone calls related to claims Advice policyholders on claim procedure Ensure fair settlement of a claim with TAT Manage all administration aspects of the claim

Cognizant Walk-in drive for Senior Claim Adjudicator - US Healthcare in Coimbatore location Interview Date : 13th Sep 2025 (Saturday) Interview Time : 10:00 AM 12:30 PM Venue : Cognizant, CCC Campus, CHIL SEZ Campus, CHIL SEZ IT Park, Saravanampatti, Keernatham Village, Coimbatore-641035 Building Details : Food court 2 nd floor South End Contact Person : Govindaraj S / Raguvaran R Preferred candidates Profile: Must Be a graduate. Minimum 1 to 4 Years of experience in US Healthcare Claims adjudication process (Payer side) Must have experience into End to End claims processing (Candidates with only denial claims experience are not eligible) Experience in AMISYS tool is an added advantage Must have strong knowledge in US Healthcare plans and claims forms like CMS1500 & UB04 Must be willing to work in Night Shift (US Shifts ) - 5:30 PM to 3:30 AM IST Should be ready to Work from Office Interested candidates can walkin to the Venue with the following documents Updated resume (2 hard copies) Any one Government ID Proof ( AAdhar Or Pan)

Responsibilities: * Manage health claims from submission to payment * Ensure compliance with regulatory requirements * Collaborate with medical providers on claim resolution * Review insurance policies and procedures

Job Description: Analyze the claim submission process and how to create batches & submit claims. Should know all types of rejections. Should be aware of Eligibility rejections. Medicare & Medicaid Payer guidelines. Different payer website knowledge. Must have knowledge of Scrubber edits.CMS 1500 OR UB04 Billing. Should be aware of the basic RCM cycle. Must be aware of the Secondary claim process. Knowledge on different Clearing Houses. Required Skills: Min one year of experience in relevant skills Ability to communicate effectively Good analytical skills Contact: HR Revati Mobile: 7219717605 Email: hr@mdcsglobal.com